Medication vs CT in the Treatment of Severe Depression

>From Judith S. Beck and Andrew C. Butler at the Beck Institute for Cognitive Therapy and Research: [re-posted from the ACT listserv with Andrew's permission]

Contrary to a recent listserv message, CT is effective with severe depression. Rob DeRubeis (a founding fellow of ACT) recently mega-analyzed the outcomes of antidepressant medication and CBT for severely depressed outpatient subgroups from four major randomized trials including the National Institute of Mental Health Treatment of Depression Collaborative Research Program (TDCRP). DeRubeis et al. (1999) found that CBT was ***equally effective*** as antidepressant medication for severely depressed patients. This finding is particularly important since it challenges treatment guidelines, based on the TDCRP, that state that CBT is not an effective treatment for severe depression.

We ourselves have found clinically that "standard" cognitive therapy sometimes needs to be modified for severe depression, e.g., increased frequency of sessions initially, specific target on hopelessness, involving family or significant others, modifying dysfunctional beliefs about change that interfere with, among other things, behavioral activation, increased emphasis on therapeutic relationship, focus (if applicable) on medication and treatment compliance, etc.

DeRubeis, R. J., Gelfand, L. A., Tang, T. Z., & Simons, A. D. (1999). Medications versus cognitive behavior therapy for severely depressed outpatients: Mega-analysis of four randomized comparisons. American Journal of Psychiatry, 156(7), 1007-1013.

Andrew C. Butler, Ph.D.
Research Coordinator
Beck Institute for Cognitive Therapy and Research
One Belmont Avenue, Suite 700
Bala Cynwyd, PA 19004
Phone: (610) 664-3020
Fax: (610) 664-5137
Email: butler2@mail.med.upenn.edu

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