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November 14, 2007

Treatment for Depression Symptoms in Ugandan Adolescent Survivors of War and Displacement

Author Affiliations

Letters Section Editor: Robert M. Golub, MD, Senior Editor.

JAMA. 2007;298(18):2138. doi:10.1001/jama.298.18.2138-a

To the Editor: In the study of interpersonal psychotherapy in Ugandan war survivors by Dr Bolton and colleagues,1 the choice of treatments for investigation deserves comment. It is not clear why the authors have targeted depression in treatment, when the clinical picture in the participants appears to be one of mixed anxiety and depression caused by traumatic stress. The symptoms listed under “anxiety-like syndromes” are consistent with fear-related stress symptoms; evidence suggests that depression in such cases is often secondary to chronic anxiety/fear caused by exposure to unpredictable and uncontrollable stressors.2 This implies that treatment should focus on anxiety/fear as the causal process.

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