Does the brain behave differently during talking therapies? A narrative integrative review of neural responses in depression

Applied psychotherapy or talking therapies and antidepressant medication are both used in treatment of Major Depressive Disorder (MDD, depression) within the counselling and psychiatric practices. This narrative integrative review aims to investigate the neural changes during talking therapies using brain metabolism results from comparative neuroimaging across a positron emission tomography (PET), single photon emission computed tomography (SPECT), and functional magnetic resonance imaging (fMRI). Cognitive-behavioural therapy, interpersonal therapy and psychodynamic therapy neurobiological responses were compared to those of antidepressant medication. It is known that talking therapies operate by brain-based metabolic mechanics and alter neurotransmitter in a manner very similar to antidepressant medication. Behavioural Activation therapy was briefly examined as a medication-free option consideration within the cognitive-behavioural domain. Literature recommends antidepressants for people with hypoactivated orbitofrontal areas, while hyperactivated prefrontal areas are considered to respond best to talking therapies. Qualitative research, statistical power and human studies remain as limitations to both talking therapies and antidepressants making suggestions to further examination of the bi-directional flow of MDD symptomatology. Further studies into the neurobiology of talking therapies for improved psychiatric and counselling decision-making processes, are recommended.