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Let's get real on depression

From Dr Mary Taylor

Craigston, Aberdeenshire

I have been following your articles and letters concerning CBT with great interest. I fear we are being led up the garden path by the evidence base, and are in danger of making serious errors of judgment in what is necessary and cost-effective for the treatment of mild to moderate depression.

I have been a GP for 25 years and recently completed the diploma course in cognitive and behavioural psychotherapy at the University of Dundee. I learned a great deal about when and where CBT could be useful.

Far from it being the treatment of choice for all patients with depression, I think CBT is a very useful and effective treatment for some. The statistics show CBT is equally effective as SSRIs for mild to moderate depression. The combination of both seems to be even better statistically.

There are several variables that must also be factored in to the equation. The diagnosis must be fairly certain, the patient must engage with this type of therapy, and the quality of the therapist is of great importance.

The claims for CBT as the 'magic' answer to treating depressed patients are obviously flawed. The necessity for training 10,000 CBT therapists has been promoted as a serious option.

I think this is a figment of someone's fertile imagination.

We are faced in general practice with many unhappy people, some with very difficult life situations, and some with clinical depression.

Having 'someone with time' to unravel what the underlying problem is, and then to decide what treatment, if any, is appropriate, is the first step. Then the decision to treat or not with antidepressants, and whether CBT would be appropriate, should be made.

SSRI drugs are effective for people with clinical depression. CBT for 10 to 15 sessions is also effective, but only if suitable patients are selected, and a skilled therapist available.

Like all things in medicine, there is usually not one correct answer, and different therapies work for different people.

Instead of sweeping generalisations, let's get real when discussing the treatment of depression.

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