BMJ 1995;310:1267 (13 May)

Letters

There is a place for a combined treatment approach

EDITOR,--Primary care is assuming an increasing role in community psychiatry, and L M Mynors-Wallis and colleagues' study of problem solving treatment has implications for the treatment of major depression in this setting.1 The approach, however, adheres strictly to an either/or model of biological or psychosocial approaches to treatment. The authors' reference to traditional treatment dates from 1978 and is not one that reflects the conventional psychiatric model of depression as being biopsychosocial (aetiologically and therapeutically). Most referral letters from general practitioners reference the complicated but relevant range of such issues, which suggests that "drugs and reassurance" are an inaccurate reflection of primary care treatment. The face validity of the biopsychosocial model is inadvertently endorsed by the results of the study. The reductionist approach would leave 48% (drugs) and 40% (problem solving) of treated patients not recovered. Would such patients be referred to specialist care for treatment for persistent depression? It . . . [Full text of this article]


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Relevant Article

Randomised controlled trial comparing problem solving treatment with amitriptyline and placebo for major depression in primary care
L M Mynors-Wallis, D H Gath, A R Lloyd-Thomas, and D Tomlinson
BMJ 1995 310: 441-445. [Abstract] [Full Text]

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