Nowadays, we are confronted to a very huge choice of medicines. The many advertisements that can be shown on television reflect the place that this consumption occupies in our society. Nevertheless, this automated care by taking medicines asks more and more questions and we can observe a kind of “back to basics” movement leading people to think about their consumption. There are various ways to treat yourself other than by medication, such as alternative medicine, sophrology or hypnosis, which are more natural technics.
● The place of psychotherapy in the care of depression
Concerning mood disorders treatment, depression in particular, there is a rich literature evaluating antidepressant and psychotherapy treatments. Antidepressants have long been perceived as miraculous drugs that were trusted blindly. Nevertheless, there are other solutions that are increasingly being studied, such as psychotherapies, which have proven their effectiveness in many cases. These psychotherapies try to provide adapted help based on the specific needs of each patient. Furthermore, their effects are reparative in the longterm, because they are more psychologically rooted. It has been shown that concerning depressive states, except for the most severe cases, there was no significant difference between the effectiveness of antidepressants and placebos in curing symptoms (Kirsch et al., 2008). In addition, it has been argued that the improvement of depressive symptoms also depends on the quality and intensity of the therapeutic relationship (Blatt, Zuroff, Quinlan, & Pilkonis, 1996). Taking into account the impact of therapeutic relationship promotes that psychotherapies produce more lasting effects than treatments with a placebo or antidepressant. These results can be explained by the fact that a placebo / antidepressant keeps the patient in a passive posture.
● Effects and sustainability
The study of Siddique, Chung, Brown & Miranda (2012) seeks to compare the efficiency of antidepressants (Paroxetine) to CBT in the treatment of severe and moderate depression.The results show that CBTs are more effective for participants 12 months after discontinuation of treatment. A study by Keller, Giroux-Gonon and Gonon (2013) supports these results and shows that psychotherapies, regardless of their theoretical framework, turnout to be more effective over the long term than antidepressants and placebo treatments.The risk of relapse in depressive states is also an essential component that has to be taken into account. Hollon et al (2005) demonstrated that CBTs had a lasting effect even after the end of therapy. Moreover, antidepressants are only effective during the course of the treatment. A recent meta-analysis also showed that the relapse rate was significantly lower after the end of psychotherapy (even more than two years after), contrary to any other treatment that was not therapeutic in the care of depression (Steinert, Hofmann, Kruse, & Leichsenring, 2014).
● Does unity make strength ?
A study focused on moderate and severe depression in adolescents proposes two experimentations: a simple treatment with Fluoxetine and a double treatment with Fluoxetine and CBT (Mars et al., 2007). Results show that both of the experimental situations aim a diminution of the depression. Nevertheless, we note that the medicine on is own or with aCBT is more efficient than a simple CBT in the treatment of a moderate or severe
depression symptoms in adolescents. However, adding a CBT cure strengthen the pharmaceutical treatment. Those observations promote therefore not choosing one form of treatment rather than another one. Indeed, both of them have advantages and drawbacks.On the contrary, it is possible to consider the combined use of these treatments, setting up specific cares and adjusting to patients’ troubles and needs. Then, psychotherapies were able to demonstrate their efficiency, but we need to be careful and use them with consistency and adapt them with flexibility regarding the type of the patient, the issues and the pathology.
Blatt, S. J., Zuroff, D. C., Quinlan, D. M., & Pilkonis, P. A. (1996).Interpersonal factors in brief treatment of depression: Further analyses of the National Institute of Mental Health Treatment of DepressionCollaborative Research Program. Journal of Consulting and ClinicalPsychology, 64(1), 162 171. https://doi.org/10.1037/0022-006X.64.1.162
Hollon, S. D., De Rubeis, R. J., Shelton, R. C., Amsterdam, J. D., Salomon,R. M., O’Reardon, J. P., Lovett, M. L., Young, P. R., Haman, K. L.,Freeman, B. B., Gallop, R. (2005). Prevention of Relapse FollowingCognitive Therapy vs Medications in Moderate to Severe Depression.Archives of General Psychiatry, 62(4), 417.https://doi.org/10.1001/archpsyc.62.4.417
Keller, P.-H., Giroux-Gonon, A., & Gonon, F. (2013). Effet placebo et antidépresseurs : une revue de la littérature éclairée par la psychanalyse. L’Évolution Psychiatrique, 78(2), 327-340. https://doi.org/10.1016/j.evopsy.2013.02.004
Kirsch, I., Deacon, B. J., Huedo-Medina, T. B., Scoboria, A., Moore, T.J., & Johnson, B. T. (2008). Initial Severity and Antidepressant Benefits:A Meta-Analysis of Data Submitted to the Food and Drug Administration.PLoS Medicine, 5(2), e45. https://doi.org/10.1371/journal.pmed.0050045
Mars, J., Silva, S., Petrycki, S., Curry, J., Wells, K., Fairbank, J.,Burns, B., Domino, M., McNulty, S., Vitiello, B., Severe, J. (2007). TheTreatment for Adolescents With Depression Study (TADS): Long-termEffectiveness and Safety Outcomes. (2007). Archives of General Psychiatry,64(10), 1132. https://doi.org/10.1001/archpsyc.64.10.1132
Siddique, J., Chung, J. Y., Brown, C. H., & Miranda, J. (2012).Comparative effectiveness of medication versus cognitive-behavioral therapy in a randomized controlled trial of low income young minority women with depression. Journal of Consulting and Clinical Psychology,80(6), 995 1006. https://doi.org/10.1037/a0030452
Steinert, C., Hofmann, M., Kruse, J., & Leichsenring, F. (2014). Relapse rates after psychotherapy for depression – stable long-term effects? A meta-analysis. Journal of Affective Disorders, 168, 107 118.https://doi.org/10.1016/j.jad.2014.06.043
Words we have learned
- Automated care = automatisme du soin
- Psychologically rooted = ancré psychologiquement
- Discontinuation = interruption
- Sustainability = durabilité
- Theoretical framework = cadre théorique
Louise Chesneau
Eva Cormerais
Laureen Gueguen