BMJ  2008;336:1046-1048 (10 May), doi:10.1136/bmj.39541.470023.AD

Analysis

Autonomy, stress, and treatment of depression

¹ School of Philosophy and Bioethics, Monash University, Clayton, Victoria 3800, Australia, ² Emergency Department, Sandringham Hospital, Sandringham, Victoria, ³ Faculty of Medicine, Nursing and Health Sciences, Monash University

Psychotherapy canhelp patients understand the triggers for depression and how to deal with them. Paul Biegler argues that these effects should be given moral weight when deciding on treatment

The first 150 words of the full text of this article appear below.

Most guidelines on the treatment of less severe forms of depression conclude that antidepressants and psychotherapy have similar efficacy and recommend that either can be used.^{1 2} The evidence for these recommendations derives from studies that measure reduction of symptoms on instruments such as the Hamilton rating scale. However, these studies fail to take into account the role of self knowledge in the success of evidence based psychotherapy and the potential importance it has for depressed people. Psychotherapy affords people with depression greater autonomy in decisions and actions that relate to the object, or trigger, of the depressed response. Patient autonomy is rightly given considerable weight in medicine, and it should have greater influence on the discussions that guide treatment in depression.

Depression as a response to stressors

Some years ago, the philosopher and physician Carl Elliot wondered what might be wrong with using antidepressants to treat a melancholy Sisyphus, sentenced in perpetuity to pushing a big . . . [Full text of this article]

Personal autonomy

Material facts in depression

Psychotherapy and autonomy

Antidepressants and autonomy

Beneficence and autonomy

Implications for clinical practice

Summary points

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