Psychotherapy Versus Medication for Unipolar Depression

D about outpatient treatment of unipolar depression is characterized by tensions between science and the marketplace and by ideological differences between and within the major mental health professions. Billions of dollars are spent annually on sales and marketing of antidepressant medications; the pharmaceutical industry also funds research, but it controls whether to submit results of funded clinical trials for publication. Funding for psychotherapy research and marketing is scant in comparison. Ideologically, psychiatrists overall are commonly viewed as major proponents of medication for depression, whereas psychologists are viewed as stronger advocates of psychotherapy. Even within psychiatry, however, the biological and psychoanalytic factions disagree as to the best treatment for depression; and within psychology, debate is under way about pursuing prescription privileges. In the competition to treat this illness, the stakes are high, not only in direct financial ways but also indirectly: when untreated, depression costs billions of dollars in lost productivity, and the cost in human suffering is immeasurably high. Because of these high stakes and the potential of marketing and ideological forces to control the debate, it is essential that clinicians be aware of the latest research findings comparing psychotherapy and medication treatment for depression, as well as combined treatments. The purpose of this columnthe first in a seriesis to provide an update on the latest research and thinking on this topic. I will summarize and comment on all the major review articles I could find that were published in this decade. ABSTRACTS