PPRNet Clinical summary: Use of Anti-Depressant Medication May Slow the Response to Psychotherapy

Meta-analyses suggest that combining psychotherapy and antidepressant medications (ADM) is an effective way of treating depressive disorders. But it is unclear how ADM affects psychotherapy outcomes for patients. Many patients experience negative side effects from ADM (sexual problems, weight gain, emotional numbness). Emotional blunting may affect patients’ capacity to make the most of some psychological treatments. In this study, which utilized data collected within the Norwegian health system, Høstmælingen and colleagues examined 166 patients who received ADM plus psychotherapy (n = 84) or psychotherapy alone (n = 82). The main outcomes were depressive symptoms and interpersonal problems measured on multiple occasions during treatment, at post-treatment, and at 1-year follow-up. Interpersonal problems are an important outcome for depressed patients because they often have persistent relational difficulties that worsen their depressive symptoms. All patients received an average of 64.4 sessions (SD = 74.1) of open-ended non-manualized therapy from one of 52 therapists who had an average of 9 years (SD = 7.05) of experience. Treatment orientations varied, but most therapists endorsed a psychodynamic orientation. There were no differences between the ADM-plus-psychotherapy and the psychotherapy-alone groups at baseline when it came to depressive symptoms, interpersonal problems, or personality disorder diagnosis. The average patient in the study improved during treatment in depressive symptoms (Cohen’s d = 1.35) and interpersonal problems (d = .47), with a symptomatic remission rate (no longer meeting diagnostic criteria for depression) of 59%. Non-medicated psychotherapy patients exhibited greater progress in both depressive symptoms (y = .02, p = .008) and interpersonal problems (y = .01, p = .006) compared to those receiving ADM-plus-psychotherapy.

Practice Implications 

Patients who used antidepressant medications needed a longer time in treatment to achieve similar outcomes as nonmedicated patients for both depressive symptoms and interpersonal problems. It is possible that for patients who are engaged in psychotherapy that requires some emotional processing, ADM may blunt their emotional experiences, making it more difficult for them to benefit from the treatment. Long-term users of ADM may need more time in psychotherapy, calling into question the continued use of ADM after initial symptom reduction.

Høstmælingen, A., Nissen-Lie, H.A., Monsen, J.T., Heinonen, E., Wampold, B.E., Czajkowski, N., Visted, E., Lau, B., & Solbakken, O.A. (2025). Use of antidepressant medication is associated with slower response to open-ended psychotherapy for depressed patients. Frontiers in Psychiatry, 16:1503848. https://doi.org/10.3389/fpsyt.2025.1503848.