Mood disorders are mental health conditions including depression, bipolar disorder, and other variants of these disorders (1). They are among the most prevalent mental disorders in the world. According to the World Health Organization (WHO), over 300 million people suffered from depression in 2017. In 2015, 4.4% of the global population was suffering from depression and it was more common among females (5.1%) than males (3.6%). There was an increase in the number of people suffering from depression between 2005 and 2015 by 18.4% (2).

Depression is characterized by sadness, loss of interest and pleasure, feelings of guilt, feeling of worthlessness, low appetite, fatigue, and poor concentration. Consequently, emotional flattening is acknowledged, with hypo-mobile facies and reduction of body language (3). People with depression can also complain of physical symptoms without apparent physical causes. Depression can be long lasting or recurrent, affecting people's ability to work and cope with daily life. In its most severe form, depression can lead to suicide.

Bipolar disorder affects approximately 45 million people worldwide (4). It usually consists of both depressive and manic episodes, which have periods between them of normal moods. Manic episodes involve a high or irritable mood, over-work, fast speech, excessively high self-esteem, and a decreased need for sleep. People suffering from manic attacks without depressive episodes are also considered to have bipolar disorder.

Over 25% of all patients suffer from chronic depression and for most of them, major impairment in occupational and social functioning can be observed. Most of the depressive patients will experience recurrences after they recover (5).

The objective of treatment in acute cases is to lower the symptoms and provide relief. The result of treatment may be in the form of a response (visible improvement in the patient's condition) or remission (total or major absence of symptoms) (6).

Antidepressant medication should continue for 6 months in patients with remission, to avoid the risk of relapse (5).

Besides ADM, other therapeutic forms are used in the treatment of depression, cognitive-behavioral psychotherapy (CBT) being often associated with the medication.

According to several imagistic studies some brain mechanisms are modified in depression:

Changes in amygdala volume and activity have been observed in depressed subjects in various studies. The processing of emotion has been influenced this way and the emotional associations in memory were changed by influencing the hippocampus (5).

Changes in the prefrontal cortex (decreasing the prefrontal control). fMRI studies suggest that depressed individuals have a decreased prefrontal activity compared with healthy individuals (8-10).

Some studies have analyzed and discussed ADM, as well as CBT, and concluded that CBT is as effective as ADM, but the effects of CBT are more lasting. However, CBT and ADM act by the same mechanisms in the same order for a relief of the acute stress associated with depression (5).

Eight studies were analyzed and the results are summarized in Table I. All studies investigated the effects of ADM and CBT, but each study started with specific assumptions. However, the results of the studies reach similar conclusions, suggesting that both ADM and CBT have consistent effects in the treatment of depression.

The analysis of the two methods of treating depression (ADM and CBT) followed different studies, which observed and compared the results of each treatment modality or both on depressive patients. Probably the general conclusion would be that the most effective intervention in depression is a mixed one, using both ADM and CBT.

Studies in recent decades have led to the development and testing of new treatments that work best in treating depression. Studies in the field of neuroscience can improve the ability to match patients with the most effective treatments for them. The correlation between ADM and CBT should include, in addition to neuroimaging studies, assessments of other fundamental aspects that influence the onset and maintenance of depression, so that an association and an integrative view can be achieved on the symptom, imaging, cognitive and genetic elements, and the patient's history together with the results of the psychotherapeutic or drug intervention (5).

However, in this study we have to consider several important limitations and observations:

Depression was evaluated with different instruments and the results of the measurements were different according to the specificity of these scales [e.g., Hamilton Depression Rating Scale (HDRS); Beck Depression Inventory (BDI)]. These differences influenced the statistical analysis and result in the studied samples.

The study samples were from different cultures (e.g., refugees from different countries; different religions) and this influenced their visions on life and the stressful or depressing events.

The cultural differences influenced the way CBT was perceived. In this case, psychoeducation could be a good start.

Therapeutic compliance is of major importance both in ADM and CBT.

The mentioned studies have significant implications in the research on the pathophysiology of chronic forms of major depression and the treatment of chronic depression. The response to CBT and ADM in the treatment of depression may differ depending on the presence or absence of early trauma, which shows the importance of the patient's history since childhood (18,19).

The vast majority of the findings still have the same direction: The most effective intervention in depression is a mixed one, using both ADM and CBT.