Michael Thase, MD: Pharmacological Interventions Versus Therapy in Depressed Patients

How do you determine when to use therapy versus pharmacological interventions in patients with depression?

Michael Thase, MD:

Patient preference is a top one. And I really feel like patient preference is only overridden when a patient is hearing voices or experiencing hallucinations - so a psychotic depression must be treated with medication.

If the person is simply just completely disabled, and is having trouble getting out of bed, is not going to work, is not taking care of their responsibilities at home, I have less confidence that therapy alone is an adequate treatment, so i would be more insistent about going with medication.

And then there are things I see as a clinician, just in terms of a loss of a sense of humor, loss of the ability to lift your spirit in conversation, a kind of type of antidonian and pervasive loss of interest that I think is more part of a medical illness kind of depression, and I'll do my best to try to persuade the patient why I think their progress in therapy would be enhanced by taking medication in addition to psychotherapy.