Contradictions, methodological flaws, and potential for misinterpretations in ranking treatments of depression.

Abstract

In this journal Malhi et al. recommended cognitive-behavior therapy (CBT), antidepressants, and counseling ahead of short-term psychodynamic therapy (STPP) referring to UK NICE guidelines for depression. However, these recommendations continue the ambiguous and therefore confusing NICE guidelines, which on the one hand list the above treatments as equal options as first-line treatment for depression and emphasizes the importance of patient preference and implementations factors, but on the other hand rank these first-line treatments, implying superiority of some treatments over others. Furthermore, we highlight several methodological flaws of the NICE treatment ranking and that the NICE treatment ranking is not justified by NICE's own and independent evidence and criteria. Presently it is not clear which patients benefit from which empirically-supported treatment. Thus, we continue to discourage the devaluing of efficacious treatments so that as many patients as possible may benefit from them.