PHILADELPHIA (Reuters Health) - People with moderate to severe depression get as much benefit from cognitive therapy as they do from antidepressant medication, but the depression-relieving effect may take a bit longer to take hold, according to a report presented here at the American Psychiatric Association annual meeting.

What's more, the effects of cognitive therapy may be longer lasting. People on antidepressants tended to have depression return if they stopped their medication, while many of those treated with cognitive therapy did not experience a relapse.

"There are two different ways to protect against relapse of severe depression," Dr. Robert DeRubeis told Reuters Health. "One has been shown to be effective over and over again: stay on an antidepressant medication. The benefit experienced by patients who continued on medication wasn't surprising. What was interesting and important is that 75% of the therapy was free of relapse for a year," said DeRubeis, a professor and chair of psychology at the University of Pennsylvania.

In the study of 240 patients with moderate to severe depression, 50% of patients on antidepressants showed an improvement after 2 months of treatment compared with 38% with cognitive therapy and 27% on a placebo, or inactive treatment. After 4 months of treatment, about 57% of patients had responded to treatment whether it was with antidepressant drugs or cognitive therapy.

The patients taking antidepressants were then randomly assigned to either continue on medication or to receive a placebo pill. Those who had undergone cognitive therapy continued to remain free of depression after their treatment stopped. However, most patients switched from medical treatment to placebo experienced a return of their symptoms.

At one year, 75% of the cognitive therapy group remained free of relapse. Among those taking an antidepressant, 60% who remained on medication were relapse-free compared with just 19% of those who were switched to a placebo.

Cognitive therapy initially consisted of twice-weekly sessions, which were tapered to once a week for the rest of the 4-month period after the patient was experiencing some relief of symptoms. People in the cognitive therapy group were required to discontinue therapy after 4 months but were allowed up to three sessions for the rest of the year.

"The cognitive therapy subjects were not remaining in treatment, and in that way were comparable to the subjects receiving pharmaceutical care who were switched to placebo," DeRubeis told Reuters Health. "The therapy patients learned something that would protect them through the year. One could say that a course of cognitive therapy does to your brain what staying on medication does."

The findings seem to indicate that cognitive therapy offers patients and healthcare professionals an effective alternative to drug treatment, he said.

"One of the advantages also seems to be is that you won't necessarily need to continue cognitive therapy once the course is finished," he said. "However, we'd like to know more than that. We would like to follow patients for a longer period of time in order to see how long the benefits persist."

Although cognitive therapy involves more time and effort than drug treatment, it is free of medical side effects. Even though psychotherapy can be expensive initially, over time it is less so, "because it allows the person to become his or her own therapist," DeRubeis said.

Dr. Steven Hollon, who coordinated the study at the Vanderbilt University site in Nashville, Tennessee, pointed out that 20% of the study participants had been hospitalized at some point in time for their depression. Most had other psychiatric illness, including post-traumatic stress disorder, generalized anxiety disorder, panic disorder and obsessive-compulsive disorder. One of seven patients had eating disorders, and more than one-third had been previously diagnosed with substance abuse or dependency disorder.

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