Logo of brjgenpracRCGP homepageJ R Coll Gen Pract at PubMed CentralBJGP at RCGPBJGP at RCGP
Br J Gen Pract. Sep 1999; 49(446): 738–743.
PMCID: PMC1313506

Should general practitioners refer patients with major depression to counsellors? A review of current published evidence. Nottingham Counselling and Antidepressants in Primary Care (CAPC) Study Group.

Abstract

Major depression can be treated effectively with antidepressants. However, in the United Kingdom, patients with depression are often referred to counsellors, and surveys indicate that public opinion favours this approach. We carried out a literature review to determine the evidence for the effectiveness of counselling for depression in primary care. Because no studies were identified in which counselling had been evaluated specifically in relation to treating depression, we examined indirect evidence from studies evaluating the overall effectiveness of generic counselling in primary care, and studies evaluating the effectiveness of psychological treatments, other than counselling, for depression. Methodological problems influencing the interpretation of such studies are discussed. We conclude that, while specific psychological treatments have been shown to have equivalent effectiveness as antidepressants, there is currently insufficient evidence to recommend that generic counselling should be used alone in the treatment of patients with major depression.

Full Text

The Full Text of this article is available as a PDF (49K).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.
  • Shea MT, Elkin I, Imber SD, Sotsky SM, Watkins JT, Collins JF, Pilkonis PA, Beckham E, Glass DR, Dolan RT, et al. Course of depressive symptoms over follow-up. Findings from the National Institute of Mental Health Treatment of Depression Collaborative Research Program. Arch Gen Psychiatry. 1992 Oct;49(10):782–787. [PubMed]
  • Scott J, Eccleston D, Boys R. Can we predict the persistence of depression? Br J Psychiatry. 1992 Nov;161:633–637. [PubMed]
  • Paykel ES, Priest RG. Recognition and management of depression in general practice: consensus statement. BMJ. 1992 Nov 14;305(6863):1198–1202. [PMC free article] [PubMed]
  • Paykel ES, Hart D, Priest RG. Changes in public attitudes to depression during the Defeat Depression Campaign. Br J Psychiatry. 1998 Dec;173:519–522. [PubMed]
  • Pharoah PD, Melzer D. Variation in prescribing of hypnotics, anxiolytics and antidepressants between 61 general practices. Br J Gen Pract. 1995 Nov;45(400):595–599. [PMC free article] [PubMed]
  • Kerr MP. Antidepressant prescribing: a comparison between general practitioners and psychiatrists. Br J Gen Pract. 1994 Jun;44(383):275–276. [PMC free article] [PubMed]
  • Matthews K, Eagles JM, Matthews CA. The use of antidepressant drugs in general practice. A questionnaire survey. Eur J Clin Pharmacol. 1993;45(3):205–210. [PubMed]
  • Sibbald B, Addington-Hall J, Brenneman D, Freeling P. Counsellors in English and Welsh general practices: their nature and distribution. BMJ. 1993 Jan 2;306(6869):29–33. [PMC free article] [PubMed]
  • Clark A, Hook J, Stein K. Counsellors in primary care in Southampton: a questionnaire survey of their qualifications, working arrangements, and casemix. Br J Gen Pract. 1997 Oct;47(423):613–617. [PMC free article] [PubMed]
  • Boot D, Gillies P, Fenelon J, Reubin R, Wilkins M, Gray P. Evaluation of the short-term impact of counseling in general practice. Patient Educ Couns. 1994 Aug;24(1):79–89. [PubMed]
  • Friedli K, King MB, Lloyd M, Horder J. Randomised controlled assessment of non-directive psychotherapy versus routine general-practitioner care. Lancet. 1997 Dec 6;350(9092):1662–1665. [PubMed]
  • Harvey I, Nelson SJ, Lyons RA, Unwin C, Monaghan S, Peters TJ. A randomized controlled trial and economic evaluation of counselling in primary care. Br J Gen Pract. 1998 Mar;48(428):1043–1048. [PMC free article] [PubMed]
  • Tylee A. Counselling in primary care. Lancet. 1997 Dec 6;350(9092):1643–1643. [PubMed]
  • Hemmings A. Counselling in primary care: a randomised controlled trial. Patient Educ Couns. 1997 Nov;32(3):219–230. [PubMed]
  • Dobson KS. A meta-analysis of the efficacy of cognitive therapy for depression. J Consult Clin Psychol. 1989 Jun;57(3):414–419. [PubMed]
  • Gloaguen V, Cottraux J, Cucherat M, Blackburn IM. A meta-analysis of the effects of cognitive therapy in depressed patients. J Affect Disord. 1998 Apr;49(1):59–72. [PubMed]
  • Scott AI, Freeman CP. Edinburgh primary care depression study: treatment outcome, patient satisfaction, and cost after 16 weeks. BMJ. 1992 Apr 4;304(6831):883–887. [PMC free article] [PubMed]
  • Catalan J, Gath DH, Anastasiades P, Bond SA, Day A, Hall L. Evaluation of a brief psychological treatment for emotional disorders in primary care. Psychol Med. 1991 Nov;21(4):1013–1018. [PubMed]
  • Mynors-Wallis LM, Gath DH, Lloyd-Thomas AR, Tomlinson D. Randomised controlled trial comparing problem solving treatment with amitriptyline and placebo for major depression in primary care. BMJ. 1995 Feb 18;310(6977):441–445. [PMC free article] [PubMed]
  • Sireling LI, Freeling P, Paykel ES, Rao BM. Depression in general practice: clinical features and comparison with out-patients. Br J Psychiatry. 1985 Aug;147:119–126. [PubMed]
  • Weissman MM, Prusoff BA, Dimascio A, Neu C, Goklaney M, Klerman GL. The efficacy of drugs and psychotherapy in the treatment of acute depressive episodes. Am J Psychiatry. 1979 Apr;136(4B):555–558. [PubMed]
  • Elkin I, Shea MT, Watkins JT, Imber SD, Sotsky SM, Collins JF, Glass DR, Pilkonis PA, Leber WR, Docherty JP, et al. National Institute of Mental Health Treatment of Depression Collaborative Research Program. General effectiveness of treatments. Arch Gen Psychiatry. 1989 Nov;46(11):971–983. [PubMed]
  • Frank E, Kupfer DJ, Wagner EF, McEachran AB, Cornes C. Efficacy of interpersonal psychotherapy as a maintenance treatment of recurrent depression. Contributing factors. Arch Gen Psychiatry. 1991 Dec;48(12):1053–1059. [PubMed]
  • Kupfer DJ, Frank E, Perel JM, Cornes C, Mallinger AG, Thase ME, McEachran AB, Grochocinski VJ. Five-year outcome for maintenance therapies in recurrent depression. Arch Gen Psychiatry. 1992 Oct;49(10):769–773. [PubMed]
  • Zeiss AM, Lewinsohn PM, Muñoz RF. Nonspecific improvement effects in depression using interpersonal skills training, pleasant activity schedules, or cognitive training. J Consult Clin Psychol. 1979 Jun;47(3):427–439. [PubMed]
  • Imber SD, Pilkonis PA, Sotsky SM, Elkin I, Watkins JT, Collins JF, Shea MT, Leber WR, Glass DR. Mode-specific effects among three treatments for depression. J Consult Clin Psychol. 1990 Jun;58(3):352–359. [PubMed]
  • Rounsaville BJ, Chevron ES, Prusoff BA, Elkin I, Imber S, Sotsky S, Watkins J. The relation between specific and general dimensions of the psychotherapy process in interpersonal psychotherapy of depression. J Consult Clin Psychol. 1987 Jun;55(3):379–384. [PubMed]
  • Nietzel MT, Russell RL, Hemmings KA, Gretter ML. Clinical significance of psychotherapy for unipolar depression: a meta-analytic approach to social comparison. J Consult Clin Psychol. 1987 Apr;55(2):156–161. [PubMed]
  • Teasdale JD, Fennell MJ, Hibbert GA, Amies PL. Cognitive therapy for major depressive disorder in primary care. Br J Psychiatry. 1984 Apr;144:400–406. [PubMed]
  • Blackburn IM, Bishop S, Glen AI, Whalley LJ, Christie JE. The efficacy of cognitive therapy in depression: a treatment trial using cognitive therapy and pharmacotherapy, each alone and in combination. Br J Psychiatry. 1981 Sep;139:181–189. [PubMed]
  • Ross M, Scott M. An evaluation of the effectiveness of individual and group cognitive therapy in the treatment of depressed patients in an inner city health centre. J R Coll Gen Pract. 1985 May;35(274):239–242. [PMC free article] [PubMed]
  • Scott C, Tacchi MJ, Jones R, Scott J. Acute and one-year outcome of a randomised controlled trial of brief cognitive therapy for major depressive disorder in primary care. Br J Psychiatry. 1997 Aug;171:131–134. [PubMed]

Articles from The British Journal of General Practice are provided here courtesy of Royal College of General Practitioners

Formats:

Related citations in PubMed

See reviews...See all...

Cited by other articles in PMC

See all...

Links

  • MedGen
    MedGen
    Related information in MedGen
  • PubMed
    PubMed
    PubMed citations for these articles

Recent Activity

Your browsing activity is empty.

Activity recording is turned off.

Turn recording back on

See more...