Talk Therapy vs. Drugs

Two different kinds of treatment, drugs and cognitive behavioral therapy, combat depression but affect different parts of the brain.

By Hara Estroff Marano, published on February 1, 2004 - last reviewed on November 20, 2015

Talk therapy and drug therapy both combat major depression, but an imaging study shows that the two treatments have distinctly different
effects on specific parts of the brain.

Cognitive behavioral therapy (CBT) changes metabolic activity in
the cortex, the thinking brain, to modulate mood states. It works from
the top down, altering how people monitor and react to negative emotional
stimuli in their environment. Drugs, by contrast, work from the bottom
up, modulating neurotransmitters in the brainstem, which drive basic
emotional behaviors.

Reporting in the Archives of General Psychiatry, neurologist Helen
Mayberg and colleagues at the University of Toronto found that the unique
metabolic changes produced by CBT in the cortex reflect newly learned
ability to detect troubling emotional stimuli and to keep them out of
working memory, where they get amplified by rumination. Such changes may
make a relapse of depression far less likely.

The effects produced by both types of therapy point to a larger,
complex circuit of depression in the brain. "Our imaging study shows that
you can correct the depression network along a variety of pathways," says
Mayberg. "Drugs change the chemical balance in the brain through effects
at very specific target sites. Cognitive therapy is tapping into a
different part of the same depression circuit board."

To learn more about cognitive behavioral therapy and other therapeutic approaches, visit Psychology Today's Therapy Center.