[Behavior therapy and/or drug therapy in depression? Critical remarks on published comparative studies]

Are published results of comparative treatment-evaluation studies in depression meaningful for everyday practice? The most recent German- and English-language review-articles and large scale comparative studies--with tricyclic antidepressants, cognitive behavior therapy, and interpersonal psychotherapy--are assessed using a specific list of criteria, in order to find an answer to this question. Basic design problems and specific weaknesses in the pharmacological as well as in the non-pharmacological treatments are identified. It turns out, that the published "statistically significant" results of these studies are not clinically convincing, neither for the pharmacological nor for the two nonpharmacological treatments--not even for the emerging superiority of cognitive behavior therapy. A cost-comparison does not reveal a major advantage of pharmacotherapy. Recommendations for future research and psychiatric practice are derived.