On the question regarding studies that show that a combination of medication and therapy is the most effective, I haven't reviewed that literature lately but the last time I looked there were some studies showing that medication plus CT was more effective than either alone and there were some studies showing that medication plus CT was no more effective than either alone (see http://www.behavior.net/forums/cogni...996/msg83.html). While there are plenty of people (both clients and practitioners) who assume that the combination medication and therapy is best with depression, I don't think that is what the data shows. In fact, I think that there is a study or two suggesting that a combined approach has a higher drop-out rate and thus actually ends up being less effective. Obviously more research is needed.

My clinical experience leads me to think that there may be some people for whom a combined approach is best, some people for whom either approach will work well, some people for whom medication works better than CT, and some people for whom CT works better than medication. (There may well be some people for whom neither approach will work but I don't run into very many of those.) Unfortunately, we haven't figured out how to predict who will need a combined approach and who won't. The "state of the art" is "try it and see."

As we develop a better understanding of the genetics of serotonin metabolism and the role it plays in depression, that may help us predict who needs medication and who doesn't. It will be interesting to see how that research turns out.