Should Depression Severity Indicate Treatment with Medication or CBT?

To evaluate the conventional wisdom that antidepressants are more effective than psychotherapy for more-severe depression, researchers conducted a meta-analysis considering individual patient data from 16 randomized, controlled outpatient studies.

Participants received either manualized cognitive-behavioral therapy (CBT; n=794) or a variety of antidepressants (n=906) for major depression or dysthymia. Severe depression on the Hamilton Rating Scale for Depression (HRSD; score, >23) was diagnosed in 17% of antidepressant recipients and 13% of CBT recipients.

Overall, antidepressants were significantly more effective than CBT in reducing clinician-rated HRSD scores but not self-rated Beck Depression Inventory scores. Treatment groups did not dif…