Abstract: Antidepressant medications are the most popular treatment for unipolar depression in the United States, although there may be safer alternatives that are equally or more effective. This article reviews a wide range of well-controlled studies comparing psychological and pharmacological treatments for depression. The evidence suggests that the psychological interventions, particularly cognitive–behavioral therapy, are at least as effective as medication in the treatment of depression, even if severe. These conclusions hold for both vegetative and social adjustment symptoms, especially when patient-rated measures are used and long-term follow-up is considered. Some aspirational guidelines for the treatment of depression are proposed.

Insight-oriented psychotherapy was the least effective on most outcome measures at both evaluation periods; 30% of those patients remained in the moderate to severe range of depression, in comparison with 19% of those in the control condition. There were no significant differences between drug therapy and relaxation therapy on any outcome measure. No treatment had a significantly better outcome with the severely depressed subgroup (McLean & Taylor, 1992).