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Letters to the Editor
Psychiatric News
Volume 39 Number 22 page 33-33

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 reasoning concepts.

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.

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