There’s a lot of “received wisdom” in the field of depression treatment, such as:
- Medication is more powerful than talk therapy.
- Psychotherapy plus medication is the best treatment approach.
- Depression is caused by a “chemical imbalance” involving low serotonin.
- Antidepressant medication is better than placebo for most people with depression.
Are these ideas well-supported by research data? To explore these issues I spoke with Dr. Rob DeRubeis, a clinical psychologist and expert in depression research. Rob’s work has challenged many of the established beliefs in this field, and has sharpened my own thinking in these areas.
Our discussion spanned multiple decades of Rob’s work as his and others’ research refined our understanding of depression and the best ways to treat it. In this episode we explored:
- The different types of depression
- Potential negative side effects of medication and psychotherapy
- The likelihood that depression will return after the first episode
- Patient preference for psychotherapy versus medication
- Possible downsides of combining medication and therapy for depression
- The difficulty in following through on a therapy referral
- How to make the best cognitive behavioral treatments more readily available
- Applying precision medicine to the treatment of depression
- How Rob applies to principles of CBT in his own life
As you’ll find from our discussion, Rob thinks very carefully and clearly about these ideas, and is skilled at explaining important nuances that shouldn’t be ignored. You’ll also learn about the history of the depression treatment field, and the evolution in our understanding of depression and how to treat it.
If you’d like to learn more about the topics Rob and I discuss, check out these videos:
Here are links to some of the relevant articles we discussed so you can see the data yourself:
- The 1999 study showing that medication and CBT were equally effective in treating severe depression: Medications Versus Cognitive Behavior Therapy for Severely Depressed Outpatients: Mega-Analysis of Four Randomized Comparisons
- The 2005 study comparing CBT, an SSRI medication, and pill placebo: Cognitive Therapy vs Medications in the Treatment of Moderate to Severe Depression
- The companion piece showing that CBT was more effective than SSRI medication at preventing depression relapse: Prevention of Relapse Following Cognitive Therapy vs Medications in Moderate to Severe Depression
- The 2010 JAMA study showing that antidepressants on average are better than placebo only at severe levels of depression: Antidepressant Drug Effects and Depression Severity: A Patient-Level Meta-Analysis
- And an explanation of the issues involved in applying precision medicine to depression treatment: Treatment Selection in Depression
Robert J. DeRubeis, PhD, is the Samuel H. Preston Term Professor in the psychology department at the University of Pennsylvania where he also serves as the Director of Clinical Training. His work has shaped the field of modern depression treatment research, and has been supported by multiple major grants from the National Institute of Mental Health.
Rob has authored over 125 peer-reviewed publications, as well as countless book chapters and conference presentations. He has received numerous awards for his work, including the Aaron T. Beck Award from the Academy of Cognitive Therapy for significant and enduring contributions to cognitive therapy; the Distinguished Career Award from the Society for Psychotherapy Research; the Provost’s Award for Distinguished PhD Teaching and Mentoring at the University of Pennsylvania; as well as the James McKean Cattell Fellow Award from the Association for Psychological Science for a lifetime of outstanding contributions to the area of applied psychological research.
To learn more about Rob’s work, check out his Lab Page.
“The best time to act is when it seems to me I don’t want to act.”