International guidelines for the treatment of anxiety disorders recommend a combination of antidepressants and psychotherapeutic methods, such as cognitive behavioral therapy.
However, four high-quality and well-designed individual studies1 suggest that cognitive behavioral therapy without the additional use of medication might be significantly more effective than the currently recommended combination of both methods, particularly when looking not only at the short-term recovery of anxiety patients but also at their long-term progress.
While antidepressants can help reduce anxiety symptoms more quickly at the beginning of treatment, this benefit comes at a high cost. Psychotropic medications appear to make it harder, rather than easier, for patients to learn from therapy and retain the strategies they’ve acquired after therapy concludes.
Antidepressants do not protect against relapses after depression
Antidepressants are also not suitable for preventing future relapses after a depressive episode. A study published in the American Journal of Psychiatry2 in 2004 showed that, over a six-year period, only 40% of participants who had received cognitive behavioral therapy as a preventive measure experienced a relapse. In contrast, the relapse rate was 90% among those who relied solely on antidepressants to prevent another depressive episode.
In practical terms, this means that patients treated exclusively with cognitive behavioral therapy feel better after completing therapy and experience significantly fewer relapses than those who also took antidepressants.
The responsible authorities should, therefore, urgently revise the guidelines for the treatment of anxiety disorders. In their current form, they are highly likely to lead to an increase in anxiety symptoms over time rather than a reduction.
Troy A.
Tampa, Florida