Psychology Versus Psychiatry: Do The New Depression Guidelines Take Sides?

But on the front lines of mental health, the debate still rages, according to Time Healthland, which has a niece piece today on the new American Psychiatric Association guidelines for treating depression, and why all these various mental health providers can't just get along. The bottom line? In this latest battle, at least, the psychiatrists (or is it the drug industry?) won.

According to the new guidelines — which will govern treatment for the 200,000 in-patient psychiatric patients in the U.S., as well as the 20 million or so who get out-patient treatment — the No.-1 preferred approach is drugs. Just drugs. The guidelines don't mention psychological approaches like cognitive-behavioral therapy until No. 3, just after electroshock therapy. Ouch.

The new guidelines underplay an enormous body of data from the past decade showing that even the best psychiatric drugs work better than sugar pills only when the drugs are used in conjunction with psychological therapies that help patients change how they behave and how they form their thoughts. Neither a strictly psychiatric approach (just drugs) nor a strictly psychological approach (just talk therapy) works much better than a placebo pill on its own. But when used in combination, the psychiatric and psychological treatments help a majority of people get better.

Medscape offers a less pointed analysis of the new guidelines.

Clearly, the questions raised here aren't going away soon. An accompanying story reports that 1 in 10 Americans, or 9 percent, suffer from depression and 3 percent suffer from major depression.