Psychotherapy instead of medicine or added to medicine may be the right treatment for your depression according to the American Psychiatric Association 2010 depression guideline.
The guideline reviews six different types of psychotherapy:
1. Cognitive and Behavioral Therapies
a. cognitive-behavioral therapy
b. behavior therapy
2. Interpersonal therapy
3. Psychodynamic therapy
4. Marital Therapy and Family Therapy
5. Problem Solving Therapy
6. Group Therapy
The guideline concludes that cognitive-behavioral therapy, interpersonal therapy, and problem solving therapy are useful in depression treatment although the evidence for problem solving therapy effectiveness is less than for the others. These therapies are time limited, often once a week for six to twelve weeks.
Psychotherapy can be used alone as a treatment for depression (usually milder depression). Just as with drug therapy of depression, you and the doctor need to monitor the effectiveness of the therapy. Are you better, worse, or the same? We answer that question by a symptom monitoring instruments like the PHQ-9, and a level-of-function instrument like the Sheehan Disability Scale.
If there is not significant improvement in symptoms and level-of-function within four to eight weeks, then you and the doctor need to consider making a change. Perhaps a different sort of psychotherapy is needed, or more frequent sessions are needed, or perhaps a change to an antidepressant medicine.
There is evidence of a modest advantage for the combination of psychotherapy and antidepressant medicine for major depression. But for combination therapy, there is no clear evidence to guide the choice of a particular psychotherapy with a particular medicine.
As with all treatment, the key is to measure treatment effect with a symptom questionnaire and a level-of-function instrument like the Sheehan Disability Scale.
The various questionnaires are the way we ask and attempt to answer the question: Are you better, worse, or the same?
