Why Cognitive Behavioral Therapy is More Important than Medication in Treating Depression
Psychotherapy, especially Cognitive Behavioral Therapy (CBT), and antidepressant medication are the two main strategies for getting professional help for depression. And both strategies can be combined. Medication has some advantages: prescription co-pays are cheaper than psychotherapy and antidepressants often work a little quicker than psychotherapy alone – but multiple studies show that 75% of these benefits are a placebo effect. While antidepressants may work somewhat better than placebo pills, they don’t work much better, and most of the benefit comes merely from people’s hopes for relief rather than from the actual medication and even talking to an in-person therapy in New York City.
Moreover, by itself, medication usually only yields a partial reduction in depression: only between 25% – 50% of people taking antidepressants find that their depression severity drops by more than 50%. Adding CBT to antidepressants makes achieving a strong reduction in depression much more likely.
Moreover, unlike CBT, antidepressants generally cause unwanted side effects while taking them as well as withdrawal symptoms upon stopping them. While most antidepressant side effects ease after a few weeks, some remain troublesome throughout the course of treatment – particularly weight gain and reduced libido. In fact, most people report sexual difficulties while taking SSRI’s, the most commonly prescribed class of antidepressants. Additionally, when people stop taking antidepressants, about half experience uncomfortable withdrawal symptoms, including insomnia, fatigue, dizziness, nausea, headaches, irritability, sadness, and anxiety. These symptoms can last 1-3 weeks, and often occur even when people gradually taper their dosage rather than stopping “cold turkey”. These withdrawal symptoms can be so difficult that many restart antidepressants despite wanting to quit.
Furthermore, once people stop taking antidepressants, their depression is far more likely to start creeping back than for people who’ve received CBT. About 50% of people who take antidepressants for 3-4 months and then stop, experience significantly increased depression (relapse) after being off their medications for 6 months. For those who discontinue medication even a year after recovery, eventual relapse is still common unless they have received CBT therapy. Most people who receive 12 to 16 sessions of successful CBT for depression don’t relapse even when evaluated 3 to 5 years (60 months) after their therapy ends. That’s an impressive return for 3 to 4 months of treatment!
Why do people who receive CBT maintain their reduction in depressive symptoms for far longer than people who only take antidepressants? While there’s no one answer for this, the most common explanation is that “pills don’t teach skills”. In other words, CBT teaches people specific strategies for dealing with upsetting thoughts, emotions, and difficult external situations that people who only receive medication do not get. When life becomes more stressful or people suffer painful losses, those who’ve received CBT have an effective “toolbox” of skills that they can use in order to avoid relapsing into depression. This increased ability to deal with stressful thoughts, emotions, and circumstances is also a reason why people receiving CBT in addition to antidepressants generally experience stronger reductions in depression than those taking medication alone.
Taken together, antidepressants’ side effects, withdrawal symptoms, high relapse rates, and the placebo effect, all argue against treating depression with medication alone. While some people may want to add an antidepressant while undergoing CBT to get slightly quicker symptom relief, I believe that CBT is far more important than medication in bringing people long-lasting true freedom from depression. If you are in two minds, get in touch with in-person therapy in New York City for the best suggestions.