آیا رفتاردرمانی شناختی برای افسردگی مالیخولیایی سودمند است؟

Abstract Objective This paper seeks to determine the relevance and likely salience of cognitive behaviour therapy (CBT) as a treatment for melancholic depression. Methods The findings of a randomised trial comparing 12-week outcome of 18 patients with melancholic depression receiving antidepressant medication and 11 receiving CBT were evaluated, and qualitative explanations for the outcomes were provided principally by the treating CBT practitioners.

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4. Conclusion Group comparisons indicated that antidepressant medication was significantly superior to CBT by four weeks and at the end of the three-month trial. Such findings could argue for CBT being judged as ineffective and an inappropriate treatment for melancholia. By reference to three vignettes and individual observations reported by participants we suggest that CBT may complement medication. The most likely interpretation of study results is that medication had the potential to address the core physiological perturbations intrinsic to melancholia, while CBT assisted with some of the concomitants (e.g. anxiety), consequences (e.g. demoralisation) and possible vulnerability factors (e.g. personality style) that cause those with melancholia to seek help. To paraphrase one sufferer of melancholia: “I equate medication with surgery and psychological intervention with healing – helping me through the mourning for my previous life and envisaging what a new or changed life might be”.