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The Arts in Psychotherapy 37 (2010) 387–390
Contents lists available at ScienceDirect
The Arts in Psychotherapy
Effects of music therapy on depression compared with psychotherapy
Sergio Castillo-Pérez, MDa,b, Virginia Gómez-Pérez, BPb, Minerva Calvillo Velasco, MScc,
Eduardo Pérez-Campos, PhDa,d, Miguel-Angel Mayoral, PhDa,e,∗
aMedical and Biological Research Center (CICIMEBIO), Benito Juarez Autonomous University of Oaxaca (UABJO),
School of Medicine, Carretera a San Felipe del agua SN, ex-Hacienda de Aguilera, C. P. 68020, Oaxaca, Oax., Mexico
bISSSTE (Social Security and Services Institute for Government Employees) Clinic-Hospital, Violetas #19,
Fraccionamiento Jardines del Sur, C. P. 69007, Heroica Ciudad de Huajuapan de Leon, Oaxaca, Mexico
cNeurodegenerative Diseases Experimental Laboratory, “Manuel Velasco Suarez” Neurology and Neurosurgery
National Institute (INNN), Insurgentes Sur #3877, Colonia La Fama, Delegación Tlalpan, C. P. 14269, Mexico City, Mexico
dThe “Dr. Eduardo Pérez Ortega” Clinical Pathology Laboratory, Zaragoza #213, Centro, C. P. 68000, Oaxaca, Oax., Mexico
eResearch and Diagnostic Support Center, HMCH Hospital, Eucaliptos #401, Colonia Reforma, C. P. 68050, Oaxaca, Oax., Mexico
article info
Keywords:
Depression
Music therapy
Psychotherapy
Randomized controlled trial
abstract
This paper reports a study testing the effects of music on depression and compares them with the effects
of psychotherapy. There are mainly three conventional treatments for depression: psychotherapy, phar-
maceutical treatments, and electroconvulsive therapy. Because conventional treatment has proven to be
poorly successful, new means of treatment must be found that might improve depression when used
together with other therapies. A randomized controlled clinical trial was performed with a convenience
sample of 79 patients aged 25–60 years with low- and medium-grade depression. The Zung Depression
Scale was employed for selection purposes. Patients were randomly assigned to the music-therapy group
(classical and baroque music) (n= 41), or the psychotherapy group based on conductive-behavioral ther-
apy (n= 38). The music therapy was applied for 50 min a day, every day, for eight weeks. At the end,
the music-therapy group had less depressive symptoms than the psychotherapy group, and this was
proven to be statistically significant with the Friedman test. We propose that patients with low- and
medium-grade depression can use music to enhance the effects of psychological support.
© 2010 Elsevier Inc. All rights reserved.
Introduction
In this changing world, increasingly severe changes are occur-
ring in the frequency and types of stressors which, combined
with certain personal vulnerabilities, are causing a general rise in
depressive symptoms. Depression is a chronic disorder that can
affect anyone of any age. Some risk factors are, family history of
depression, female gender, childhood abuse or neglect, stressful
life events, and chronic illness, which, if appearing, in child-
hood and adolescence, represent a risk for recurrent depressive
disorders in adulthood (Hankin, 2006). There are three main effec-
tive treatments for depression: drug treatment, psychotherapy,
and electroconvulsive therapy (Fountoulakis, Grunze, Panagiotis,
& Kaprinis, 2008). The common triggers of depressive episodes
include the following: divorce or separation from a romantic rela-
tionship, serious financial problems, physical disease, problems at
∗Corresponding author at: Eucaliptos 401, Colonia Reforma, C. P. 68050, Oaxaca,
Oax., Mexico. Tel.: +52 951 515 25 63; fax: +52 951 515 25 63.
E-mail addresses: mianmayo@prodigy.net.mx,mianmayo@yahoo.com
(M.-A. Mayoral).
home, being laid off, marital problems or problems in an affec-
tive relationship, conflicts or difficulties at work, and negative
events involving a close person, such as a relative or a close
friend. Pharmaceutical treatments for depression, using either tri-
cyclic antidepressants or selective serotonin reuptake inhibitors
(Ferguson et al., 2005), make no difference in the odds ratio of
suicide attempts. Music, on the other hand has been found to be
effective for several disorders, like the management of acute pain
(Koch, Kain, Ayoub, & Rosenbaum, 1998), cancer pain (Zimmerman,
Pozehi, Duncan, & Schmitz, 1989), and labor pain (Phunmdoung
& Good, 2003). This beneficial effect has been in part explained
by the response to music and the physiological connectivity of
the mesolimbic system, which provokes pleasurable experiences
(Menon & Levitin, 2005).
Music therapy is the planned use of music to achieve therapeu-
tic outcomes. In mental health services, music therapy is regularly
offered through group and individual programs following a pro-
cess of referral and assessment (Odell-Miller, 1995). Several studies
describe the effect of music on mental states; for example, Mozart’s
Sonata for two pianos in D major K. 448 has been largely associated
with the ‘Mozart effect’ condition, which has proven to enhance
brain capacity by activating several signal pathways (Jauˇ
sovec,
0197-4556/$ – see front matter © 2010 Elsevier Inc. All rights reserved.
doi:10.1016/j.aip.2010.07.001
388 S. Castillo-Pérez et al. / The Arts in Psychotherapy 37 (2010) 387–390
Table 1
Demographic characteristics of the subjects included in this study.
Group assignment
Variable MT (n= 41) PT (n= 38)
Gender Men Women Total Men Women Total
8 33 41 6 32 38
Age (years)
25–35 2 12 14 0 12 12
36–45 3 12 15 1 9 10
46–60 3 9 12 5 11 16
Educational level
<Bachelor’s 3 6 9 1 10 11
Bachelor’s 1 4 5 1 9 10
2–4 years in professional 4 17 21 4 13 17
>4 years in professional 2 4 6
Marital status
Married 3 18 21 5 20 25
Separated 0 0 0 0 4 4
Widow 1 2 3 0 2 2
Common-law marriage 5 6 11 0 4 4
Other (single) 5 5 1 2 3
Annual income ($, Mexican pesos)
<60,000.00 6 6 6 8 14
60,000.00–100,000.00 9 23 32 6 15 21
>100,000.00 3 3 1 1 2
MT, music therapy; PT, psychotherapy.
Jauˇ
sovec, & Gerlic, 2006). Bach’s Italian Concertos have demon-
strated their effectiveness in recovering memory in adults with
neurodegenerative disorders (Williamon & Valentine, 2002), and
Corelli’s Clavier Sonatas have been employed to enhance neu-
ronal development in premature babies (Aikman, Nolte, & Dorfling,
1997). In the same way, music could have beneficial effects on some
other neurological disorders like depression.
Few research studies have assessed the effects of music ther-
apy on depression. No adverse effects for music therapy have
been reported so far, whereas music therapy can indeed exert a
positive effect on mental health (Edwards, 2006). In one study,
adolescent women, randomly assigned to either massage or music
therapy treatment, were noted to have a reduction in right
frontal electroencephalography (EEG) scores after only 20 min of
music listening while behavior and self-evaluations of mood states
remained unchanged (Field et al., 1998). Moreover, music therapy
was used over a two-week period with patients with major depres-
sive disorders. Depressive scores for the music-listening group
were significantly reduced, as were their sub-scores of depression
in comparison with controls (Hsu & Lai, 2004). People with chronic
non-malignant pain exposed to music showed more power and less
pain, depression, and disability than the control groups (Siedliecki
& Good, 2006).We compared the effects of music therapy and psy-
chotherapy in a group of subjects with low and medium levels of
depression from the city of Huajuapan de Leon, Oaxaca, Mexico. Our
study is based on the fact that music can stimulate and activate
signal pathways, which can, in turn, modulate chemical media-
tors; thus, facilitating recovery from depression or diminishing its
symptoms.
Subjects and methods
Patients (n= 79) selected for the study were from a clinic-
hospital belonging to the ISSSTE (for its initials in Spanish: Institute
of Social Security and Services for Government employees) in
Huajuapan de León, Oaxaca, Mexico. Approval for the study was
obtained from the Institutional Review Boards for the Master’s in
Sciences Program of the School of Medicine and Surgery of the
UABJO (Benito Juarez Autonomous University of Oaxaca), Oaxaca,
Mexico. The study was also approved by the Ethics Committee of
the corresponding health care institution. During the initial inter-
views, potential recruits were given an oral description of the study
and, if interested in participating, they were given a copy of the
consent form to review together with the researcher, and had the
opportunity to ask questions. A signed consent form was obtained
from all participants, whether they agreed or not to participate
in the study; the data-collection instruments did not contain any
identifying data; and all results of this study are reported as sup-
plemental information.
An expert in psychology, with more than 10 years of experience
in the diagnosis of psychological disorders, identified all patients
to select only those with low and medium levels of depression.
Patients were included only if they were not on any drug therapy
or were not suffering from any other neurological pathologies or
disturbances that could pose a problem for treatment. Two ran-
domized groups were established: the music-therapy (MT, n= 41)
group and the psychotherapy (PT, n= 38) group. Data from both
groups are summarized in Table 1. Sociodemographic aspects, as
well as the history and intensity of current and past depressive
disorders, were evaluated during the interviews.
Psychological interview
The initial selection was performed by applying the Zung Self-
rated Depression Scale. We carefully monitored all patients to
detect any discomfort, stress, or unrest, and provided all necessary
attention and support. Every week, patients were evaluated using
the Beck Depression Inventory (Beck, Ward, Mendelson, Mock, &
Erbaugh, 1961). The Beck Inventory is self-rating and was used in
this study to evaluate the intensity of depressive symptoms based
on patient perception. We also made a final evaluation using the
Hamilton Depression Scale (Williams, 1988). The Hamilton Scale
was used in this study to quantitatively evaluate the depressive
symptoms. The Zung Scale and Beck Inventory were self-rating, and
a member of the research team applied the Hamilton Scale.
The improvement criteria in the Beck Depression Inventory
were measured by the total scores reported: 0–13 minimal depres-
sion, 14–19 mild depression, 20–28 moderate depression, and
29–63 severe depression. MT patients showed changes in their final
scores that suggested improvement. Higher total scores indicate
S. Castillo-Pérez et al. / The Arts in Psychotherapy 37 (2010) 387–390 389
Table 2
The progressive effect of music therapy or psychotherapy over eight weeks of treatment. MT patients show a decreased score on the Hamilton scale; when both groups were
compared via the Friedman test, the p-value was 0.0356, considered statistically significant.
MT PT
Session number Subjects without improvement Subjects with improvement Subjects without improvement Subjects with improvement
3rd 38 1 37 0
5th 34 3 27 3
7th 19 16 19 10
Final 4 29 16 12
MT, music therapy; PT, psychotherapy.
more severe depressive symptoms. The improvement criteria in
the Hamilton Depression Scale were measured by the total scores:
0–7, generally accepted to be within the normal range (or in clinical
remission); 20 or higher, moderate severity.
An expert psychologist at the health care center in Huajuapan
de Leon, Oaxaca, Mexico, provided psychotherapy through indi-
vidual sessions at the clinic. The psychotherapy method was of
the conductive-behavioral type and consisted of 30-min sessions
once a week. Evaluations were made weekly. As with the other
group, we carefully monitored all patients to detect any discom-
fort, stress or unrest, and provided all necessary attention and
support.
Music therapy
The therapist only monitored the development of the musical
session and took care that there were no factors of inconvenience
or stress. The music-therapy group was exposed to a selection of
baroque and classical music. Baroque (Johann Sebastian Bach’s Ital-
ian Concerto in F Major, BWV 780; Arcangelo Corelli’s Concerto
Grosso in D Major, Op. 6) and classical music (Wolfgang Amadeus
Mozart’s Sonata for Two Pianos in D Major, K. 448) were selected
according to some other studies on their beneficial neurobiological
effects. Music exposure was provided in single, self-administered
50-min sessions once a day at home, and one group session per
week at the hospital. Patients were provided with a comfortable
environment, with no distractions or stressful factors. The therapy
was given over eight consecutive weeks.
Data analysis
Data were entered into GraphPad Prism Version 5.0 for Win-
dows (GraphPad Software, San Diego, CA, USA). Friedman’s test was
used to test the research hypotheses.
Results
The sample (n= 79) consisted of 41 participants in the music-
therapy (MT) group, and 38 in the psychotherapy (PT) group.
Sample characteristics are summarized in Table 1. The sample
included 14 men and 65 women, ranging in age from 25 to 60
years, with a mean age of 42.5 years. The duration of depression
symptoms reported by the participants ranged from 6 months to 3
years, with a mean of 20 months. Of the 79 participants, 46 were
married, 15 had at least a high school education, and 20 reported
a family income of <60,000.00 Mexican pesos per year. A number
of patients (43/79) reported that the initial cause of their depres-
sion were unknown, and more than half (67/79) of them reported
that they had never received a depression-related diagnosis. Due
to cultural and social reasons, this type of population does not seek
care for what they consider to be emotional or psychological alter-
ations. They came to the psychology service for the first time and,
in this way, they were recruited. The reasons for consultation were
symptoms of fatigue, lack of self-esteem, sensation of emotional
discomfort. After the interview and careful physical and medical
examination, the diagnosis of depression was established. Of the
79 subjects, 67 answered that they did not know they were suf-
fering from depression, 5 understood that something was wrong,
although they had not thought to ask for help. Patients were mon-
itored weekly via application of the Beck Depression Inventory.
We found positive changes at the fourth session in the MT group,
with the participants showing improvement in their symptoms.
Between the seventh and eighth weekly sessions, we observed
improvement in 29 participants, with a lack of improvement in 4,
and 8 abandoned the MT group. In contrast, the PT group gave a final
result of 12 subjects showing improvement, 16 without improve-
ment, and 10 abandoned the study (Table 2).
When we compared the MT and PT groups with the Friedman
test, we found the p-value to be 0.0356, considered statistically
significant in favor of the music therapy treatment.
Discussion
Our results show a statistically significant effect for music, with
the music-therapy group revealing a better improvement in their
symptoms than the psychotherapy group. At the beginning of the
study, many of the chosen patients did not show a good disposi-
tion to listen to the music, but, later on, they not only proved to be
interested parties, but also asked for more music of this type. Sta-
tistical differences were found between both groups. Our findings
extend the knowledge derived from previous studies by showing
that Classical and Baroque music not only decrease the frequency
of depressive symptoms, but also stimulate beneficial feelings and
decrease levels of depression.
Music offers a simple and elegant way to treat anhedonia, the
loss of pleasure in daily activities. Music has been used to treat a
number of mental disorders including depression, schizophrenia,
and bipolar disorder. Musical stimuli, such as those used in the
present study, could be used to treat depression in conjunction with
other forms of therapy.
A number of neuropeptides, including dopamine, are involved
in producing the pleasurable sensations that enhance positive emo-
tions and diminish depressive states (Burgdorf & Panksepp, 2006).
Moreover, low levels of dopamine in the brain (Nestler et al., 2002)
and a low number of dopamine receptors (Gotlib, Joorman, Minor,
& Hallmayer, 2008) constitute two of the main causes of depres-
sion. Mozart’s music improves dopaminergic neurotransmission,
and regulates and/or affects various brain functions, and might,
therefore, be effective for eliminating symptoms in a number of
diseases that involve dopaminergic dysfunction (Sutoo & Akiyama,
2004), including depression. Depression is often accompanied by a
lack of interest in pleasurable stimuli. The hedonic aspect of reward
is thought to be modulated by endogenous opioid peptide trans-
mission within the nucleus accumbens, which, in turn, is known
to be regulated by dopaminergic input from the ventral tegmental
area (Kelley & Bridge, 2002). Music activates brain regions involved
in reward and emotion, and can provoke intensely pleasurable
responses in these areas (Blood & Zatorre, 2001). Music is clearly
390 S. Castillo-Pérez et al. / The Arts in Psychotherapy 37 (2010) 387–390
a means for increasing positive affect and, in this way, we come to
understand why it reduces depression.
Another fact about music is that it can activate several processes,
which facilitate brain development and/or plasticity. Depressive
disorders have a neurochemical basis and have been associated
with regional reductions in central nervous system volume, as well
as in the number and/or size of glia and neurons in discrete brain
areas (Manji, Drevets, & Charney, 2001). Experimental and clinical
studies have shown that signaling pathways involved in regulat-
ing cell survival and cell death are long-term targets for the action
of music. At this point, exposure to music enhances neurotrophins,
such as brain-derived neurotrophic factor (BDNF) and nerve growth
factor (NGF) production in the hypothalamus (Angelucci, Ricci,
Padua, Sabino, & Tonali, 2007). Mozart’s music has been proven
to enhance BDNF and its receptor, called TrkB (Chikahisa et al.,
2006), as well as synaptophysin expression (Rickard, Toukhsati, &
Field, 2005), syntaxin, and the anti-apoptotic Bcl2 protein (Alladi,
Roy, Singh, & Wadhwa, 2005). On the other hand, psychother-
apy improves post-treatment responses for depressed patients, but
benefits are not sustained at longer-term follow-up (Merry, 2008).
Because music can stimulate some brain areas strongly related with
reasoning and cognitive function, it not only reduces depression,
but can also repair neurodegenerative disturbances in brain cells by
anti-apoptotic and neurotrophic factor expression, thereby facili-
tating neurogenesis, regeneration, and repair of neurons (Fukui &
Toyoshima, 2008).
The major limitation in this study was the relatively small
sample size. However, the observed differences in depression
between the music-therapy group and the psychotherapy group
were strong. In addition, most participants in the MT group showed
less depressive symptoms than the PT group. Our results coincide
with other studies that reveal the use of music to assist patients in
relaxation. People who treat depressed patients could use music to
enhance the effects of decreased depression and disabilities, and
promote feelings of power.
Depression remains a major health problem and, despite using
pharmaceutical agents, patients continue to report high levels of
unrelieved depression. In conclusion, we consider that music is safe,
inexpensive, and easy to use for and by patients. Music alters a num-
ber of behavioral and disability patterns associated with depression
and self-administered music treatment can facilitate the decrease
of depressive symptoms. In addition, self-administered music ses-
sions allow patients the freedom to schedule their music therapy
at times when it is most convenient and, perhaps, at times when it
is most needed. Specific selections or types of music may have dif-
ferent effects on different people, and may provide different effects
for the same people at different times. Our results strongly suggest
that some Baroque music and the music of Mozart have conclusive
beneficial effects on depressed patients.
Acknowledgements
The authors would like to acknowledge the School of Medicine
and Surgery of the UABJO and to the Colegio of Oaxaca for their
partial financial support for this study, and to the ISSSTE Health Care
Center in Huajuapan de León, Oaxaca, for the facilities to perform
the study. We grateful acknowledge to Ms. Ingrid Mascher for their
appropriate criticism and editorial assistance.
References
Aikman, E., Nolte, A. G., & Dorfling, C. S. (1997). The effect of constant baroque music
on premature infants. Curationis,20, 17–20.
Alladi, P. A., Roy, T., Singh, N., & Wadhwa, S. (2005). Prenatal auditory enrichment
with species-specific calls and sitar music modulates expression of Bcl-2 and Bax
to alter programmed cell death in developing chick auditory nuclei. International
Journal of Developmental Neuroscience,23, 363–373.
Angelucci, F., Ricci, E., Padua, L., Sabino, A., & Tonali, P. A. (2007). Music expo-
sure differentially alters the levels of brain-derived neurotrophic factor and
nerve growth factor in the mouse hypothalamus. Neuroscience Letters,429, 152–
155.
Beck, A. T., Ward, C. H., Mendelson, M., Mock, J., & Erbaugh, J. (1961). An inventory
for measuring depression. Archives of General Psychiatry,4, 561–571.
Blood, A. J., & Zatorre, R. J. (2001). Intensely pleasure responses to music correlate
with activity in brain regions implicated in reward and emotion. Proceedings of
the National Academy of Sciences,98, 11818–11823.
Burgdorf, J., & Panksepp, J. (2006). The neurobiology of positive emotions. Neuro-
science & Biobehavioral Reviews,30, 173–187.
Chikahisa, S., Sei, H., Morishima, M., Sano, A., Kitaoka, K., Nakaya, Y., et al. (2006).
Exposure to music in the perinatal period enhances learning performance and
alters BDNF/TrkB signaling in mice as adults. Behavioural Brain Research,169,
312–319.
Edwards, J. (2006). Music therapy in the treatment and management of mental
disorders. Irish Journal of Psychological Medicine,23, 33–35.
Ferguson, D., Doucette, S., Glass, K. C., Shapiro, S., Healy, D., Hebert, P., et al.
(2005). Association between suicide attempts and selective serotonin reuptake
inhibitors: Systematic review of randomised controlled trials. British Medical
Journal,330, 1–7.
Field, T., Martinez, A., Nawrocki, T., Pickens, J., Fox, N., & Schanberg, S. (1998). Music
shifts frontal EEG in depressed adolescents. Adolescence,34, 529–534.
Fountoulakis, K. N., Grunze, H., Panagiotis, P., & Kaprinis, G. (2008). Treatment of
depression: An update. Journal of Affective Disorders,109, 21–34.
Fukui, H., & Toyoshima, K. (2008). Music facilitates the neurogenesis, regeneration
and repair of neurons. Medical Hypotheses,71, 765–769.
Gotlib, I. H., Joorman, J., Minor, K. L., & Hallmayer, J. (2008). HPA axis reactivity: A
mechanism underlying the association among 5-HTTLPR, stress, and depression.
Biological Psychiatry,63, 847–851.
Hankin, B. L. (2006). Adolescent depression: Description, causes and interventions.
Epilepsy & Behavior,8, 102–114.
Hsu, W., & Lai, H. (2004). Effects of music on major depression in psychiatric patients.
Archives of Psychiatric Nursing,18, 193–199.
Jauˇ
sovec, N., Jauˇ
sovec, K., & Gerlic, I. (2006). The influence of Mozart’s music on brain
activity in the process of learning. Clinical Neurophysiology,117, 2703–2714.
Kelley, A. E., & Bridge, K. C. (2002). The neuroscience of natural rewards: Relevance
to addictive drugs. The Journal of Neuroscience,22, 3306–3311.
Koch, M. E., Kain, Z. N., Ayoub, C., & Rosenbaum, S. H. (1998). The sedative and
analgesic sparing effects of music. Anesthesiology,89, 300–306.
Manji, H. K., Drevets, W. C., & Charney, D. S. (2001). The cellular neurobiology of
depression. Nature Medicine,7, 541–547.
Menon, V., & Levitin, D. J. (2005). The rewards of music listening: Response and
physiological connectivity of the mesolimbic system. Neuroimage,28, 175–184.
Merry, S. N. (2008). Psychotherapy for adolescents with depression: Initial but no
sustainable benefits. Evidence-Based Mental Health,11, 49.
Nestler, E. J., Barrot, M., DiLeone, R. J., Eisch, A. J., Gold, S. J., & Monteggia, L. M. (2002).
Neurobiology of depression. Neuron,34, 13–25.
Odell-Miller, H. (1995). Why provide music therapy in the community for adults
with mental health problems? British Journal of Music Therapy,9, 4–11.
Phunmdoung, S., & Good, M. (2003). Music reduces sensation and distress of labor
pain. Pain Management Nursing,4, 54–61.
Rickard, N. S., Toukhsati, S. R., & Field, S. E. (2005). The effect of music on cognitive
performance: Insight from neurobiological and animal studies. Behavioral and
Cognitive Neuroscience Reviews,4, 235–261.
Siedliecki, S. L., & Good, M. (2006). Effect of music on power, pain, depression and
disability. Journal of Advanced Nursing,54, 553–562.
Sutoo, D., & Akiyama, K. (2004). Music improves dopaminergic neurotransmission:
Demonstration based on the effect of music on blood pressure regulation. Brain
Research,1016, 255–262.
Williamon, A., & Valentine, E. (2002). The role of retrieval structures in memorizing
music. Cognitive Psychology,44, 1–32.
Williams, J. B. (1988). A structured interview guide for the Hamilton Depression
Rating Scale. Archives of General Psychiatry,45, 742–747.
Zimmerman, L., Pozehi, B., Duncan, K., & Schmitz, R. (1989). Effects of music in
patients who had chronic cancer pain. Western Journal of Nursing Research,11,
298–309.
