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 the existence of diseases for which no obvious brain abnormalities can be demonstrated. These uncertainties create room for much doubt about the best way of treating unipolar major depression. I present here a case report of a patient with unipolar depression treated with cognitive therapy. The patient had been treated with an SSRI and a tricyclic antidepressant without substantial improvement. This case is discussed in the light of the current controversies in the literature concerning the comparative value of psychotherapy, particularly that designed to treat depression, and pharmacotherapy. We would suggest that cognitive therapy, as well as other depression-specific short psychotherapies, is the treatment of choice in milder depressions. However, there is evidence to support the widespread clinical impression that combined therapy with both psychotherapy and pharmacotherapy is superior to each single mode of therapy for the treatment of more severe, recurrent depressions.