Interventions and Therapies for Depression
Treating Depression: Two Main Approaches
The spec identifies two main interventions for depression: biological and psychological. The choice of treatment often reflects the theory of what causes depression — biological treatments target brain chemistry, while psychological treatments target thought patterns. In practice, a combination of both is often recommended.
Antidepressant Medications
Antidepressant medications work by altering the chemistry of the brain to reduce the symptoms of depression. The most widely prescribed type in the UK are SSRIs (Selective Serotonin Reuptake Inhibitors). SSRIs work by blocking the reuptake of serotonin into the pre-synaptic neuron after it has crossed the synapse — leaving more serotonin available to continue stimulating the post-synaptic neuron. This increases serotonin activity in the brain, which is associated with improved mood.
Antidepressants are prescribed by a doctor, take several weeks to have their full effect, and typically need to be taken daily. They reduce the chemical symptoms of depression, which can make it easier for a person to engage in psychological therapies or resume normal functioning. However, they do not address the underlying thought patterns that may have contributed to depression.
Antidepressants (especially SSRIs) treat depression by blocking serotonin reuptake, increasing serotonin availability at the synapse. This is a biological, reductionist intervention targeting brain chemistry directly.
Cognitive Behaviour Therapy (CBT)
Cognitive Behaviour Therapy (CBT) is a psychological talking therapy. It is based on the idea that depression is maintained by negative thought patterns (the cognitive element) and the behaviours that follow from them (the behavioural element). By identifying and challenging these patterns, a person can change how they think and behave, which in turn improves their mood.
In CBT sessions, a therapist works collaboratively with the client to identify automatic negative thoughts — patterns of thinking such as overgeneralising, catastrophising or personalising failure. The therapist then uses techniques such as cognitive restructuring (examining evidence for and against a negative thought) and behavioural activation (gradually reintroducing activities the person has withdrawn from) to build healthier patterns.
Antidepressants represent a reductionist approach: they reduce the treatment of depression to a single causal mechanism — a chemical imbalance in the brain — and correct it with medication. This has the advantage of being straightforward and evidence-based, but it ignores the wider context of the person’s life, relationships and thought patterns.
CBT represents a more holistic approach: it treats the person as a whole, addressing not just the symptoms but the thought patterns, behaviours and coping strategies that maintain depression. However, it requires significant engagement and effort from the client and may not be suitable for everyone, particularly those with severe depression.
Antidepressants = reductionist (target brain chemistry alone). CBT = holistic (addresses thoughts, behaviours and the whole person). The spec expects you to apply these terms to evaluate both treatments.
Aim: Wiles and colleagues aimed to investigate whether adding CBT to usual antidepressant medication improved outcomes for patients with treatment-resistant depression (patients whose symptoms had not improved with antidepressants alone).
Method: Participants were patients who had not responded to antidepressant treatment. They were assigned to one of two conditions: continuing antidepressants as usual, or continuing antidepressants plus receiving CBT sessions. Symptoms were measured at regular intervals over a follow-up period.
Results: Those who received CBT in addition to their medication showed greater improvement in depressive symptoms than those who received medication alone. A significantly higher proportion of the CBT group showed a meaningful reduction in symptoms.
Conclusion: CBT is an effective additional treatment for depression, even when antidepressants alone have not worked. This supports a combined (holistic) approach to treatment rather than relying solely on medication.
Evaluating the Therapies
Both therapies have strengths. Antidepressants typically take 2–6 weeks to have their full effect — faster than a complete course of CBT, but not quick in absolute terms. They are widely accessible (a GP can prescribe them without a long waiting list) and can be taken independently. CBT has long-lasting effects because it teaches skills the person can use independently — it does not just treat symptoms but addresses underlying patterns. Wiles’ study provides good evidence that the two can work together effectively.
Weaknesses also exist. Antidepressants can have side effects and do not address thought patterns — depression may return when medication is stopped. CBT is resource-intensive, requires a willing and engaged client, and may have a waiting list on the NHS. Neither treatment is effective for every person.