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The case for CBT over antidepressants

THIS BOOK is by a doctor with an abiding interest in the philosophy of medicine. Paul Biegler is an Australian Research Council Postdoctoral Fellow at the Centre for Human Bioethics, Monash University, and a recipient of the 2011 Australian Museum Eureka Prize for Research in Ethics.

The book describes the therapeutic use of antidepressant medication (ADM) versus cognitive behaviour therapy (CBT), and concludes that it is unethical to provide the former as a first option to all patients suffering from depression. This is based on the author’s view that ADMs do not promote autonomy nor change vulnerability, whereas CBT enhances resilience and changes cognitive vulnerability to depression.

However, Biegler does not sufficiently discriminate between different types of depression. He acknowledges that some types may require ADMs to allow patients to process information, but underplays this point. In these cases — such as melancholic and psychotic depression, some medical illnesses and, arguably, depression related to serious personality disorders — ADMs can improve cognition and judgement to enable sufferers to make informed choices, while ongoing ADMs and psychotherapy may be necessary to decrease vulnerability and promote autonomy. And although Biegler talks about precipitating stressors, he doesn’t acknowledge the place that environmental stressors…