Randomized controlled trials from 1990 through September 2015 compared second-generation antidepressants (SGAs) to non-drug treatments, such as therapy, acupuncture, St John’s Wort, and exercise. A review of the trials found that cognitive behavioral therapy (CBT) was just as effective at treating depression as antidepressants. Due to the lack of harmful side effects, non-drug options should considered as the first plan of treatment.
CBT takes more work than just getting a prescription, as a psychiatrist must be found and scheduled, yet the side effects of SGAs – including headaches, insomnia, dizziness, and drowsiness – are more adverse in the trade-off.
St. John’s Wort is a popular herbal supplement known as a natural treatment for depression. It is not regulated by the FDA and active ingredient amounts may vary by bottle. The supplement may not be as effective as SGAs, but is better tolerated. It also interferes with the effectiveness of other medications if taken together. Side effects of St John’s Wort can be gastrointestinal symptoms, skin reactions, fatigue, and dry mouth.
Several factors should be considered when deciding on what kind of treatment to choose:
- Is there is a trained CBT physician in the patient’s area?
- Does the patient has insurance accepted by the physician?
- Can the patient can get appointments in evening hours or whenever the patient prefers?
These hurdles to therapy do not occur with medication. Sometimes drugs are an easier option, even though therapy is just as effective. Cost comparisons between the two is hard for physicians to estimate.
It is important for primary care physicians to recognize depression and educate patients about effective treatment options.
Frellick, Marcia. “Therapy, Antidepressants Similarly Effective for Depression.” Medical News. Medscape, 9 Feb 2016. Web. 14 Feb 2016.