When should psychotherapy be the treatment of choice for major depressive disorder?
Clinicians should think carefully before deciding on the initial treatment for a patient with major depressive disorder. The author argues that this does not happen often enough, and that psychotherapy may be overlooked too often as a first treatment option. Based on the research literature and the American Psychiatric Association Practice Guidelines, this article reviews potential cautions and relative indications for initiating treatment with evidence-based psychotherapies for major depressive disorder. Potential indications include 1) patient preference; 2) symptom severity; 3) relative contraindications to pharmacotherapy; 4) prior treatment history; 5) nature of symptoms; 6) psychosocial context, including a life crisis or complicated bereavement; 7) control and credit; and 8) new and enduring skills.
Markowitz
John C
JC
New York State Psychiatric Institute, 1051 Riverside Drive, Unit #129, New York, NY 10032, USA. jcm42@columbia.edu
D000928:Antidepressive Agents / Q000627:therapeutic use; D015928:Cognitive Behavioral Therapy; D003131:Combined Modality Therapy; D015897:Comorbidity; D003865:Major Depressive Disorder / Q000175:diagnosis / Q000523:psychology / Q000628:therapy*; D019317:Evidence-Based Medicine; D006801:Humans; D008016:Life Change Events; D010043:Outcome and Process Assessment, Health Care; D010554:Personality Disorders / Q000175:diagnosis / Q000523:psychology / Q000628:therapy; D010698:Phobic Disorders / Q000175:diagnosis / Q000523:psychology / Q000628:therapy; D017410:Practice Guidelines as Topic; D011613:Psychotherapy; D055502:Secondary Prevention; D016896:Treatment Outcome
D000928:Antidepressive Agents