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Sunday 22 December 2024

Peer Reviewed

Feature Article Psychiatry and psychology

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

Ralf Ilchef

An updated version is available in the linked supplement

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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.