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Editorials |3 December 2019

Universal Access to Cognitive Behavioral Therapy and Antidepressants Is Necessary for All Patients With Major Depressive Disorder

Mark Sinyor, MSc, MD

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This article was published at Annals.org on 29 October 2019.
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More than a century ago, Sigmund Freud pioneered a scientific approach to psychotherapy, which has since evolved to include several forms—none more ubiquitous than cognitive behavioral therapy (CBT) (1). Although these treatments may differ substantially in content, they share a simple overarching premise: Spending time talking with patients about their inner experiences can help change thinking and behavior. The mid-20th century discovery of psychotropic medications resulted in a parallel movement in psychiatry in which biological interventions were sought to treat mental disorders analogous to earlier efforts identifying antibiotics to treat infections (2). Although both forms of treatment have strong evidence of efficacy in a subset of patients, neither has been a panacea (3). Just as penicillin is not effective for every bacterium, neither fluoxetine nor CBT are effective for every person with depression. Ultimately, both psychotherapy and psychopharmacology are valuable tools for treating mental illness, but psychiatry has struggled for the past half century to identify how, when, and in whom to use each.
Recent systematic reviews and meta-analyses have examined the available literature to identify efficacy differences between CBT and second-generation antidepressants (SGAs), such as selective serotonin reuptake inhibitors, in an acute episode of major depressive disorder (MDD) (3, 4). The 2 treatments appear equally effective, but these studies have been agnostic to cost differences. That is the key gap addressed by Ross and colleagues (5). They found that, compared with SGAs, CBT had higher initial costs but...
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Sinyor M. Universal Access to Cognitive Behavioral Therapy and Antidepressants Is Necessary for All Patients With Major Depressive Disorder. Ann Intern Med. 2019;171:849–850. [Epub ahead of print 29 October 2019]. doi: https://doi.org/10.7326/M19-2623

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Published: Ann Intern Med. 2019;171(11):849-850.

DOI: 10.7326/M19-2623

Published at www.annals.org on 29 October 2019

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2019 American College of Physicians
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