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According to a new study, if provided by experienced psychotherapists, cognitive therapy may be as effective as antidepressant drugs in initial treatment of moderate to severe depression.

The study included 240 people with moderate to severe depression. One group of 60 people received cognitive therapy, another group of 120 received an antidepressant drug (usually Paxil) and a third group of 60 received a placebo pill. The researchers said the patients in the cognitive therapy group attended two 50-minute sessions a week for the middle eight weeks and one session a week for the final four weeks of the study.

After eight weeks of treatment, response rates were 50 percent in the medication group, 43 percent in the cognitive group therapy and 25 percent in the placebo group. After 16 weeks of treatment, response rates were 58 percent for patients receiving either medication or cognitive therapy. Remission rates for patients receiving medication were 46 percent and for cognitive therapy groups they were 40 percent, indicating the effects of cognitive therapy might also last longer.

Refuting what the current American Psychiatric Association guidelines say, that “most moderately and severely depressed patients will require medication,” the study authors said it appears cognitive therapy with experienced cognitive therapists can be as effective as medications, even among more severely depressed outpatients.

Lead researchers Robert DeRubeis, a Penn psychologist, and Steven Hollon at Vanderbilt argued the American Psychiatric Association should change its treatment guidelines for moderate to severe depression, which currently call for antidepressants as the first-line treatment. Some experts think that unlike antidepressant drugs, the cognitive approach teaches patients to practice thinking about their ideas and how realistic they are, which provides the patients with skills to manage their lives better.

More experts and patients are concerned with the over-reliance on prescription drugs, especially given the deadly effects some drugs are associated to. Paxil has been the target of growing complaints and lawsuits, including its severe withdrawal effects. Last May, Paxil was one of ten antidepressant drugs whose manufacturers wrote notices to doctors informing them that patients “may experience worsening of their depression and/or the emergence of suicidal ideation and behavior.”

New York State Attorney General Eliot Spitzer filed court briefings against Paxil maker GlaxoSmithKline, stating the company deceived, defrauded and damaged the public with Paxil “by concealing critically important scientific studies on Paxil.” Because of withheld information, Spitzer said doctors’ decisions were impaired, exposing patients to risk of jeopardized healthcare. Spitzer made claims that four Paxil studies were suppressed, charging the company was part of a “dangerous industry practice”.

Despite any safety debates regarding Paxil and other antidepressant drugs, any depression treatment guideline changes are unlikely to happen soon, according to Dr. Laura Fochtmann, the guideline’s medical editor. The last time the guidelines were revised was in 2000 after a two-year process involving the analysis of all the available research. According to Fochtmann, revisions every time a new study comes cannot be made. Though many people continue to be wary of antidepressants, the use of prescription drugs is much more widely available and easier for many patients than cognitive therapy.