Psychotherapy As Effective As Drugs, Study Reports

By John Thomas, Associate Editor
July 1, 2000



Psychotherapy developed by a Virginia psychologist to specifically treat chronic depression works as well as drugs alone, according to a study reported in May in the prestigious New England Journal of Medicine.

Co-Author James P. McCullough, Ph.D., of Virginia Commonwealth University in Richmond, said a study of 681 chronically depressed individuals showed that patients using the therapy he has developed over the last 25 years worked as well as Serzone, an antidepressant.

While those who were given the antidepressant showed more initial improvement, by week four of the test those who received Cognitive Behavioral Analysis System of Psychotherapy (CBASP) had caught up.

Fifty-five percent of both groups showed improvement, he said. When administered both psychotherapy and Serzone, 85 percent showed improvement, he added.

McCullough said the study represents a watershed event in the study of psychotherapy in the treatment of chronic depression. He said 14 million Americans suffer from the disease.

He said the study was the largest to compare drugs and psychotherapy for chronic depression.

Of the 519 patients who completed the 12-week study (around 25 percent dropped out after four weeks), the response among those given only an antidepressant and the patients who received 16 to 20 sessions of psychotherapy were about the same.

Fifty-five percent in the drug group and 52 percent in the psychotherapy group showed improvement.

McCullough said his therapy “teaches patients to focus on the consequences of their behavior and uses a social problem solving approach to interpersonal relationships.”

He said the article was the first one dealing with psychotherapy to appear in the New England Journal of Medicine.

“The Journal hardly deals with psychiatry, let alone psychology,” he said.

He said the study was significant in that it showed that the 5% of Americans who suffer chronic depression can be treated effectively. Chronic depression was once thought not to be treatable at all since it was viewed as a personality disorder, McCullough added.

Also of significance, he said, was learning that the two treatments to be equivalent in effectiveness and demonstrating the additional benefits of combining them.

McCullough said that other data from the study will be released in the months ahead. He said it is important that the study group continue to receive medications and have access to psychotherapy.

He was pessimistic that managed care will change its mind about paying for long-term therapy, but said there is hope that HMOs will take a different view now that it has been proven that both psychotherapy and medications work equally well in the chronic depressed population.

“One of the questions I have is ‘what will psychology do?’ with the new information,” McCullough said.

He said that in 10 years he hopes his therapy, CBASP, will be accepted as the accepted treatment for the chronically depressed.

His new book, Treatment for Chronic Depression: Cognitive Behavioral System of Psychotherapy, was published by Guilford Press this year.

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