Comparative Effectiveness of Cognitive Behavioural Therapy and Pharmacotherapy on Functional Recovery and Relapse Among Young Adults in Pakistan in a Quasi Experimental Study

Background Psychological distress among young adults represents a significant public health challenge in low- and middle-income countries (LMICs), including Pakistan, where access to sustained mental healthcare remains limited. Although Cognitive Behavioural Therapy (CBT) and pharmacotherapy are widely used, evidence comparing their real-world effectiveness in resource-constrained settings is scarce. Methods This quasi-experimental comparative effectiveness study included 220 young adults (18–35 years) diagnosed with moderate psychological distress and receiving routine care in Peshawar, Pakistan. Participants were allocated to CBT (n = 110) or pharmacotherapy (n = 110) through standard clinical pathways. CBT was delivered in weekly 60-minute sessions for 12 weeks, while pharmacotherapy involved selective serotonin reuptake inhibitors under psychiatric supervision. Outcomes included functional recovery (GAF), symptom severity (DASS-21), sleep quality (PSQI), physical activity, relapse at 3-month follow-up, and peripheral serum dopamine measured using fasting morning ELISA assays. Analyses included within- and between-group comparisons with effect sizes and relative risk estimates. Results Both treatments were associated with statistically significant improvements in psychological symptoms and functional outcomes (p < .001). Greater mean improvements in health status, physical activity, and lower relapse incidence were observed in the CBT group (7.3%) compared with pharmacotherapy (19.1%; RR = 0.38, 95% CI: 0.18–0.79). Peripheral dopamine levels increased in both groups, with modestly larger changes in the CBT arm. Gender-stratified analyses showed broadly similar symptom reductions across males and females. Conclusion Under routine clinical conditions, CBT was associated with larger functional gains and lower short-term relapse rates compared with pharmacotherapy. Findings support strengthening access to structured psychological interventions within LMIC mental health systems.