background The current opinion under clinicians is that a combination of psychotherapy and pharmacotherapy is the most effective treatment for outpatients with a major depression. Available research does not support this opinion. Authors propose that this discrepancy is mainly due to specific problems encountered in this type of research.
aims To summarize which specific problems have important repercussions on studies in this area. methods Based on the available litature and the opinions of the authors a description of the conceptual and methodological problems encountered in studies is given.
results Research in this area presents a lot of specific problems. Nine recommendations are given for future studies in this area. Size and composition of the population, expertise in pharmacotherapy and psychotherapy by the researchers, the use of other outcome measures besides the usual depression rating scales and a sufficient duration of the follow-up period are the most important recommendations for future studies.
conclusions Most studies do not satisfy the recommendations. This can very well be an explanation for the found discrepancy between clinician-based opinion and the results of the studies in this area. Future studies should take into consideration the recommendations given in this article. A more definite answer can then be given.