Dr Biegler argues that the under use of psychotherapy, and the over-prescription of antidepressants, is cause for serious ethical concern.
Most people seeking relief for depression through the healthcare system will receive antidepressants. In the United States alone, nearly 170 million prescriptions for antidepressants were written in 2005, resulting in more than $12 billion in sales.
In his new book, The Ethical Treatment of Depression, Dr Biegler takes aim at the fact that antidepressants can lift mood independent of a person’s understanding of symptoms or stressors. Yet, he points out, nearly 70 per cent of depressive episodes are triggered directly by stressful life events. Moreover, depressed mood causes biased information processing that leads to unrealistic pessimism.
“Despite the dominance of antidepressants in the marketplace and the consulting room, another treatment for depression has proven equally effective – psychotherapy, in particular, cognitive behavior therapy (CBT). CBT teaches patients skills for dealing with distressing feelings, negative thoughts, and causal stressors, and in so doing promotes personal autonomy,” said Dr Biegler.
Dr Biegler’s research shows that depression is a disorder in which autonomy is routinely and extensively undermined. He argues that physicians have a moral obligation to promote the autonomy of depressed patients.
“The insights that patients gain from the therapeutic process promote autonomy and so medical practitioners have an ethical imperative to prescribe psychotherapy – CBT in particular – for depression,” said Dr Biegler.
“Doctors who treat depressed people with medication alone, and make no attempt to explore the causes, or tackle them through evidence-based psychotherapy, engage in unethical practice.
The Ethical Treatment of Depression: Autonomy through Psychotherapy by Dr Paul Biegler is published by The MIT Press.