Psychotherapy affects depression differently than antidepressants

A personal exploration into the science behind antidepressants and CBT

Psychotherapy affects depression differently than antidepressants

Content warning: discussions of depression and suicide.

The first time I walked through the door of my psychiatrist’s office, I was full of doubt. I had been feeling low for quite a while, and I had trouble believing that any treatment would truly help me feel better.

I had just completed my second year of university, and I felt broken and exhausted. A blend of burning out, experiencing depressive episodes, disengaging from pastimes I used to enjoy, and fantasizing about dying drove me to seek treatment at U of T’s Health & Wellness Centre.

As part of my initial assessment, which occurred over the course of several sessions, my psychiatrist asked me questions about practically every aspect of my life: recent events, medical history, sleep patterns, appetite, suicidal ideations, and more. After considering all my symptoms, she prescribed me Prozac, an antidepressant medication, and recommended cognitive behavioural therapy (CBT). Both are common treatments for depression.

I gave them both a try. I was fortunate to be able to see a therapist for CBT, which was covered by my family’s health insurance. At first, I was skeptical that it would work, but I decided to commit myself to at least a few sessions.

CBT, as I learned, is a short-term form of psychotherapy that helps people build skills for staying healthy. In essence, it helps people identify, question, and change distorted thoughts and beliefs they might have about themselves and the world. By recording their thoughts during upsetting situations, people examine how their unhelpful thoughts might contribute to problems like depression.

Research on how CBT compares to antidepressants

Dr. Zindel Segal, a U of T psychology professor and an expert in CBT, said in an interview with me that “when people are in certain mood states, they tend to have thoughts that are very compatible with those mood states. So, when someone’s feeling depressed, they’re more likely to feel hopeless, judge themselves, and be very critical.”

According to Segal, CBT provides a way of treating people’s thoughts and assumptions as hypotheses that can be tested, rather than as hard facts. “That can help people alleviate the impact that some of these thinking styles can have on their moods,” he elaborated.

For me, CBT was extremely challenging more so than any math or biochemistry course I have ever taken. Perceptions are simply hard to change. At the time, for example, I felt incredibly worthless and undeserving of love. In the face of this, CBT helped me stay objective and not always accept my perceptions as truth. Psychotherapy made me stand back from my thinking to consider situations from different viewpoints.

“In the face of [critical challenges], CBT helped me stay objective and not always take my perceptions as truth.”

However, distorted thoughts and beliefs are often not the only culprits of depression. Much is still unknown about the causes of depression, but researchers suspect that chemical imbalances in the brain play a role in maintaining low moods. Antidepressant medications are designed to address these chemical imbalances by boosting concentrations of neurotransmitters namely serotonin and norepinephrine in the brain.

At first, I was very reluctant to try antidepressant medication because I was wary of possible side-effects. However, my psychiatrist assured me that the starting dose was low, that I would be closely monitored, and that we could always adjust my treatment if the medication was not right for me. In the end, I experienced only minor side-effects and really benefited from the resulting stability in my mood.

The differences between CBT and antidepressants

So, what are the differences between CBT and antidepressants in treating depression, according to experts? Researchers like Segal, who recently co-authored a paper comparing the efficacy of CBT versus antidepressants, are working hard to answer this question.

Segal’s research team found that CBT and antidepressants target different symptoms of depression. Antidepressants were found to be best for treating symptoms specifically related to depressed mood, feelings of guilt, suicidal thoughts, and psychic anxiety.

On the contrary, CBT and antidepressants were equally effective in treating patients who struggled with other specific symptoms of depression, like changes in sleep and appetite. “This paper tries to address more of a symptom-to-patient matching approach so that people are getting antidepressants if they have a symptom profile that might be more responsive to the drug,” said Segal.

In my case, CBT and antidepressants were temporary treatments that helped me bounce back from a bout of depression and develop long-term skills in staying healthy. Each treatment helped me in different ways: CBT helped me build emotional resilience, whereas antidepressant medication gave me the extra energy to ‘get back on my feet’ and return to doing the things I love to do.

But whichever treatment people are prescribed, Segal stressed that depression is treatable. “Whether you have hypertension or depression, it is possible to get treatment.”


If you or someone you know is in distress, you can call:

  • Canada Suicide Prevention Service phone available 24/7 at 1-833-456-4566
  • Good 2 Talk Student Helpline at 1-866-925-5454
  • Ontario Mental Health Helpline at 1-866-531-2600
  • Gerstein Centre Crisis Line at 416-929-5200
  • U of T Health & Wellness Centre at 416-978-8030.

Warning signs of suicide include:

  • Talking about wanting to die
  • Looking for a way to kill oneself
  • Talking about feeling hopeless or having no purpose
  • Talking about feeling trapped or being in unbearable pain
  • Talking about being a burden to others
  • Increasing use of alcohol or drugs
  • Acting anxious, agitated, or recklessly
  • Sleeping too little or too much
  • Withdrawing or feeling isolated
  • Showing rage or talking about seeking revenge
  • Displaying extreme mood swings

The more of these signs a person shows, the greater the risk. If you suspect someone you know may be contemplating suicide, you should talk to them, according to the Canadian Association for Suicide Prevention.

What does a scientist look like?

Seven U of T students discuss their passions and paths in science

What does a scientist look like?

W hat does a scientist look like? For many, the answer involves white lab coats, goggles, and beakers. Yet the people who pursue science are just as diverse as the field itself. Scientists can be activists, athletes, artists, or all of the above. Science can happen indoors or outdoors, under the night sky, or on the internet. Read about the journeys of seven student researchers at U of T.

ASHIMA KAURA/THE VARSITY

“As a little girl, I saw a shooting star, and that made the night sky my favourite view. I thought a lot about what was up there and how cool it would be to go to space. This led to my studying physics and astronomy in undergrad and I have never looked back since then.

I currently seek to understand the early universe and how it transitioned to the stars and galaxies we see today. Specifically, what happened in the [epoch] of re-ionization. The epoch of re-ionization is a period in the universe’s history over which the matter in the universe ionizes again.

[My dad] taught me always to strive for more, that there could always be a way if there is a will. He taught me to never give up and to always ask questions. My curiosity in life and career comes from him.”

— Margaret Ikape, first-year PhD in Astronomy and Astrophysics, email

ASHIMA KAURA/THE VARSITY

 “I have always been interested in science, but also equally interested in the arts. I went to an arts middle school and high school where half my day was spent doing art and not academics. I spend a lot of my time outside of school engaging in the arts. I still consider myself an artist as much as I consider myself a scientist. It took me a while to come to terms with the fact that I can [be] both.

When I decided I wanted to go to university, I chose to study science since I liked it and was good at it. Moving into my later years of my undergrad I found that I was drawn to ecology courses, field courses, and also really liked the people I met in those classes.

I am interested in the pollutants, that comes from roads, such as road salt, and how it impacts the animals that live in nearby streams. I also study other pollutants that come from roads, such as metals, polycyclic aromatic hydrocarbons, and small bits of car tires (tire dust).”

— Rachel Giles, first-year Master’s in Ecology and Evolutionary Biology, email

“Initially I had my heart set on being a professional dancer and veterinarian (a very practical dual career). Science had been my academic focus for some time, but it took several years after completing my BSc for me to realize that I passionately loved research and applying the scientific method to various questions of animal behaviour and cognition. I had this epiphany while I was juggling three jobs as a lab manager, veterinary assistant, and dog trainer. Out of all of those, I found research to be fulfilling and exciting and it was something I could see myself doing for the rest of my life.

I want to know how [dogs] perceive the world and how they process cues and information present in the environment. I am motivated by the hope that my research can possibly help change how people view dogs, give greater value to them through the recognition of their mental abilities and ultimately lead to greater wellbeing and better access rights in North America.”

— Julia Espinosa, second-year PhD in Cognitive Psychology, email

Julia Espinosa (left) and Madeline Pelgrim (right) work with dogs like Loki to determine animal behaviour. ASHIMA KAURA/THE VARSITY

“Julia Espinosa, the graduate student in my lab, has had the greatest influence on my career. She has been endlessly patient with me since we began working together in the fall of 2016, and has pushed me to advocate for myself and not be afraid to try something new. I would not be at this point in my career without her sage advice and constant confidence.

Like many other students, I had a bit of a rough transition into University in my first year. Adjusting to life away from home (my hometown is a 10 hour drive from Toronto) and everything that comes with living on your own for the first time caused my academics to suffer. When I first applied to join my lab, I was confident that I would not be accepted because of my marks. I am very thankful for my Principal Investigator — Dr. Buchsbaum — and the lab manager at the time — Kay Otsubo — for taking a chance on me and overlooking my performance first-year.”

— Madeline Pelgrim, fourth-year Bachelor’s in Psychology and Biology, email

ASHIMA KAURA/THE VARSITY

“There are definitely a lot of challenges throughout a PhD. I would say the biggest one for me were the mental challenges at the early stage of my PhD. How do I keep being confident in front of the language barrier, failure experiments, competitions, and where is my direction for the future? Having been through such a mental struggling stage, I am now clearer of myself, and ready for unknowns.

I always want to help bring positive impacts to our future world. I like the discovery and innovation side of research studies and its potential impact on our better world. My research is to design advanced photo-responsive nanomaterials that can store solar energy into chemical energy by catalyzing the conversion of greenhouse gas carbon dioxide to useful chemicals and fuels. It is a promising solution to reduce the usage of fossil fuels and global warming caused by greenhouse gas.”

— Yuchan Dong, fifth-year PhD in Materials Chemistry, email

ASHIMA KAURA/THE VARSITY

“As a child while it was true that I was always curious about nature and the world around us — Asking questions like why is the sky blue? How are clouds formed? etc. It was only when I got older and started to understand ‘what is science? what are scientists? How is science performed?’ that I gained a tremendous passion for it.

This notion that with a few chemical reactions, chemists can ‘creatively’ and rationally generate a molecule which when administered to human can halt disease progression, pain and even extend life — was a very powerful catalyst for my interest in medicinal chemistry. My work mainly focuses on the development of novel small-molecules that specifically target disease-causing cellular components which have been shown to cause certain cancers.

I think as with any budding student of science, whether in graduate studies, professional programs or even out in the workforce, the biggest challenge is to become comfortable with and know how to effectively deal with failure and hardship. As a scientist, at times we learn more from failed experiments than successful ones.”

— Yasir S. Raouf, third-year PhD in Organic and Biological Chemistry, email

ASHIMA KAURA/THE VARSITY

“I’ve been both playing sports competitively and going to school since I was six years old. Honestly, if I didn’t play water polo I don’t know what I would be doing in the evenings — I think I would just be sitting on my phone doing nothing. I love to represent Canada, and it’s a really exciting opportunity to do so on an international stage. Looking forward to the future, it would be an honour to represent Canada at the Olympic Games. U of T has opened so many doors for me, with research and athletics.

Initially I came to U of T and I wanted to do Genetics and Cell & Systems Biology — all that nitty gritty stuff. Then I took BIO230, and I was like this is not for me. I was trying to figure out a field where I could apply Life Science techniques, but without wet lab stuff. I had the opportunity to do an ROP [Research Opportunity Program] in Pascal Tyrrell’s lab — which is focused on medical imaging and statistics — and just fell in love with it.”

— Rachael Jaffe, third-year Bachelor’s in Global Health, Statistics, and Economics, spoken

UTSC researchers awarded NSERC instrumentation grants

Professors Ruby Sullan and Maithe Arruda-Carvalho will use the grants to accelerate their research

UTSC researchers awarded NSERC instrumentation grants

Each year, the Natural Sciences and Engineering Research Council of Canada (NSERC) awards Research Tools and Instruments (RTI) Grants to researchers who require specific tools to conduct their research.

Earlier in November, Professors Ruby Sullan and Maithe Arruda-Carvalho were awarded NSERC-RTI grants.

RTI grants are awarded based on the need for particular instruments, the merit of the research programs and applicants, and the contribution that the equipment will have on the training of research personnel, like students.

Ruby Sullan and biofilms

Sullan is a professor in the Department of Physical and Environmental Sciences at UTSC. Her research lies in understanding the stages of bacterial biofilm development.

Biofilms are a major reason for hospital-acquired infections because they easily form on the surfaces of biomedical and implanted devices, like catheters and intrauterine devices.

Sullan and her team hope to better understand major contributors of biofilm formation and ultimately encapsulate antimicrobial agents in nanoparticles that can target and eradicate the initial adhesions that cause the initiation and maturation of biofilms.

Her team will use the NSERC-RTI grant to install a Dynamic Light Scattering (DLS) system for biological chemistry studies.

According to Sullan, the DLS system is a particle analyzer and will be used to characterize nanoparticles for effective and targeted treatment of electrochemical sensor development against biofilms.

The DLS system can also be used to monitor the mechanisms and kinetics of protein aggregations. This can enable scientists to learn more about disease progression caused by protein aggregation, like neurodegenerative diseases.

Sullan also mentioned that the DLS system will be used by a number of other research groups, and it will be used to address a wide range of research questions and themes in biophysical research.

Maithe Arruda-Carvalho and brain development

Another recipient of an NSERC-RTI grant, Arruda-Carvalho works in the Department of Psychology at UTSC and is cross-appointed to the Department of Cell & Systems Biology at UTSG.

Arruda-Carvalho’s research is directed toward extending current knowledge about the maturation of neural networks, like emotional processing, that shape our complex behaviour and sensitivity to stress through to adulthood.

Carvalho and her research team are particularly interested in investigating how changes in brain development caused by early life experiences influence neural circuits and ultimately affect behaviour.

The onset of most mental illnesses first manifest during childhood and adolescence. This suggests the importance of proper brain development during these critical periods of life.

With the funding from the NSERC-RTI grant, Arruda-Carvalho and her lab will explore developmental windows during which critical neural connections of brain regions involved in decision making emerge and how they are fine-tuned with age.

Study shows angelfish can discriminate quantities

Scientists develop a novel method to study how fish ‘count’ when foraging

Study shows angelfish can discriminate quantities

The ability to discriminate between different quantities is not a skill unique to humans. Different animals, including fish, may possess the ability to count.

UTM Professor Robert Gerlai of the Department of Psychology contributed to a study that examines whether and, if so, how Pterophyllum scalare, otherwise known as angelfish, discriminate quantities while foraging.

Scientific literature on quantity discrimination in a foraging context has predominantly focused on mammals and birds. Several of these studies have shown that when animals are tested in laboratory conditions, they are sensitive to quantitative differences and often choose larger sets of food items over smaller sets.

Previous studies have shown that fish have the ability to distinguish between quantities of conspecifics, or members of their species. Angelfish are a social species, so there is an evolutionary benefit to being able to distinguish between sizes of groups. Choosing the larger group of fish, or shoal, offers better protection and reduces the risk of predation.

There is a literature gap in quantity discrimination experiments in fish with food as the discriminant. Fish, especially those that live in shoals, are often negatively affected when tested in complete isolation in a laboratory setting. In addition to the frightening test environment, other complications like uneven odour cues have prevented scientists from focusing on quantity discrimination in foraging contexts in fish.

Gerlai and his colleagues devised a novel methodology that allowed for angelfish to be tested individually while in a shoal, and therefore mitigated stress on the fish. Their new procedure also reduced other variables. For example, by presenting the stimuli outside of the aquarium, chemical and olfactory cues were excluded. This novel setup opens the way for developing more methods to accurately test numerical abilities in fish.

When quantity discrimination in a foraging context is tested in animals, often a binary choice test is given. This is a test in which two options are given to the animal and the choice the animal makes is observed. In the context of fish, a picture of a single item of food is shown on one side of the tank. On the opposite side of the tank, a picture of multiple items of food is shown. The side in which the fish spends the longest amount of time can be taken as the choice that animal has made.

There are two predominant theories that are said to explain how animals have the ability to count. The first is called the object file system, which allows animals to differentiate based on the number of elements, such as food items, in different groups — it is therefore thought to be more precise. The object file system of discrimination is said to be limited to small number of food items, with a maximum of four elements.

The second theory, known as the approximate number discrimination system, is used when larger sets of elements are presented. The approximate number discrimination system depends on ratios, not the absolute numerical differences between the number of elements compared.

In this study, Gerlai and his colleagues found a significant increase in accuracy in choosing the larger number of food items as the numerical ratio between the contrasting sets of food items increased. Overall, their results point to evidence that activation of the approximate number system was being used to discriminate.

Fish may not be solving complex math problems any time soon, but studying decision-making in this species when a binary choice test is given in a foraging context may help understand more complex behaviours.

Scientists are still left with several questions about the extent to which quantity discrimination in a foraging context is learned and if it is a result of evolutionary fine-tuning of neural circuitry.