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Bipolar blogger Natasha Tracy offers exclusive insight into the world of bipolar disorder.

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Therapy Plus Medication No Better Than Medication Alone?

Natasha Tracy provides the details of an analysis regarding the effectiveness of therapy and medications and passionately defends her stance on the matter.

I have always heard, and always believed, that medication plus therapy was better than either treatment alone in the treatment of major disorders like major depression and bipolar disorder. This was the information given to me by my first doctor and the information I have relayed to countless others.

Moreover, it’s the information that guides current treatment recommendations. In minor depression, therapy should be the first course of treatment whereas with major depression medication and therapy should be frontline treatments.

But an analysis came out that reviewed the data on the effectiveness of medication with therapy and the results really surprised me—no significant benefit was noted when participants with chronic depression were given therapy plus medication when compared to medication alone.

What the Analysis Revealed

The analysis was of a small number of studies—only nine —as only nine met their inclusion criteria of being scientific, randomly controlled and other criteria. Of these nine, it was noted that the results varied greatly between studies and the analysis sought to understand why.

It was found that people the therapy plus medication treatment was more effective when the therapy was cognitive behavioral than when it was interpersonal. It was also found that people with chronic depression benefited more than those who were dysthymic (a more minor chronic depression). These effects partially explained the differences in study outcomes but were, in and of themselves, insignificant.

It was found that non-selective-serotonin reuptake inhibitor (SSRI) medication plus therapy showed a statistically significant greater effect than non-SSRI medication alone whereas this effect was neutralized with SSRI medication. It is not known why this is the case.  

Problems with the Analysis

The authors of the analysis freely admit that due to data variance (and they looked at the data from all angles) and limited number of studies included that these results are not conclusive.

Certainly more work would have to be done to show whether these results are truly meaningful.
Also the statistically insignificant variance among some variables may turn out to be significant with more research and other variables may turn out to be important.

The main problem I have with any study that uses “therapy” is that therapy varies widely even within type so that comparing therapy to therapy is rarely like comparing apples to apples. I suspect the data variance has more to do with this than anything else; however, this is simply an intrinsic barrier to studying the effectiveness of therapy.

After all, there is no such thing as ten milligrams of therapy.

The Good News

The good news is that while the depression scores were not significantly better for those that received medication plus therapy when compared to medication alone; their quality of life scores were statistically significantly better (although the effect was small).

What Did We Learn?

As I said, I would be hesitant to draw any sweeping conclusions due to the analysis limitations, but the important thing, to me, is that therapy does appear to help people in one important way—in quality of life. And I would call that significant.

For all the details please see: Combination of pharmacotherapy and psychotherapy in the treatment of chronic depression: A systematic review and meta-analysis.

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About the Author

Natasha Tracy is an award-winning writer who specializes in writing about bipolar disorder.