Heymans Colloquium: Professor Steven Hollon, Is Cognitive Therapy Enduring or is Antidepressant Mediation Iatrogenic?

Professor Steven Hollon,

Gertrude Conaway Professor of Psychology

Professor of Psychology and Human Development

Professor of Psychiatry, VanderBilt University USA

Is Cognitive Therapy Enduring or is Antidepressant Mediation Iatrogenic?

Cognitive therapy appears to have an enduring effect that reduces risk for subsequent relapse and recurrence by about half relative to antidepressant medications following treatment termination. However, these conclusions are almost wholly derived from direct comparisons between prior cognitive therapy versus prior medication. Findings from the extended maintenance phase of our most recent trial suggest that cognitive therapy provided in combination with medication does little to prevent subsequent recurrence. These findings raise the concern that adding medications may interfere with the enduring effects of cognitive therapy as they do in panic. Moreover, depression appears to have “coarsened” over recent decades and there are concerns that antidepressant medications may suppress symptoms at the expense of prolonging the underlying episode. Antidepressant medications are known to work by perturbing the complex homeostatic regulatory systems that underlie affective response and differences in that perturbation are associated with risk for relapse following medication discontinuation. It remains unclear whether cognitive therapy truly has an enduring effect or antidepressant medications have an iatrogenic effect that that either interferes with cognitive therapy’s enduring effect or (even worse) prolong the length of the underlying episode. Two studies are described that are intended to address those concerns.

Organiser: prof. C.L.H. Bocking