Answers to just three questions can determine best depression treatment

University of Haifa research shows whether drugs or psychotherapy are better option.

Teen depression (photo credit: INGIMAGE)
Teen depression
(photo credit: INGIMAGE)
University of Haifa researchers have determined that answers to just three questions asked of people suffering from depression can determine whether they should be given medications or treated with psychotherapy.
Prof. Sigal Zilcha-Mano, a psychologist and author of the study, found it can be predicted whether patients should undergo psychotherapy or get psychotropic drugs based on their age, expectations of the relationship with the therapist and level of vindictiveness towards others.
The probability that people suffering from depression will complete treatment can be increased significantly by asking the questions before beginning therapy.
“Asking these three questions will save a lot of time in identifying the most appropriate treatment for the patient,” she said. “The answers will help solve a dilemma that many patients face in choosing the best type of treatment.”
One in five patients with depression drops out of treatment before completing it, with most of them returning to their pretreatment condition, said Zilcha-Mano, who worked with her student Avinadav Rubin and a team of researchers from the psychology departments at the University of Pennsylvania and Adelphi University in New York.
Many people with depression find it difficult to decide to seek treatment, she said.
When they do make this decision, it is often based on a friend’s recommendation or a name they happened to encounter, without examining whether the form of treatment is suitable for them.
The research team studied whether any traits or characteristics that can be identified prior to treatment can predict the type of treatment protocol that will reduce the chance of dropping out. To this end, 156 patients diagnosed with clinical depression were divided on a random basis into three treatment groups.
The first group of 51 patients underwent psychotherapy, the second group of 55 received 50 mg. to 200 mg. of a selective serotonin reuptake inhibitor antidepressant, and the third group of 50 were given a placebo.
Before beginning treatment, participants were asked various questions about different characteristics, some related to the treatment and others unrelated.
Many characteristics were found to have no predictive significance, including: gender; whether the patient avoided intimate relationships; education; and expectations for the success of treatment.
However, the study did identify three questions that can predict which treatment will be most effective.
The findings showed the more an individual expected a positive relationship with the therapist, the greater the chance of completing psychotherapy and the lower their chance of completing medication.
It was also found that people who show a high level of vindictiveness in interpersonal relationships are at higher risk of stopping their medication.
Last, it was found that people over the age of 45 have a higher chance of completing medication, whereas those below that age – if they opt for psychotherapy – have a better chance of completing treatment.
For the researchers the lesson was clear: Before beginning treatment, therapists should ask patients to state their age, their level of vindictiveness (in an appropriate, professional way) and, above all, ask their personal expectations regarding the therapist.
“Within the hopelessness that forms a key part of depression, people try to find the strength to turn to treatment,” Zilcha-Mano said.
“When they manage to do so, they sometimes find themselves in therapy that isn’t suitable for them and accordingly they soon drop out, thereby becoming even more pessimistic about the chances of overcoming depression.
Thus this study has enormous potential to identify the most appropriate treatment for each patient, so that when people find the strength in their depression to seek treatment, they can truly benefit from it.”