Cognitive behavioural therapy or antidepressants for acute depression?BMJ 2015; 351 doi: https://doi.org/10.1136/bmj.h6315 (Published 08 December 2015) Cite this as: BMJ 2015;351:h6315
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Choice between cognitive behavioural therapy and antidepressants does not concern France yet, despite the unprecedented epidemic.
The Sinyor et al editorial about the Amick et al meta-analysis showing no substantial differences in short term efficacy and tolerability between second generation antidepressants and cognitive behavioural therapy deserves comment.(1,2)
First, in France, in contrast to the UK, the mandatory health insurance fund does not reimburse care by licensed clinical psychologists. Moreover, GPs will always find it quicker to sign a prescription for antidepressants than to provide information on the conduct of psychotherapy sessions and perform a motivational interview.(3)
Second, Sinyor et al praised the World Health Organization’s projection that major depressive disorder will be the leading cause of disease burden worldwide by 2030.(1) WHO has a long lasting and poor record of frightening predictions which questions whose interests are served. Could this be to sell sickness?(4) In 2009 WHO called for unprecedented campaign of mass vaccination and stockpiling of antiviral drugs against the H1N1 flu but rebutted major conflicts of interest could be the rationale.(5) In 1994 the WHO’s definition of normal bone density classified half of all women over 50 as suffering from osteoporosis and osteopenia.(6) The first prediction about depression was in 1996, WHO viewed it would be a worldwide epidemic that within twenty years will be second only to cardiovascular disease as the world’s most debilitating disease.(7) Happily, WHO was wrong. Sadly, its new prediction may be right. Indeed, the bereavement exclusion has been removed from the diagnosis of major depression in the DSM V!
1 Sinyor M, Fefergrad M, Zaretsky A. Cognitive behavioural therapy or antidepressants for acute depression? BMJ 2015;351:h6315.
2 Amick HR, Gartlehner G, Gaynes BN, et al. Comparative benefits and harms of second generation antidepressants and cognitive behavioral therapies in initial treatment of major depressive disorder: systematic review and meta-analysis. BMJ 2015;351:h6019.
3 Keeley RD, Burke BL, Brody D et al. Training to use motivational interviewing techniques for depression: a cluster randomized trial. J Am Board Fam Med 2014;27:621-36.
4 Moynihan R, Heath I, Henry D. Selling sickness: the pharmaceutical industry and disease mongering. BMJ 2002;324:886-91.
5 Butler D. Flu experts rebut conflict claims. Nature 2010;465:672-673.
6 Alonso-Coello P, García-Franco AL, Guyatt G, Moynihan R. Drugs for pre-osteoporosis: prevention or disease mongering? BMJ 2008;336:126-129.
7 Summerfield D. Depression: epidemic or pseudo-epidemic? J R Soc Med 2006;99: 161–162.
Competing interests: No competing interests