Treatment of Depression: A Psychologist's Opinion

A recent study of the treatment of depression in the May 2000 edition of the New England Journal of Medicine provided some insight into the importance of combining psychotropic medication with psychotherapy. In this important study of the treatment of depression, 681 adults with chronic major depressive disorder were randomly divided into three groups, and treated for 12 weeks with either (a) medication (b) psychotherapy or (c) both. Among the 519 subjects who completed the study, the rates of positive outcome (remission or satisfactory response) were 55 % for the group on medication, 52 % for the psychotherapy group, and 73 % for the combined treatment group. These impressive results indicate that the combination of medication and psychotherapy may be superior to either medication or psychotherapy alone, when treating chronic major depressive disorder.

These results cannot be generalized to all types of depression or to the general population. However it does underscore the fact that various modalities may be utilized in the treatment of depression, with some level of significant improvement. Also, it may also be indicative of the fact that depressions are much more than a “biological imbalance” as we frequently hear as therapists. If it were strictly a biological imbalance, the addition of psychotherapy to the medication treatment would not have any additional effect.

As the former Director of the Department of Psychiatry at a local St. Louis, MO hospital, and former Program Manager of the Partial Hospital Program and Outpatient Counseling Services for approximately five years, I have seen thousands of individuals with anywhere from mild to severe, and even life-threatening levels of depression. The most appropriate treatment of depression for most individuals, is not usually a “cut and dried” issue of being able to apply any certain formula to the overall population. Some individuals do very well on medications alone. Likewise, many do well with a good psychotherapist and do not require medications. Others need both. There is even a small minority who seem to not require any of these, and the depression simply remits over a period of time on its own. Some may even have depression which is so severe that it only is effected by electro-convulsive therapy (ECT) or what is commonly referred to as shock treatments ( which incidentally have been found to be extremely effective in patients with psychotic depression as well as treatment resistant, severe depressions). A good psychologist, psychiatrist or counselor, should initially focus on helping their patients to figure out which category they may fall into and try to get them the best treatment possible.

I have a real problem with specialists attempting to consider their modality of treatment superior to the others, or simply ignoring other interventions for the treatment of depression, when in fact they are all just “different tools”, which are effective for some individuals and not quite as effective for others. My suggestion is that if you or a loved one is in need of treatment for depression, and the clinician you’re talking to does not discuss that there may possibly be a need to consider additional options, beware. When you are discussing effective treatment of depression, “one size does not fit all“.

By Paul Susic MA Licensed Psychologist Ph.D Candidate