Treatment of Depressive Disorders: The Value of Psychotherapeutic Methods in Treating Depression

Abstract

The CME article is biased in its unilateral evaluation in favor of pharmacological therapy with antidepressants and at expense of psychotherapeutic therapeutic options. The stipulated division of therapy into phases thus implies a psychopharmacological approach; authors cite a publication that is 35 years old and published by pharmaceutical industry. The treatment setting that is discussed subsequently does include basic therapy provided by general practitioner, as well as psychiatric referral, but up to this point, no psychological or medical psychotherapists or psychosomatic specialists are mentioned. What follows is somewhat blurred, when an algorithm of whatever preference would be helpful here: in mild and moderate depressive disorders—the vast majority—the authors prefer monotherapy, whether as pharmacotherapy or psychotherapy; differential indication in authors’ view being availability of service provision and patient preference. Even psychosomatically oriented compendia (1) offer more helpful, more objective approaches. The decisive effective factor of specific psychotherapy (which includes both psychoanalytical and cognitive behavior therapies)—the therapeutic relationship (2)—is stripped of its value and misunderstood in its essence if authors stipulate conversation with an empathic and understanding physician, sensing the physician’s acceptance of his or her worries and fears and should feel relieved as a result of therapeutic interview as basis of depression treatment beyond specific psychotherapy. Outside setting of specific psychotherapy these are platitudes that every patient would desire and appreciate. A more honest title of article would have restricted itself to pharmacological therapy, as authors themselves do in their algorithm-based stepwise treatment regimen for depressive disorders; psychotherapy does not exist here. The opportunity was sadly missed, to provide a summarizing overview of psychotherapeutic approaches in depressive disorders and of their value and differential indications (as done in locations that are not always easily accessible[3]).