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Treatment of depression needs to be individualized: new findings suggest the role of clinical judgment
17 April 2012
Journal of Psychotherapy and Psychosomatics
In an article appeared in the current issue of Psychiatric Clinics of North America, Elena Tomba and Giovanni Fava (University of Bologna) bring new data suggesting the need of individualizing treatment of depression.
Treatment indications that derive from randomized controlled trials and meta-analyses refer to the average patient and often clash with the variety of clinical situations. The customary clinical taxonomy in psychiatry does not include patterns of symptoms, severity of illness, effects of comorbid conditions, timing of phenomena, rate of progression of illness, responses to previous treatments, and other clinical distinctions that demarcate major prognostic and therapeutic differences among patients who otherwise seem to be deceptively similar since they share the same psychiatric diagnosis. Clinical judgment should mediate the choice of the main evidence-based treatment ingredients in depression (pharmacotherapy and psychotherapy). Each treatment selection carries advantages and disadvantages. For the treatment of the acute episode of unipolar depression pharmacotherapy appears to be the most viable strategy for most of the patients. For preventing recurrence of depression, the sequential use of pharmacotherapy and psychotherapy, when available, may be the treatment of choice in many cases, even though long-term drug treatment or intermittent pharmacotherapy may be applied to other cases.