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.
Biegler P. Autonomy, stress, and treatment of depression. British Medical Journal 2008; 336: 1046-1048