Academic journal article Journal of Mental Health Counseling

Tablets or Talk? A Critical Review of the Literature Comparing Antidepressants and Counseling for Treatment of Depression

Academic journal article Journal of Mental Health Counseling

Tablets or Talk? A Critical Review of the Literature Comparing Antidepressants and Counseling for Treatment of Depression

Article excerpt

Antidepressants are generally considered to be the standard treatment. for depression, despite a large body of research evidence documenting the equal or superior efficacy of counseling. This article provides a critical review of the literature comparing the efficacy antidepressants and counseling for adults with depression. Highlighted are several issues that must be considered when reviewing the literature, including methodological problems, the placebo effect, trauma and depression, comparative safety profiles, and the marketing of antidepressants. Implications for mental health counseling practice and research, including the suggestion that counseling alone should be the first treatment of choice for most persons with depression, are discussed.


Depression affects 9.5% of the U.S. population 18 years and older (NIMH, 2008), and women suffer depression at twice the rate of men (Antonuccio, Danton, DeNetsky, Greenbert, & Gordon, 1999; Nemeroff et al., 2003; Stoppard, 1999). Worldwide depression rates have increased 1,000-fold since the emergence of selective serotonin reuptake inhibitor (SSRI) antidepressants 15 years ago (Currie, 2005), and the World Health Organization (WHO) has predicted that by 2020 depression will be the second leading source of global disability (WHO, 2007).

Most persons with depression are treated by primary care physicians (Olfson, Marcus, Druss, Elinson, Tanielian, & Pincus, 2002), and 87 to 89 percent of U.S. physician visits for depression result in antidepressant prescriptions (Olfson et al; Stafford, MacDonald, & Finkelstein, 2001). The number of antidepressant prescriptions in Canada has increased exponentially, from 3.2 million in 1981 to 14.5 million in 2000 (Hemels, Koren, & Einarson, 2002), and the percentage of persons treated for depression with antidepressants in the U.S. jumped from 37.3% in 1987 to 74.5% in 1997 (Olfson et al.). Just as women are diagnosed with depression at twice the rate of men, they are given antidepressants at twice the rate (Munoz, Hollon, McGrath, Rehm, & VandenBos, 1994). Canadian statistics show that one in five women in the province of British Columbia was taking one or more SSRIs between 2002 and 2003 (Currie, 2005).

Given these statistics, counselors are likely to encounter clients (many of them women) who are taking antidepressants. Yet as Schaefer and Wong-Wylie (2008) found in their Canadian study, counselors vary considerably in their attitudes, practices, and training regarding antidepressants. Many bemoan the lack of clear guidelines on whether counseling alone, antidepressants alone, or a combination is optimal for treatment of depression. Furthermore, the literature comparing the effectiveness of antidepressants and counseling for depression is vast, complex, and often contradictory. And there is a paucity of concise and critical reviews of this literature, particularly from a counseling perspective.

Therefore, the purpose of this paper is to critique the literature on the comparable effectiveness of counseling and antidepressants for treating depression in adults. Given the 100+ research studies on this topic, this review is limited to systematic reviews and meta-analyses of studies published in the last 20 years (1987 onward). We also review issues that influence an understanding of the literature and conclude with recommendations for counseling practice.


A review of the MEDLINE, CINAHL, PSYCHInfo, and Academic Search Complete databases yielded 21 systematic reviews and 12 meta-analyses of research studies published since 1987 on the comparative effectiveness of any form of antidepressants or counseling, each addressing anywhere from six to over a hundred studies. A number of general conclusions emerge from these systematic reviews and meta-analyses, depending on the nature of the studies (i. …

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