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June 26, 1996

Treatment of Chronic Depression-Reply

Author Affiliations

Center on Neuroscience, Behavior, and Society George Washington University Washington, DC

JAMA. 1996;275(24):1884. doi:10.1001/jama.1996.03530480025034

In Reply.  —The authors of these letters express a level of interest in my Clinical Crossroads discussion that is quite gratifying. With regard to Dr Chutkow's comments, I agree that ECT is a safe and effective treatment for depression, especially when it is severe and/or when antidepressants have failed to work. Although the patient under discussion had a history of major depressive episodes, in recent years he suffered from dysthymia, a condition for which ECT is not generally indicated. Chutkow also suggests that the psychiatrist should provide both psychotherapy and pharmacotherapy. While clinical experience suggests that there are some patients for whom this is best, other patients do quite well with nonmedical psychotherapists working collaboratively with the psychiatrist. Indeed, in most controlled studies demonstrating the efficacy of psychotherapy for depression, the therapists have been either psychologists or social workers.1 What is surely needed are randomized trials of the comparative