Patients treated to remission with cognitive therapy are less than half as likely to relapse following treatment termination as patients treated to remission with antidepressant medications. What remains unclear is whether cognitive therapy truly is enduring or antidepressant medications iatrogenic in terms of prolonging the life of the underlying episode. Depression is an inherently temporal phenomenon and most episodes will remit spontaneously even in the absence of treatment. There is reason to believe that depression is an adaptation that evolved because it keeps organisms focused on (ruminating about) complex social issues until they can be resolved and that medications work not so much by addressing a nonexistent deficit in neurotransmitters in the synapse as by perturbing underlying regulatory mechanisms to the point that they reassert homeostatic control over those systems. If the latter is true then medications may work to suppress symptoms in a manner that leaves the underlying episode unaddressed and patients at elevated risk of relapse whenever they are taken away. Cognitive therapy is predicated on the notion that people become depressed because they misinterpret life events in a negative fashion and that helping them examine the accuracy of their beliefs will relieve their distress. Such an approach would not work if patients were not capable of thinking clearly (if their "brains were broken") and it is likely that cognitive therapy works by making rumination more efficient so as to facilitate the resolution of the complex social issue(s) that brought the episode about. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

中文翻译：

---

认知疗法是否持久或抗抑郁药物是医源性的？抑郁症是一种进化的适应。

接受认知疗法缓解的患者在治疗终止后复发的可能性不到接受抗抑郁药物治疗缓解的患者的一半。尚不清楚的是，就延长潜在发作的寿命而言，认知疗法是否真的是持久的或抗抑郁药物是医源性的。抑郁症是一种固有的时间现象，即使在没有治疗的情况下，大多数发作也会自发缓解。有理由相信抑郁症是一种进化的适应，因为它让生物体专注于（沉思）复杂的社会问题，直到它们得到解决，药物的作用与其说是解决突触中不存在的神经递质缺陷，不如说是通过扰动潜在的监管机制，以至于他们重新主张对这些系统的稳态控制。如果后者是真的，那么药物可能会以某种方式抑制症状，从而使潜在的发作得不到解决，并且患者在被带走时复发的风险增加。认知疗法基于这样一种观念，即人们之所以变得抑郁，是因为他们以消极的方式误解了生活事件，帮助他们检查信念的准确性将减轻他们的痛苦。如果患者不能清晰地思考（如果他们的“脑子坏了”），那么这种方法就行不通了，而且认知疗法很可能通过使反刍更有效来促进复杂的社会问题的解决而起作用这带来了这一集。（PsycInfo 数据库记录 (c) 2020 APA，保留所有权利）。