Cognitive Behavioral Therapy for Depression Medication

Updated: Jan 12, 2015
  • Author: Jerry L Halverson, MD; Chief Editor: David Bienenfeld, MD  more...
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Medication

Medication Summary

As described above, CBT is often used in depression as standalone treatment in mild-to-moderate depression or in combination with other treatments such as medication in more severe depression. Several meta-analyses of studies of the combination of psychotherapy and pharmacotherapy for patients with depression have documented an advantage of the combination treatment compared with either treatment alone. [35, 36, 37, 38] This advantage may be particularly pronounced in patients with chronic depression or severe recurrent depression and hospitalized patients.

Combination treatment theoretically adds the unique advantages of both treatment modalities. Pharmacotherapy may provide earlier symptomatic relief and psychotherapy may provide longer lasting symptomatic improvement. [39] CBT can be used to target anxiety and procrastination and can help the patient adhere to more of a schedule, all of which can enhance medication adherence. A Cochrane review showed that adding CBT to a medication regiment improved adherence to the medication and decrease the incidence of hospitalization. [40] CBT can do this by eliciting and modifying maladaptive cognitions about pharmacotherapy such as “if I take a drug I’m weak” or “I’m always the one to get side effects.”

Behavioral methods such as reminder systems and pairing medications with routine activities can also enhance adherence. Medications can enhance the therapy by augmenting concentration, sleep, energy or other functions needed to obtain full benefits from psychotherapy.

Risks of combination therapy include medications that interfere with learning and memory, which may make CBT less effective. Medication may also lead to “premature” relief of symptoms, which might reduce motivation to continue in psychotherapy.

Evidence does not suggest whether particular antidepressants or classes of antidepressants “combine better” with CBT.