Electronic Letters to:

PAPERS:
Judit Simon, Stephen Pilling, Rachel Burbeck, and David Goldberg
Treatment options in moderate and severe depression: decision analysis supporting a clinical guideline
The British Journal of Psychiatry 2006; 189: 494-501 [Abstract] [Full text] [PDF]
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Electronic letters published:

[Read eLetter] Confusion of treatment options for depression
Alastair M Hull, John S Swan   (18 December 2006)

Confusion of treatment options for depression 18 December 2006
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Alastair M Hull,
Consultant Psychiatrist in Psychotherapy
NHS Tayside,
John S Swan

Send letter to journal:
Re: Confusion of treatment options for depression

alastair.hull{at}tpct.scot.nhs.uk Alastair M Hull, et al.

Sir, We read with interest Simon and colleagues’ paper on treatment options in moderate and severe depression (Simon et al, 2006).

However, we feel the paper may be misleading and its core conclusions erroneous. It is essential to differentiate between acute and chronic depression when deciding upon treatment. Decisions upon effectivenesss of treatment require the assessment of whether the psychological treatment was for an acute or a chronic disorder. One of the studies referenced uses a type of therapy called Cognitive Behavioural Analysis System of Psychotherapy (CBASP: Keller et al, 2000). CBASP is specifically designed to treat chronic depression (depression over 2 years) and claims no efficacy for acute depression as set out in the core text (McCullough, 2000). The CBASP theoretical underpinnings, focus and therapeutic approach are quite different to Cognitive Behavioural Psychotherapy (CBT) though it employs a number of strategies that would be familiar to CBT therapists.

Within this analysis of the overall assessment of effectiveness of psychological treatment table 3 highlights the importance of Keller and colleagues’ study in the conclusion that CBT is effective. This is misleading. In our opinion, evidence for the effectiveness of CBASP should not be interpreted as evidence for CBT for individuals with chronic depression and the case for CBT is thus overstated.

Delaration of interests Alastair Hull (AMH) has previously received educational sponsorship and honorarium for presentations from various pharmaceutical companies who market medications used in the pharmacological treatment of chronic depression in the UK.

Both AMH and John Swan have undertaken a one-week training course run by Professor James P McCullough in Richmond, Virginia.