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Feature Article

On the (examination) couch: psychotherapy for depression in general practice

Ralf Ilchef

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Abstract

Psychotherapeutic treatments can be matched to individual patient requirements and delivered effectively in general practice.

Key Points

  • Patients prefer psychotherapy. It should be considered as a first line treatment in uncomplicated mild or moderate nonmelancholic depression.
  • Supportive counselling, cognitive behavioural therapy (especially problem solving) and interpersonal psychotherapy have been shown to be effective in primary care settings.
  • Short forms of interpersonal psychotherapy and cognitive behavioural therapy (four to six 30 minute sessions) have been developed for general practice.
  • Add a first line antidepressant if no benefit after four to six sessions.
  • Substance abuse, a personality disorder or acute intercurrent stressor should be excluded in patients who do not respond to psychotherapy.
  • Specialist review is indicated for patients with suicidal ideation, mania or psychosis, and for patients with progressive or treatment-resistant depression.

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