If you have depression, you (or your doctor) may think of therapy and antidepressant drugs as alternative treatments that solve the same problem. But a new study supports the idea that each works a different way in the brain.
Photo by Neil Conway.
The analysis, published in Brain Imaging and Behaviour, reviewed brain function studies of drugs (mostly Prozac and other SSRIs) and talk therapy, mainly cognitive behavioural therapy. Here is how Science of Us summed up the results:
Drug treatments tended to be associated with increases in brain activity in the limbic system and other sub-cortical structures, including in the insula. These areas are broadly associated with emotional processing, and the insula in particular is involved in representing our internal bodily states. [Cognitive psychologist Maddalena] Boccia and her colleagues characterised these therapeutic effects as “bottom up”
In contrast, psychotherapy appeared to lead to changes to activation patterns in parts of the frontal cortex and temporal cortex — brain areas known to be associated with thinking about ourselves and to storing and processing memories. The researchers characterised these effects as “top down”, related to how we interpret the world and our place in it, which makes sense given that a major goal of CBT is to alter unhelpful thinking habits.
If the two treatments work differently, that may mean they complement each other when used together — so the answer to which is best may be “Why not both?”