Those suffering from severe depression, which the Centers for Disease Control and Prevention estimates is one in 10 adults in the United States, may not be a stranger to antidepressants. What they may be unfamiliar with is the concept their prescription is more effective when paired with cognitive therapy.

As described by the National Alliance on Mental Illness, cognitive therapy is a form of treatment that focuses on the kind of thinking that leads to self-destructive behavior. And a study published in JAMA Psychiatry finds this particular therapy is an important part of the treatment equation.

Study authors worked with 452 outpatients with chronic or recurrent major depressive disorder (MDD), treating half with antidepressants and the other half with antidepressants and therapy over the course of three and a half years. The objective was to treat patients until they were in recovery, or going 26 consecutive weeks without a relapse in symptoms.

The results showed that the combined treatment improved rates of recovery (73 percent) compared to antidepressants-only (63 percent). However, authors noted the impact of this treatment was noticeably different in those with severe MDD. Recovery rates weren’t much different in patients with less severe MDD.

"Our findings suggest that CT engages different mechanisms than ADM but that it likely does so only in some patients,” Dr. Steven Hollon, lead study author of Vanderbilt University in Nashville, Tenn., said in a press release. “Identifying these mechanisms may suggest ways to enhance treatment response. Future combinatorial trials should include comparisons with CT alone to examine the viability of each monotherapy, especially given evidence that CT effects persist beyond the end of treatment."

Hollon’s findings come on the heels of a previous study that found depression treatments are more effective when they focus on the brain more so than a chemical imbalance (the purpose of antidepressants) — specifically, treatments that focus on reducing chronic stress, a condition thought to be a leading cause of depression. The researchers wrote that when stress is maintained for a long period of time, both the brain and body are harmed.

Similarly, research out of the University of Washington found women who received collaborative care, or counseling that focuses on patient engagement, for depression, experienced a 50 percent decrease after just one year. “Collaborative care benefits the community not only by helping women with depression regain function in their lives, but also by lowering health care costs,” Dr. Susan Reed, a professor of obstetrics and gynecology at UW and director of women’s health at Harborview Medical Center, said in a press release.

The theme of cognitive therapy and collaborative care is greater patient care, really taking the time to work through the thought processes and outside risk factors in order to arrive at an effective treatment. The women participating in Reed's study told her they felt it was the first time anyone cared about their mental health.

No, there isn't a universal approach to treating severe depression. But there are so many health care professionals to choose from that it's worth taking the time to meet with more than one. Finding the right psychiatrist, counselor, and/or therapist to work with, who will recommend a variety of treatments, regardless if they're in combination with another or not, makes all the difference.