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Combining Talk Therapy and Antidepressant Medication

Just as when people think that the only effective treatment for depression is to take drugs, new findings about talk therapy called cognitive behavior therapy appears to cancel the risk of suicidal thinking or behavior associated with taking antidepressant medication. Cognitive therapy is a type of talk therapy that involves counseling and changing a person's negative thought patterns. In one of the most comprehensive and long-running study to date about depression treatment among adolescents, 600 patients were treated for chronic depression. Statistics show that four out of five adolescents treated for chronic depression recovered entirely, or nearly so, when treated over nine months with medication, talk therapy or a combination of the two. Significant signs of improvement were seen from patients taking medication 6 weeks earlier than those who were undergoing cognitive behavior therapy alone, but were about twice as likely to report feeling suddenly suicidal. The combination of the two therapies, the authors found, produced the most rapid recovery and protected against sudden suicidal urges.

The argument regarding the risks of antidepressants to children and adolescents have been going on for years, prompting health regulators to require all labels for antidepressants to carry prominent warnings that the drugs have been associated with increased risks of suicidal thinking and behavior in young patients. Such a move was seen by many psychiatrists to be a case of something being blown out of proportion and scared off patients who could have benefited from drug treatment. This study showed that antidepressants lowered the risk of suicidal thoughts and actions over all, but significantly less so than talk therapy. According to Kevin Stark, a psychologist at the University of Texas who was not involved with the research, the study convincingly showed for the first time that there are very good options for a child who is going through depression and thought to be at risk for suicidal thinking. “Psychosocial therapies do work on their own, with time.

But they also help prevent relapse, and this shows that they can help make drug treatment safer,” said Stark. Experts agreed that talk therapy was a safer alternative. Almost 15 percent of the patients taking just antidepressant medication reported what were described as “suicidal events,” mainly talk and thoughts of suicide so alarming that doctors called in the patients and, often, altered dosages. The rate of such events for those receiving just cognitive behavior therapy was 6 percent. The results for combination therapy were about the same. Dr. John March, Chief of Child and Adolescent Psychiatry at the Duke University Medical Center and the principal investigator for the study believed that medication accelerates recovery while cognitive therapy protects against these bad reactions. “The combination of both treatments is the best option,” said Dr. March. Getting patients out of bed and doing something that they enjoy, like playing basketball or going to a party, are just some of the behavioral changes promoted by talk therapy.

The young patients are also taught to diffuse “poisonous assumptions” like “I’m a loser” or “I’ll never get a girlfriend.” It may not be easy to find specialists for this therapy outside large cities. However, the techniques have been widely published in various manuals and books which can serve as sources and references for a good therapist to work on a depression treatment plan.


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