THE ROLE OF PSYCHOTHERAPY IN THE TREATMENT OF DEPRESSION - REVIEW OF 2 PRACTICE GUIDELINES

We review two recent practice guidelines' assessments of the role of p sychotherapy in the treatment of major depression in adults. We examin e the practice guideline published by the American Psychiatric Associa tion (APA) and that published by the Depression Guideline Panel of the Agency for Health Care Policy and Research. We focus on the guideline s' evaluations of psychotherapies, their statements about the role of psychotherapy in first-line treatment of depression, and the procedure s they recommend for choosing among psychotherapies. We argue that the APA guideline understates the value of cognitive, behavioral, brief p sychodynamic, and group therapies. Both guidelines understate the valu e of psychotherapy alone in the treatment of more severely depressed o utpatients. The APA guideline overvalues the role of combined psyche t herapy-pharmacotherapy regimens, particularly in view of the greater c ost of this strategy. The APA guideline also makes recommendations abo ut choosing among psychotherapies that are not well supported by empir ical evidence. We conclude with some guidelines for guideline developm ent.