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Which method of treatment for depression is more effective: therapy or drugs? A new study, whose results are published in the May 18 New England Journal of Medicine, provides the most definitive answer yet. Although most mental-health practitioners have long assumed that a combination of both approaches is the best treatment, the study, which was conducted by Brown professors Martin Keller (below) and Gabor Keitner (above), along with a number of other researchers, is one of the first to rigorously test that assumption.

To do so, Keller, Keitner, and their colleagues had to find a way to measure the efficacy of a qualitative approach such as psychotherapy in a way that allowed comparison to a regimen of precisely measured medication. Using a new methodology called the Cognitive Behavioral Analysis System of Psychotherapy, which was developed by James P. McCullough of Virginia Commonwealth University, the researchers were able to study 681 chronically depressed patients in twelve locations across the United States while they underwent twelve weeks of treatment. The patients, all of whom had been continually depressed for more than two years, were divided into three groups. One was treated with only the medication nefazodone (prescribed under the brand name Serzone, whose makers funded the study); the second underwent psychotherapy; and the third group received a combination of both. The results were striking: while 55 percent of patients on the drugs-only regimen and 52 percent of those receiving psychotherapy showed positive responses to treatment, the rate was 85 percent for patients undergoing a combination of both.

"The message here is of hope for patients and families," Keller says. "Suicide is not the end result of depression; it is what happens when people with depression dont get the right treatment."





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