The treatment of unipolar major depression: pharmacotherapy, cognitive behaviour therapy or both?

There is no clear-cut line separating normal and abnormal moods. Therefore, psychiatrists often describe patterns of symptoms (syndromes) to suggest t he existence of diseases for which no obvious brain abnormalities can be de monstrated. These uncertainties create room for much doubt about the best w ay of treating unipolar major depression. I present here a case report of a patient with unipolar depression treated with cognitive therapy. The patie nt had been treated with an SSRI and a tricyclic antidepressant without sub stantial improvement. This case is discussed in the light of the current co ntroversies in the literature concerning the comparative value of psychothe rapy, particularly that designed to treat depression, and pharmacotherapy. We would suggest that cognitive therapy, as well as other depression-specif ic short psychotherapies, is the treatment of choice in milder depressions. However, there is evidence to support the widespread clinical impression t hat combined therapy with both psychotherapy and pharmacotherapy is superio r to each single mode of therapy for the treatment of more severe, recurren t depressions.