Therapy and Medication – Where’s the Breaking News?

The National Institute of Mental Health recently cited a study published in the December 2008 issue of the Journal of the American Academy of Child and Adolescent Psychiatry. The study was cited as providing evidence that supports the idea that adolescents with major depressive disorder (i.e., depression) are less likely to relapse after treatment if they receive cognitive behavioral therapy in conjunction with psychotropic medication.

I have to admit that this was not entirely shocking news to me, but I was slightly surprised to find the topic highlighted by NIMH as a “Science Update.” Granted, I don’t regularly read any psychiatric journals. I am a counselor by training, and typically receive only the professional publications that come with my professional association memberships. I suppose that I had just assumed that this was a well-researched topic. Obviously, the publications that I read are written from a different perspective. If the subject is featured, it is most likely written with the idea that therapy is inherently beneficial.

I teach in a counselor training program, and I would estimate that the majority of interventions that we discuss are primarily cognitive-behavioral in nature. Our counselors-in-training receive education is many different theoretical models, but cognitive-behavioral theory is the primary focus with respect to development of specific counseling skills.

So what is the “discovery” here? The connection with the treatment of adolescents?

The majority of my time spent in the field has been spent counseling adolescents. I’ve worked in conjunction with multiple psychiatrists over the years, and for the most part we have usually followed a similar protocol. All adolescents in treatment received counseling services. If warranted, the adolescent was seen by the psychiatrist for a medication evaluation (and management follow-up, if any medications were prescribed). One psychiatrist who I worked with, in particular, would cancel an appointment with the adolescent/family if they failed to keep their appointments with me (as their therapist).

My assumption here is that most practitioners and clients have had similar experiences. Therapy plus medication is more successful than medication alone. If that is true, why is this considered breaking news?

References

Kennard BD, Emslie GJ, Mayes TL, Nightingale-Teresi J, Nakonezny PA, Hughes JL, Jones JM, Tao R, Stewart SM, Jarrett RB (2008). Cognitive-behavioral therapy to prevent relapse in pediatric responders to pharmacotherapy for major depressive disorder J Am Acad Child Adolesc Psychiatry, 47 (12), 1395-1404 PMID: 18978634