The New York Times edition for 1-8-15 included a commentary by a psychiatrist, Richard A. Friedman, M.D., about choosing treatments for depression. The article, “To Treat Depression, Drugs or Therapy?”, provides a summary of some recent interesting research, including neurological research, about “the holy grail of personalized therapy- be it with psychotropic drugs or psychotherapy” and how it has, until recently, proved elusive. The goal is to identify individual factors that would provide some guidance about which type treatment might work better. He notes, “Rarely does a (prescriber) switch to an empirically proven psychotherapy….after a patient fails to respond to medication, although (new) data suggest this might be just the right strategy.” He also acknowledges that most psychotropic medications are prescribed on a trial-or-error basis, and psychotherapy often is presumed to provided benefits from “nonspecific” factors, such as helping the patient to feel understood and cared for by another person.
He reviews research that is helping make the selection of treatment for depression more individualized, and potentially more effective. For example, there is intriguing research about how depressed patients with a history of abuse tend to respond differently than to treatment than the average depressed patient, with a better response to psychotherapy alone than to an antidepressant alone. Dr. Friedman notes, ‘The combination of psychotherapy and a drug was not significant better than psychotherapy alone.” He also notes, “Considering the high rate of early trauma in chronically depressed patients….this should be an important factor in selecting the right treatment.”
His commentary includes additional information in support of:
1. not using medication alone for the treatment of chronic depression.
2. routinely adding psychotherapy when a patient’s response to medication is inadequate.
3. using the emerging data from treatment outcomes studies to tailor the treatment plan to the individual patient.