Antidepressant medications are the most popular treatment for unipolar depression in the United States, although there may be safer alternatives that are equally or more effective. This article reviews a wide range of well-controlled studies comparing psychological and pharmacological treatments for depression. The evidence suggests that the psychological interventions, particularly cognitivebehavioral therapy, are at least as effective as medication in the treatment of depression, even if severe. These conclusions hold for both vegetative and social adjustment symptoms, especially when patient-rated measures are used and long-term follow-up is considered. Some aspirational guidelines for the treatment of depression are proposed.The prevalence of unipolar depression is estimated to be between 3% and 13%, with as much as 20% of the adult population experiencing at least some depressive symptoms at any given time (Amenson & Lewinsohn, 1981;Kessler et al., 1994;Oliver & Simmons, 1985). The lifetime incidence of depression is estimated to be between 20% and 55%. Women are consistently found to have rates of depression twice as high as those of men. Somewhere between 9% and 18% of all depressions are the result of an underlying medical condition, suggesting that a physical examination is important in the comprehensive treatment of depression (Hall, Popkin, Devaul, Fallaice, & Stickney, 1978;Koranyi, 1979). However, the vast majority of depressions are not attributable to identifiable medical causes. Other data DAVID O. ANTONUCCIO received his PhD in clinical psychology from the University of Oregon in 1980. He is currently the assistant chief of psychology at the Reno Veterans Affairs Medical Center and an associate professor in the Department of Psychiatry and Behavioral Sciences at the University of Nevada School of Medicine. His clinical and research interests include the treatment of depression and smoking cessation. WILLIAM G. DANTON received his PhD in clinical psychology from the University of Houston in 1975. He is currently chief of psychology at the Reno Veterans Affairs Medical Center and an associate professor in the Department of Psychiatry and Behavioral Sciences at the University of Nevada School of Medicine. His clinical and research interests include the treatment of anxiety disorders and hypnotic interventions. GARLAND Y. DENELSKY received his PhD from Purdue University in 1966. He is currently head of the Section of Psychology at the Cleveland Clinic Foundation and directs its Psychology Postdoctoral Program. His general psychotherapeutic practice includes specializations in smoking cessation, performance anxiety, and coping skills enhancements.

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Antidepressant medication has apparently become the most popular treatment for depression in the USA. Several beliefs about the efficacy of antidepressant medications prevail among mental health professionals and the public. This paper explores relevant research data and raises questions about these beliefs. Many of the common beliefs about these medications are not adequately supported by scientific data. The following issues are raised: (1) industry-funded research studies which result in negative findings sometimes do not get published; (2) placebo washout procedures may bias results in some studies; (3) there are serious questions about the integrity of the double-blind procedure; (4) the ‘true’ antidepressant drug effect in adults appears to be relatively small; (5) there is minimal evidence of antidepressant efficacy in children; (6) side effects are fairly common even with the newer antidepressants; (7) combining medications raises the risk for more serious complications; (8) all antidepressants can cause withdrawal symptoms; (9) genetic influences on unipolar depression appear to be weaker than environmental influences; (10) biochemical theories of depression are as yet unproven; (11) biological markers specific for depression have been elusive; (12) dosage and plasma levels of antidepressants have been minimally related to treatment outcome; (13) preliminary evidence suggests that patients who improve with cognitive-behavioral psychotherapy show similar biological changes as those who respond to medication, and (14) the evidence suggests that psychological interventions are at least as effective as pharmacotherapy in treating depression, even if severe, especially when patient-rated measures are used and long-term follow-up is considered.

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