Defeating Depression: The Healing Power of the Therapeutic Relationship.

Abstract

Major depressive disorder is common, affecting about 7% of the population at any given time and with an estimated lifetime prevalence of 16.2%. Onset is often during adolescence, with young adults and females most commonly affected. The course is often one of a chronic pattern of recurrence. The disorder has underpinnings in family genetic history and neurobiological changes (1, 2). The cost of depression for the individual, family, and society is enormous—estimated at $83.1 billion in the United States in 2000 (3). Investigators have demonstrated that the therapeutic alliance, the collaborative bond between clinician and patient, is a potent factor in determining a positive response to the treatment of depression. This has been found to be true for specific psychotherapies as well as across theoretically and technically different psychotherapies, pharmacotherapy, or both (4–9). This strong relationship suggests that a positive rapport confers healing qualities, and without this rapport, even pharmacotherapy is less effective (4). A positive doctor-patient relationship has also been shown to improve treatment adherence. This is particularly salient in the treatment of major depressive disorder. Guidelines set forth by the American Psychiatric Association and the Agency for Health Care Policy and Research recommend continued treatment with antidepressants for at least four to nine months after depressive symptoms resolve to prevent relapse (10, 11). Despite these guidelines, up to 68% of patients have been reported to discontinue antidepressantmedicationwithin threemonths of starting treatment. More frequent visits and higher quality of the doctor-patient relationship may improve longer-term adherence, thus improving prognosis. Effective physician-patient communication that included a frank discussion about adverse medication effects throughout treatment decreased the likelihood that medication was prematurely discontinued (12–14). Building Rapport With Depressed Individuals