Antidepressants are some of the most widely prescribed drugs in the United States, but according to new research, antidepressants may be no more effective than seeing a therapist when it comes to treating major depressive disorders. Antidepressant medications work by balancing chemicals in the brain called neurotransmitters, which affect mood and emotions. By doing so, antidepressants can help people struggling with depression sleep better, improve their mood and increase their appetite and concentration. However, one new study shows that antidepressant treatment and cognitive behavioral therapy are similar in terms of efficacy and cost-effectiveness, which means that people currently taking antidepressants may do just as well by seeing a therapist.
Most treatment guidelines for depression recommend preliminary treatment with either a second-generation antidepressant drug or cognitive behavioral therapy (CBT) and many people struggling with depression find it easier to take a pill rather than committing to seeing a therapist week after week. In this study, published earlier this month in the journal Annals of Internal Medicine, researchers from the University of Michigan set out to determine whether one treatment method was superior to the other. In order to do so, the researchers used data from a meta-analysis of randomized trials, along with clinical and economic data from other publications, and their target population included adults newly diagnosed with major depressive disorder in the United States.
The purpose of the study was to quantify the cost-effectiveness of second-generation antidepressants versus cognitive behavioral therapy for the initial treatment of depression. The researchers sought to accomplish this by measuring costs in 2014 U.S. dollars, incremental cost-effectiveness ratios and quality-adjusted life-years (QALYs), a generic measure of disease burden that includes the quality and the quantity of life lived. QALYs is used to assess the value for money of specific medical interventions, such as antidepressant treatment and cognitive behavioral therapy. According to the study findings, CBT produced higher QALYs – three days more at one year and 20 days more at five years – than antidepressant treatment. The researchers also found that CBT was associated with higher costs at one year but lower costs at five years.
Because antidepressant drugs are specifically indicated to treat depression and are aggressively marketed by their manufacturers for this purpose, many people assume that antidepressants are the most effective treatment for major depressive disorders. However, this study shows that antidepressants are not superior to cognitive behavioral therapy in terms of efficacy or cost-effectiveness, yet the drugs carry a potential risk of side effects. People who use antidepressant drugs may experience adverse effects like weight gain, insomnia, anxiety, heart rhythm problems and sexual side effects, among other potential problems. Pregnant women and women of childbearing age who take antidepressant medications may also be at risk for giving birth to a child with serious congenital malformations, such as cleft lip, cleft palate, heart defects, neural tube birth defects and craniosynostosis, to name a few.
In light of the potential for cognitive behavioral therapy to have a similar efficacy and cost-effectiveness to antidepressant drugs without putting patients at risk for side effects, seeing a therapist may be a more appropriate and beneficial treatment plan for individuals facing a major depressive disorder. Based on their findings, the authors of this study noted that people newly diagnosed with depression should at least try cognitive behavioral therapy first, saving antidepressant treatment as a follow-up option if therapy doesn’t produce the desired long-term results. “Neither antidepressants nor cognitive behavioral therapy provides consistently superior cost-effectiveness relative to the other,” the researchers wrote. “Given many patients’ preference for psychotherapy over pharmacotherapy, increasing patient access to cognitive behavioral therapy may be warranted.”
