Is Psychotherapy Better Than Medication?

The American College of Physicians has released a new clinical guideline on the treatment of depression in the Annals of Internal Medicine.  They suggested that psychotherapy is as effective for treating depression as antidepressants, and “given its relative lack of potential harms, should be strongly considered as the first-line treatment.” This is consistent with the American Psychiatric Association guidelines on major depressive disorder from 2010, which show therapy and antidepressant medications as being similarly effective.

The two issues that I, personally, have with this are: 1) that the guidelines specifically mention CBT and do not adequately discuss the benefits of other modalities of psychotherapy which may lead health care providers and patients to assume that CBT is the only mode of treatment that is so effective, and 2) the suggestion that psychotherapy has a “relative lack of potential harms.”  The word “relative” is key here: psychotherapy has significant fewer potential side effects than medication, but this does not mean that psychotherapy is side effect-free.  Therapy can be difficult for many patients at different times along the course of treatment and patients should be aware of this from the outset.