Talking through depression just as effective as drugs

Therapy is at least as effective in treating depression as drugs, and its effects last longer, say scientists.

Their report is sure to annoy drug companies, which make millions selling antidepressants. The cost of therapy is about the same as drugs in the short term and cheaper in the long term, the researchers told a meeting of the American Psychiatric Association.

"This will be a surprising, controversial finding for many psychiatric professionals," said Robert DeRubeis, chairman of the psychology department at the University of Pennsylvania.

"Most believe quite strongly in the efficacy of medication, and psychiatric treatment guidelines call unequivocally for medication in cases of severe depression."

An estimated 20 million Americans suffer from depression.

DeRubeis and Steven Hollon of Vanderbilt University in Nashville studied 240 patients with the condition to see if drugs or therapy worked better.

"The question that has most often been asked in studies is, 'What gets people better faster'?" DeRubeis said.

"We asked, 'What will keep depression away over the long term'?"

Their patients got one of three treatments - 16 weeks of cognitive therapy, 16 weeks of antidepressants plus visits to a professional, or 16 weeks of placebo pills plus visits.

Cognitive therapy is a type of talking-out treatment in which patients are helped to question their negative views of themselves.

"By the 16-week, post-treatment assessment, response rates were identical [57 per cent] for both pharmacotherapy and cognitive therapy," the researchers said in their report.

"Thus, these findings suggest that cognitive therapy may work more slowly in effecting change than does pharmacotherapy, but that by the end of a four-month course of treatment, patients who receive cognitive therapy fare as well as those who receive pharmacotherapy."

Seventy-five per cent of the patients who had cognitive therapy avoided a relapse, compared with 60 per cent of patients on medication and 19 per cent of those receiving a placebo pill, they told the group's annual meeting in Philadelphia.

The 16 weeks of drugs cost an average of US$2590 ($5531), compared with US$2250 ($4805) for cognitive therapy, the researchers said. Over time, therapy might prove to be cheaper because patients had to continue taking antidepressants, they said.

"Some proponents of medication for severely depressed patients have suggested that cognitive therapy is impractical on the basis of cost," DeRubeis said.

"Our study indicates that isn't true, especially over the long term."

The study is a sharp contrast to dozens of others being presented at the meeting that show the efficacy of one antidepressant over another.

The antidepressants market is huge - and profitable. Eli Lilly and Co earned nearly US$2 billion ($4.3 billion) last year from Prozac and Sarafem, two brand names of a drug known generically as fluoxetine and used to treat depression and severe premenstrual syndromes.

The study is not the first to challenge the assumptions underlying the use of drugs to treat depression.

The idea behind the drugs is to change levels of brain chemicals. In the case of fluoxetine and related drugs, the targeted chemical is serotonin, which is linked with moods.

But two reports suggest placebos work as quickly as drugs in the short term.

- REUTERS

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