Los Angeles, London, New Delhi, and Singapore (6 May, 2008) A new revision of clinical guidelines to help doctors manage patients with depression has challenged the rationale behind the UK governments policy of rolling out of cognitive behavioural therapy (CBT) for milder depression.
According to a comprehensive review of treatments for depression, there is a lack of evidence for CBT being more helpful than other forms of psychological support in mild depression or for its efficacy in severe depression. There is also good evidence for antidepressants being effective in depression, with benefit increasing the more severe the depression. This is contrary to recent reports that antidepressants dont work except in the most severe depression.
Dr Ian Anderson, Senior Lecturer and Honorary Consultant Psychiatrist, Neuroscience and Psychiatry Unit, University of Manchester, UK, says the cost effectiveness of CBT should be thoroughly investigated before it is adopted more widely because it is likely to be offered to people with milder depression where the evidence is poorest.
There is often not a level playing field in considering evidence for drugs versus psychological treatment, especially in milder depression, Dr Anderson explains, adding that specific psychological treatments are relatively expensive compared to drug treatments because treatment involves training of the therapists as well as the costs of administering the intervention.
To measure the effectiveness of these treatments requires comparison against appropriate control treatment like non-specific supportive treatment in the same way drugs are compared against placebo, says Dr Anderson. This is important given the rolling out of CBT for milder depression probably less expensive means of support are more cost-effective.
This conclusion is just one of the issues to emerge from a comprehensive review of the evidence for various forms of management of depressi
|Contact: Mithu Mukherjee|
SAGE Publications UK