Cognitive Therapy vs Medications in the Treatment of Moderate to Severe Depression

DeRubeis, Robert J.; Hollon, Steven D.; Amsterdam, Jay D.; Shelton, Richard C.; Young, Paula R.; Salomon, Ronald M.; O’Reardon, John P.; Lovett, Margaret L.; Gladis, Madeline; Brown, Laurel L.; Gallop, Robert

doi:10.1001/archpsyc.62.4.409

Cited by 824 publications

(713 citation statements)

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“…This is especially true when patients are experiencing acute stressors (e.g., divorce), where psychotherapy may improve patients' long-term outcomes. 13 Second, antidepressants have side effects which may increase in number or severity upon adding another antidepressant. Side effects are known to reduce quality of life and increase the chances of non-adherence, thereby interfering with the treatment of MDD.…”

Section: Discussionmentioning

confidence: 99%

“…2,3 Providers have access to several effective and efficacious treatment options, including a wide array of antidepressant medications [4][5][6][7][8] and psychotherapeutic interventions. [9][10][11][12][13] For chronic MDD, a combination of psychotherapy and medication has been found to be the most effective. 14,15 Such diversity of treatment alternatives is necessary, as fewer than 50% of patients fully remit after an adequate trial of antidepressants or psychotherapy.…”

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confidence: 99%

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Examination of the Utility of Psychotherapy for Patients with Treatment Resistant Depression: A Systematic Review

2010

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

Examination of the Utility of Psychotherapy for Patients with Treatment Resistant Depression: A Systematic Review

2010

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“…81 Similarly, the clinical benefits of CBT may not be evident for 6 to 8 weeks, and recovery may take as long as 16 weeks. 82 Organized follow-up programs that include patient education, telephone or in-person contact every 2 to 4 weeks, monitoring of medication adherence, and psychiatric consultation as necessary improve outcomes for depressed cardiac patients. [83][84][85][86] "Measurement-based care," which uses frequent ratings of symptoms and adverse effects to guide dose adjustments and changes in treatment, can also be of benefit.…”

Section: How Should Cardiac Patients Be Followed Up After Initiatingmentioning

confidence: 99%

Depression and Cardiovascular Disease

Whooley¹

2006

JAMA

215

160

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Major depressive disorder is a risk factor for the development of incident coronary heart disease events in healthy patients and for adverse cardiovascular outcomes in patients with established heart disease. Depression is present in 1 of 5 outpatients with coronary heart disease and in 1 of 3 outpatients with congestive heart failure, yet the majority of cases are not recognized or appropriately treated. It is not known whether treating depression improves cardiovascular outcomes, but antidepressant treatment with selective serotonin reuptake inhibitors is generally safe, alleviates depression, and improves quality of life. This article evaluates the importance of major depression in patients with cardiovascular disease, and provides practical guidance for identifying and treating this disorder. CASE PRESENTATIONA 58-year-old man with a history of coronary heart disease (CHD), type 2 diabetes mellitus, hypertension, smoking, and alcohol dependence presented for routine medical care. He had initially sought medical attention for exertional angina 5 years previously, at which time he underwent exercise treadmill testing with thallium that was positive for reversible perfusion defects in the anterior, septal, and inferior walls. Subsequent coronary angiography revealed diffuse heavy calcifications in the left anterior descending artery with a moderate lesion prior to the first diagonal. Several major septal perforators had significant lesions at their origins. In the dominant right coronary artery, there were diffuse calcifications but no significant lesions. The left circumflex and large ramus intermedius were free of discrete lesions. Left ventricular function was normal.The patient underwent single-vessel (left internal mammary artery to left anterior descending artery) coronary artery bypass grafting (CABG) surgery. He was prescribed atenolol 100 mg/ d, lisinopril 40 mg/d, lovastatin 80 mg/d, aspirin 325 mg/d, metformin 850 mg 3 times a day, and glipizide 10 mg 2 times a day. Despite being nonadherent to his prescribed medications, he remained stable for 5 years, but then one day, while doing household chores, he suddenly developed chest pressure, shortness of breath, and diaphoresis that lasted 12 hours. On admission to the hospital his troponin I was elevated and peaked at 0.7 ng/mL (normal, <0.05 ng/mL), consistent with a myocardial infarction (MI). His electrocardiogram had not changed.

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“…Although depressive episodes can be treated with antidepressant medication, structured forms of psychotherapy, or both (DeRubeis et al, 2005;Keller, 1999), the rate of recurrence is high (Judd, Paulus, & Zeller, 1999;Mueller et al, 1999). Identifying individuals at high risk of relapse might improve overall outcome.…”

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confidence: 99%

Cognitive and serotonergic vulnerability to depression: Convergent findings.

Booij¹,

Does²

2007

Journal of Abnormal Psychology

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Cognitive reactivity (CR) is a psychological vulnerability marker of depression, whereas response to acute tryptophan depletion (ATD; a serotonergic challenge procedure) is a biological vulnerability marker. The aim of this study was to investigate the relationship between these markers. Thirty-nine remitted depressed patients participated in 2 ATD sessions in a double-blind crossover design. CR, assessed prior to the ATD sessions, predicted depressive response to high-dose ATD. CR also diminished the effects of 2 known predictors of ATD response: gender and residual symptoms. Neuroticism and behavioral inhibition were unrelated to ATD response. CR is associated with an increased sensitivity to reductions of serotonin concentrations. These findings present a small step toward unifying cognitive and neurobiological theories of depression.

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Cognitive Therapy vs Medications in the Treatment of Moderate to Severe Depression

Abstract: Cognitive therapy can be as effective as medications for the initial treatment of moderate to severe major depression, but this degree of effectiveness may depend on a high level of therapist experience or expertise.

Cited by 824 publications

References 43 publications

Examination of the Utility of Psychotherapy for Patients with Treatment Resistant Depression: A Systematic Review

Examination of the Utility of Psychotherapy for Patients with Treatment Resistant Depression: A Systematic Review

Depression and Cardiovascular Disease

Cognitive and serotonergic vulnerability to depression: Convergent findings.

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