Sept. 15, 2005 — If you are suffering from depression, the most effective treatment may be the one you most want.

Many experts agree that a combination of antidepressant medication and psychotherapy is the best treatment for severe clinical depression. But not everyone wants or needs both kinds of treatment.

So can there be a “best” treatment for depression? Yes, say researchers at the VA Puget Sound Health Care System and the University of Washington in Seattle. It tends to be what patients prefer.

Edmund F. Chaney, PhD, University of Washington associate professor of psychiatry and behavioral sciences, is a member of the research team.

“In chronic illnesses like depression and diabetes, treatment is more than just taking medicine,” Chaney tells WebMD. “A lot of the work that has to be done is with lifestyle change. So if patients are active participants in the treatment and have some choice in what they are doing, it becomes something they find much easier to do and to follow through with.”

Better Results With Preferred Treatment

Chaney and colleagues studied 335 patients with depression. Nearly all of them were male, ranging in age from 24 to 84.

All patients were asked what kind of treatment they preferred. Fifteen percent preferred medication, 24% preferred psychotherapy, and 61% preferred both. Most of this latter group, Chaney says, actually had no strong preference and were considered “matched” with their preferred treatment if they received either antidepressants or psychotherapy.

All patients’ depression improved after treatment.

But after three months of treatment, the 72% of patients matched with their preferred treatment were significantly less depressed than those not matched. Patients who got their preferred treatment also tended to be less depressed after nine months.

The study appears in the October issue of Annals of Behavioral Medicine.

How Patients See Their Depression

Psychotherapist Andrew Elmore, PhD, assistant clinical professor at New York’s Mount Sinai School of Medicine, is an expert in the behavioral treatment of depression. He says “patients’ theory of their illness” makes a difference in how well their therapy works.

“If they have a theory of their illness that it is an inherited biological problem or whatever, they are likely to do better on medication,” Elmore tells WebMD. “And even if it is an illusion, those who want the feeling of being more in charge of their lives prefer psychotherapy.”

Treatment is more than just antidepressant medications or psychotherapy, Elmore says; it’s really about people making an effort to combat their depression by controlling it and making themselves feel better.

“What this study is about is something profound: The phenomenology of the patient has an impact on the way treatment works,” Elmore says. “There are issues with any treatment for depression. With behavior therapy, there is homework. With drugs you have to take them. If you don’t like homework, or if you do not like taking pills, you will not do it and you will not benefit.”

Chaney says that patients who choose a particular treatment have expectations it will work. Those expectations may boost the treatment’s effect.

“If, because of their own experience or that of family members or significant others, a patient has the expectation that medication is going to help, then they may well prefer that and get a benefit. On the other hand, if they think psychotherapy may help, that has a big impact on whether that is successful for them or not.”

A Wake-Up Call to Doctors

There’s a lesson here for primary-care doctors — usually the first health-care professional a person with depression sees.

If their doctor merely refers them to a mental health specialist, Chaney says, many patients will simply fail to seek further help. But when doctors ask about patients’ treatment preferences, they are more likely to end up with a helpful prescription or referral. That’s especially true if a trained nurse practitioner or physician assistant follows up the visit with a call.

“Medical education is moving in the direction of helping primary-care doctors deal with the mental-care issues that come to them,” Chaney says. “One part of this skill set is listening to the patient’s preference and taking this into account.”