Depression is common but not easy to beat, and, sadly, our most common remedies aren’t as effective as the published scientific literature once suggested. Why? Researchers are less likely to submit studies for publication that don’t show a benefit.
Psychotherapy, for example, seems to boost your chance of lasting improvement in depressive symptoms by 20 percent, rather than 30 percent, according to a review led by Vanderbilt University’s Steven Hollon, PhD.
Hollon and his co-authors tracked down the results for 55 grants from the U.S. National Institutes of Health for randomized clinical trials to test treatments for major depression from 1972 to 2008. About a quarter of the grants did not lead to published results.
When the team added in the data from the unpublished studies, the benefits of psychotherapy dropped by 25 percent, almost exactly the same bias that has been found in favor of anti-depressants, the authors wrote. One of the co-authors, Erick Turner, MD, an associate professor of psychiatry at Oregon Health & Science University, was the lead author of a 2008 paper detailing bias in the publication of antidepressant trials.
Most of the studies in the latest review involved therapies in which the therapist and patient met weekly for up to an hour over several months. With an approach called cognitive behavioral therapy, they might work through a manual, generally to identify and fight ideas like “I’ll never succeed.”
In other research, Hollon has concluded that psychotherapy should be the first line of action against depression since its effects are more enduring. Taking meds at the same time could slow recovery, he argues.
If he’s right, the country needs a big change in its mental health system. About one in 10 Americans age 12 and over takes an anti-depressant, according to data from the Centers for Disease Control and Prevention (CDC), the majority for more than two years. Most of them are fighting depression (some people get anti-depressants for anxiety disorders). But less than a third of them have seen a mental health professional in the previous year. One reason is that has a shortage of mental health providers.
It’s also important to realize that many more people are depressed who never seek help. Only about a third of Americans age 12 and over with current severe depressive symptoms were taking antidepressants in the latest CDC data.
You can overcome depression. If you’ve been dragged down by a job or relationship, you can learn to manage it better, or get out of a bad situation. People with milder depression can see big benefits if they get more exercise, improve their diet, and spend more time with people and activities that help them feel better. Although therapy and medication are not as effective as once thought, don’t let that make you throw up your hands: they do help.
October 22, 2015
Christopher Nystuen, MD, MBA