Therapy may boost antidepressant drug compliance

[David Baxter PhD]

Therapy may boost antidepressant drug compliance
July 28, 2004

NEW YORK (Reuters Health) - The combination of drug treatment and psychological therapy for depression is more effective than drug treatment alone. This, researchers report in the Archives of General Psychiatry, may be because patients better adhere to antidepressant drug regimens.

As senior investigator Dr. Carmine Munizza told Reuters Health, "in addition to being a possible alternative to drug treatment, psychotherapeutic intervention in combination with drug therapy has produced outstanding results -- a 12 percent improvement in response rates to drug treatment due to its effect on drop-out rates."

Munizza of Centro Studi e Ricerche in Psichiatria, Turin, Italy and colleagues conducted a review of clinical trials that compared antidepressant treatment alone with the combination approach. The aim was to help clarify the relationship between the type of treatment and the rate of patient compliance with prescribed antidepressant drugs.

In total, the researchers examined 16 trials involving 932 patients randomly assigned to drug treatment and 910 patients assigned to combination therapy.

Overall, improvement was significantly greater in patients in combination therapy - 86 percent -- than in patients who received drug treatment alone.

There were similar proportions of non-responders and drop-outs in both groups. However, in studies lasting more than 12 weeks, the situation changed. In longer studies, combination therapy showed a significant advantage in response and in the likelihood of dropping out.

In longer therapies, the researchers suggest, "Psychotherapy helps to keep patients in treatment." Nevertheless, they concede that specific studies are required "to disentangle the genuine therapeutic effect of psychotherapy," from that of its drug-compliance enhancing qualities.

Meanwhile, they suggest that interventions that encourage drug compliance might be one way of improving the response rate to antidepressant therapy.

Archives of General Psychiatry, July 2004.

 

[David Baxter PhD]

Point-counterpoint: Therapy is more than drug-compliance

I decided to post the article above because I think it makes an important general point: my experience with depressed clients tells me that physicians and psychiatrists who prescribe antidepressants (or indeed other psychotropic medications) often fail to provide their patients with much information about possible side-effects of the medications and available remedies for those side-effects. As just one example, many of my clients are surprised to learn that to derive significant benefit from these medications is likely to require taking it for a year or longer - that's not a bad thing in itself and not a reason to avoid the medication, but it amazes me that patients are often not given this information.

Beyond that, my opinion is that for many and perhaps the majority of depressed patients, antidepressant medication is beneficial and an option that should be at least considered.

But, and this is a big but, for most depressed individuals, I think medication is an aid to psychotherapy rather than the other way round. Medications can boost mood, improve sleep patterns and appetite, and help to reduce the intensity of depressive (pessimistic, negative) thinking in a depressed person. However, psychotherapy is needed to address the reasons for the depression and to learn more permanent strategies for coping with triggers, life circumstances, and depressive thinking styles.