New Study: Psychotherapy Outperforms Medication & Combined Treatment for Major Depression

Disclaimer: This article presents the key findings of a comprehensive study regarding the effectiveness of treatments for Major Depressive Disorder (Major Depression). While this article highlights the effectiveness of psychotherapy, both medication and combined treatment remain crucial for many individuals, particularly in severe cases of depression. This information is not intended to replace professional medical advice, diagnosis, or treatment. Always consult with a qualified healthcare provider to discuss the best treatment options for your specific condition.

Major Depression is a serious mental health issue that affects millions of people worldwide. For years, the standard treatment has usually been antidepressant medication, or medication combined with psychotherapy.

Recent research is suggesting a new approach.

A comprehensive study now suggests that psychotherapy alone can be more effective for treating Major Depression than medication alone or combined therapy.

The Research

The research examined 34 studies involving adults, teens, and children diagnosed with Major Depression.

The main focus was to compare the effects of 3 treatment approaches on reducing serious psychiatric events related to major depression: suicide attempts, psychiatric emergency visits, hospitalisations, and deaths by suicide.

The 3 treatment approaches were:

• Psychotherapy Only
• Antidepressant Medication Only
• Combined Treatment (Psychotherapy + Antidepressant Medication)

Effectiveness of Treatments Across All Populations

• Psychotherapy Only vs. Combined Treatment. Psychotherapy Only was nearly twice as effective as Combined Treatment at reducing the likelihood of serious psychiatric adverse events (OR 1.96, p=0.012).
• Psychotherapy Only vs. Medication Only. Psychotherapy Only was associated with a 55% greater reduction in the likelihood of serious psychiatric events compared to Medication Only (OR 0.45, p=0.001).
• Combined Treatment vs. Medication Only. Combined Treatment was found to reduce serious psychiatric events compared to Medication Only, though the difference did not reach statistical significance in some analyses.

Effectiveness of Treatments for Adults

When looking specifically at adults, the research showed similar trends:

• Psychotherapy Only vs. Combined Treatment. Psychotherapy Only was generally found to be more effective than Combined Treatment, demonstrating nearly twice the effectiveness in reducing serious psychiatric events (OR 1.96, p=0.012). This indicates a statistically significant advantage overall, although some sub-groups showed insignificant differences in effectiveness.
• Psychotherapy Only vs. Antidepressant Medication Only. Psychotherapy Only was more effective than Medication Only, with a 55% greater reduction in serious psychiatric events (OR 0.45, p=0.001).
• Combined Treatment vs. Medication Only. Combined Treatment was found to reduce serious psychiatric events more than Medication Only, although the statistical significance of this finding varied. This suggests that Combined Treatment’s effectiveness might depend on specific adult sub-groups.

Effectiveness of Treatments for Teens & Children

The results for teens and children were particularly striking:

• Psychotherapy Only vs. Combined Treatment. Psychotherapy Only was significantly more effective in reducing serious psychiatric events compared to Combined Treatment. The data showed that psychotherapy had almost double the effectiveness (OR 1.96, p=0.012).
• Psychotherapy Only vs. Antidepressant Medication Only. Psychotherapy Only was 55% more effective than Medication Only at reducing the likelihood of serious psychiatric events (OR 0.45, p=0.001).
• Combined Treatment vs. Medication Only. Combined Treatment tended to show improved outcomes in reducing serious psychiatric events compared to Medication Only, however the statistical significance of this finding varied.

Recommendations for Medical Professionals

Based on these findings, here are my recommendations for medical professionals:

• Recommend Psychotherapy. Psychotherapy provides clients with sustainable coping skills, potentially explaining its superior outcomes. Given the evidence of its effectiveness, consider recommending psychotherapy as the first line of treatment for clients with Major Depression.
• Educate & Inform. Ensure that clients are fully informed about all of their treatment options. Highlight the benefits of psychotherapy and discuss its effectiveness compared to medication only or combined treatment. Some may prefer medication due to various reasons, but providing them with full information about the benefits of psychotherapy can help you and your client make a truly shared decision.
• Collaborate with Psychotherapists. Build your network of psychotherapists to whom you can refer. This greater pool of therapists ensures that your clients can be seen without delay and provides a greater diversity of treatment models.
• Remain Open. While this study highlights the effectiveness of psychotherapy in treating Major Depression, it's important to recognise that treatment responses vary. For some clients, particularly those with severe symptoms, medication or combined treatment can be crucial.

Recommendations for Clients

For those suffering from major depression, the findings of this research offer hope and guidance. Here are my recommendations:

• Explore Psychotherapy. Consider starting your therapy journey with psychotherapy, as the evidence suggests it can be more effective than other approaches.
• Ask Questions. Don't hesitate to ask your healthcare provider lots of questions about psychotherapy. This deeper dialogue will reveal all of your options and help you find the best solution for your mental health.
• Compare Therapists. Finding the right therapist is critical. Look for mental health professionals who specialise in treating major depression. Don't be afraid to ask for free initial consultations. I recommend interviewing 3-4 therapists to find the one with whom you feel most comfortable.
• Remain Open. While psychotherapy alone proved more effective in this study, you may still benefit from medication, especially in the short term. Discuss this with your healthcare provider to ensure your chosen therapy approach aligns with your individual needs. In severe cases, combined treatment might offer the best chance for rapid improvement and long-term management.

Notes on Psychotherapy

While psychotherapy alone demonstrated superior effectiveness in this study, it is crucial to recognise that results can vary significantly among individuals.

The effectiveness of psychotherapy can be influenced by several factors, including the client's history and environment, the presence of co-occurring conditions, and the experience and suitability of the therapist.

It is important for both clients and healthcare providers to consider these variables when making treatment decisions.

Notes on Medication & Combined Treatment

While this study highlights the effectiveness of psychotherapy in treating Major Depression, it is crucial not to overlook the essential role of medication, particularly for immediate symptom management in severe cases.

It is also important to note that neither this study nor this author suggest discontinuing medication without consulting a qualified healthcare provider, particularly in cases featuring severe depression.

In acute scenarios where rapid symptom control is vital to client safety, a combined treatment approach is often indispensable.

Next Steps

While this study shows promising results for psychotherapy, there are limitations. Further research is needed to understand the best approaches for different populations.

You can view the entire study, including its methodology and findings, here.

I hope you found this helpful.

References

Zainal, N. H. (2024). Is combined antidepressant medication (ADM) and psychotherapy better than either monotherapy at preventing suicide attempts and other psychiatric serious adverse events for depressed patients? A rare events meta-analysis. Psychological Medicine, 54(3), 457–472. doi:10.1017/S0033291723003306. DOI: 10.1017/S0033291723003306

I am a Psychotherapist and the director of Intermind. I help individuals, couples, and families overcome their mental health and relationship challenges, using evidence-based psychotherapy. I am also a Mental Health speaker, and host of the podcast The Brief Therapist with Tom Skotidas.