EFFICACY OF ANTIDEPRESSANTS VS. COGNITIVE BEHAVIORAL THERAPY. A QUALITATIVE STUDY FROM QUETTA PAKISTAN

Background: Depression is a growing public health concern in Pakistan, including Quetta, where access, stigma, and resource constraints shape treatment choices. Although antidepressant medication and cognitive behavioral therapy (CBT) are both evidence-based treatments, little is known about how their perceived efficacy compares within this cultural context. Methods: This qualitative, phenomenological study explored lived experiences of individuals receiving either antidepressants or CBT for depression in Quetta. Using purposive sampling, we conducted semi-structured interviews with eight patients (four on antidepressants, four in CBT), two psychiatrists, and two clinical psychologists. Interviews were conducted in Urdu and Pashto, recorded with consent, translated into English, and analyzed using thematic analysis (Braun & Clarke, 2006) with NVivo support. Results: Four themes emerged. (1) Speed of relief: Antidepressants were associated with faster symptom reduction (typically within weeks), but several patients reported emotional “numbness.” CBT participants described slower but deeper, more enduring improvements. (2) Understanding and empowerment: CBT fostered insight, self-efficacy, and practical coping skills; medications were sometimes viewed as suppressing rather than resolving problems. (3) Side effects and dependency concerns: Antidepressant users frequently cited drowsiness, weight gain, and fears of long-term reliance; CBT participants reported minimal adverse effects. (4) Cultural acceptance and stigma: Psychiatric medication was often stigmatized; framing CBT as “counseling” reduced resistance, particularly among younger patients. Clinicians endorsed integrated care combining pharmacotherapy with CBT especially for moderate to severe depression, but noted the scarcity of trained therapists and systemic barriers. Conclusion: In Quetta, perceived treatment efficacy reflects not only symptom change but also cultural fit, autonomy, and side-effect burden. Antidepressants offer rapid relief, whereas CBT equips patients with durable skills and a sense of control. Scaling culturally sensitive, integrated models, expanding CBT training, and strengthening public mental health literacy are critical to improving depression care in Pakistan. This study provides context-specific insights to guide clinicians, policymakers, and researchers toward more patient-centered, holistic mental health services.