From Our 2010 Archives

Survey: Talk Therapy as Good as Antidepressants

Consumer Reports Survey Shows Both Treatments Are Effective for Depression and Anxiety

By Kathleen Doheny
WebMD Health News

Reviewed By Laura J. Martin, MD

June 1, 2010 -- Antidepressants are commonly prescribed for treating both anxiety and depression, but talk therapy appears to work just as well as the medications, according to a new survey. People who both take medicine and get therapy fare even better.

Nearly 80% of survey respondents with depression or anxiety reported antidepressant use, says Nancy Metcalf, senior program editor at Consumer Reports Health, which will publish the results of its third mental health survey of its readers in the July issue.

While medication produced good results, so did talk therapy. "What we found is, if you can get yourself to talk therapy, and if you stick with it for at least seven weeks, you are going to get results as good as you would if you just popped a pill," Metcalf tells WebMD.

The survey, conducted in 2009, includes data from more than 1,500 survey respondents who had sought professional help for depression, anxiety, or another mental health problem between January 2006 and April 2009. They reported the treatments they sought and how well they helped, including specifics on types of drugs and side effects and the types of therapists they went to.

About 16% of U.S. adults have had depression at some point in their lives, according to a 2006 CDC survey, and about 11% are told by a health care professional they have anxiety.

Tracking Depression and Anxiety

Of the 1,544 respondents in the Consumer Reports survey with depression or anxiety, 30% reported depression only, 18% anxiety only, and 52% both at the same time. Most drugs now used for depression treatment also work for anxiety. The average age of the survey respondents was 58.

In the survey, those who took medications found that some drugs produced fewer side effects than other types.

Those who took the class of antidepressants known as SSRIs (selective serotonin reuptake inhibitors) such as Celexa, Prozac, Zoloft, and their generic equivalents had lower rates of side effects than those taking SNRIs.

SNRIs, or serotonin norepinephrine reuptake inhibitors, are a newer antidepressant class, often more expensive. Among them: Effexor, Cymbalta, and Pristiq.

The respondents who took SSRIs found them about as helpful as those taking SNRIs, with 53% of those on SSRIs saying they helped a lot and 49% of those on SNRIs saying that.

The side effects, Metcalf's team found, were higher than what is typically reported in drug company studies; 31% of those on SSRIs and 36% of those on SNRIs reported sexual side effects.

The first drug tried didn't always work, the readers reported; they took a median (half more, half fewer) of three.

Of the 45% of respondents who turned to talk therapy, either alone or with medication, 46% said the therapy sessions had made their condition "a lot better," while 45% termed things "somewhat better."

Overall, a psychiatrist got a somewhat higher helpfulness score from the readers. But in general, the advantages of talk therapy were consistent whether the therapist was a psychologist, social worker, or licensed counselor.

Those who stuck with the talk therapy for seven sessions or more had better results than those who completed fewer.

When single vs. combined treatment was considered, taking into account how helpful readers found their therapist or doctor, how much change they reported in emotional health, and other factors, those who used drugs and engaged in talk therapy for at least seven visits fared the best, according to Metcalf.

Second Opinion

In response to the survey results (including the finding of fewer side effects with Prozac than with Cymbalta), Charles McAtee, a spokesman for Eli Lilly and Company, which makes both of the drugs, says in a statement: "Depression is a highly individualized illness. Treatment decisions, including what type of treatment is appropriate for a given patient, are best determined by the health care professional and patient working together and based on the individual patient's needs."

"As with any medication," McAtee states, "Prozac and Cymbalta can include side effects, so patients should speak with their doctor about the risks and benefits of any antidepressant medication before starting treatment."

The report offers some good information, but there's a caveat, says Harold Pincus, MD, vice chairman of psychiatry at Columbia University, New York, who has researched and published on trends in depression treatment.

"A lot of the information is pretty sound," says Pincus, who reviewed the report for WebMD. But, he adds, it has flaws inherent in any survey.

"We have no idea who the respondent pool is, whether they are representative of the general population," he says. (The Consumer Reports authors note that they are not necessarily representative of the general U.S. population). Those who are depressed or anxious who answered the survey may also not be typical of those in the general population with the conditions, he says.

"The bottom line is, it's not something I would rely on for decision making," Pincus says.

Deciding which treatments to recommend for mental health issues, he says, is complicated, with many factors needing to be taken into account. Among them are the degree of symptoms, the patient's medical and family history, and past experiences with medications and other therapies.

If the depression is very mild, he says, "watchful waiting" for a couple of weeks may be best, as the depression may lift on its own.

If the depression is mild, he says, psychotherapy or medications can be used with equal benefit. "For those with moderate to severe major depression, medication is more effective than psychotherapy alone, but the two together may be synergistic because they may attack different components of the illness."

SOURCES: Nancy Metcalf, senior program editor, Consumer Reports Health.

Harold Pincus, MD, vice chairman of psychiatry, Columbia University Medical Center, New York.

Consumer Reports Health, July 2010: "Depression and Anxiety."

Charles McAtee, spokesman, Eli Lilly and Company.

CDC: "Anxiety and Depression."

©2010 WebMD, LLC. All Rights Reserved.