This article points out the dangers of psychiatrists' being wedded to pills
instead of skills. Although better clinical data will tell us more about the
benefit and safety of antidepressants, they will do nothing to dispel the idea
that child psychiatrists now favor medication over therapy. This is the
reversal of a time-honored perspective about work with children, which has
existed since the dawn of civilization.
Cognitive-behavioral therapy (CBT) for childhood depression has shown
efficacy in clinical trials; is easy to learn and teach; exists in manual
form, which can be adapted to most clinical situations; and is useful with
most children and adolescents of average intelligence who can grasp mental
Why not have child psychiatrists use CBT with depressed patients in place
of or in addition to medications? That way one might increase treatment
success rates. At least it would empower children and parents to do something
while waiting to see what happens to their children. And please, let's not
cede this treatment to other therapists without trying it first ourselves.
One way to encourage this "skills and pills" practice is to get
it incorporated in the Texas Medication Algorithm Project for depressed
children. It could require CBT whenever possible in place of, and in addition
to, any antidepressant trial. What harm would it do? I cannot think of any. As
far as I am aware, no suicide has been reported as a side effect of CBT. What
good would it do? A lot—especially to restore the balance in treatment
between active therapy and passive pill taking.