The Ethical Treatment of Depression ─ Autonomy Through Psychotherapy

One in six people worldwide will experience depression over the course of a lifetime.Many who seek relief through the healthcare system are treated with antidepressant medication; inthe United States, nearly 170 million prescriptions for antidepressants were written in 2005,resulting in more than $12 billion in sales. And yet despite the dominance of antidepressants inthe marketplace and the consulting room, another treatment for depression has proven equallyeffective: psychotherapy--in particular, cognitive behavior therapy (CBT). Antidepressants can liftmood independent of a person's understanding of symptoms or stressors. By contrast, CBT teachespatients skills for dealing with distressing feelings, negative thoughts, and causal stressors. InThe Ethical Treatment of Depression, Paul Biegler argues that the insights patients gain from thetherapeutic process promote autonomy. He shows that depression is a disorder in which autonomy isroutinely and extensively undermined and that physicians have a moral obligation to promote theautonomy of depressed patients. He concludes that medical practitioners have an ethical imperativeto prescribe psychotherapy--CBT in particular--for depression. To make his case, Biegler draws on awide philosophical literature relevant to autonomy and the emotions and makes a comprehensive surveyof the latest research findings from the psychological sciences. Forcefully argued, denselyresearched, and engagingly written, the book issues a challenge to physicians who believe their dutyof care to depressed patients is discharged by merely writing prescriptions forantidepressants.

Paul Biegler is Australian Research Council Postdoctoral Fellow in the Centre for Human Bioethics at the School of Philosophical, Historical, and International Studies, Monash University. He was the recipient of a 2011 Australian Museum Eureka Prize.