title: Experiences of antidepressant medication and cognitive-behavioural therapy for depression: a grounded theory study.
abstract: OBJECTIVE
  To develop a preliminary model of the experiences of people undergoing combined treatment with antidepressant medication and cognitive-behavioural therapy (CBT) for depression.
  
  
  METHODS
  The study used a qualitative methodology informed by grounded theory.
  
  
  METHODS
  Participants were 12 adults who had received treatment with antidepressant medication and CBT for depression. Participants engaged in a semistructured interview about their experiences. Interviews were transcribed and analysed using components of grounded theory methodology.
  
  
  RESULTS
  Medication was often seen as an initial aid to surviving a crisis. Staying on medication longer term resulted in some participants feeling caught in a 'drug loop'. Feeling that medication was unhelpful or actively harmful could contribute to participants seeking CBT. Medics also offered information on CBT and acted as gatekeepers, meaning that negotiation was sometimes necessary. CBT was described as a process of being guided towards skilled self-management. Occasionally, participants felt that medication had facilitated CBT at one or more stages. Conversely, developing skilled self-management through CBT could reduce feelings of dependency on medication and affect several of the other elements maintaining the 'drug loop'.
  
  
  CONCLUSIONS
  Antidepressant medication and CBT are perceived and experienced differently, with CBT often being seen as an alternative to medication, or even as a means to discontinue medication. Service users' experiences and beliefs about medication may thus affect their engagement and goals in CBT, and it may be important for therapists to consider this.
  
  
  CONCLUSIONS
  Practitioners who prescribe medication should ensure that they also provide information on the availability and appropriateness of CBT, and engage in an open dialogue about treatment options. CBT practitioners should explore aspects of clients' experiences and beliefs about medication. This would particularly include clients' experiences of the effects of medication, their beliefs about dependency on medication, their relationships with prescribers, and their future wishes. Practitioners should consider advocating for clients or supporting them to behave more assertively with prescribers. All practitioners should ensure they have up-to-date knowledge of antidepressant medication.
authors.affiliation: Sussex Partnership NHS Foundation Trust, East Sussex, UK.
authors.forename: Paul
authors.initials: P
authors.lastname: Bayliss
authors.affiliation: Salomons Centre for Applied Psychology, Canterbury Christchurch University, Kent, UK.
authors.forename: Sue
authors.initials: S
authors.lastname: Holttum
mesh_terms: D000328:Adult; D000928:Antidepressive Agents / Q000627:therapeutic use*; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D003863:Depression / Q000188:drug therapy / Q000628:therapy*; D005260:Female; D066296:Grounded Theory; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D008875:Middle Aged; D036301:Qualitative Research; D055815:Young Adult
chemical_list: D000928:Antidepressive Agents
keywords: Cognitive-behavioural therapy; Depression; antidepressant medication; grounded theory