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Background: The goal of this study was to document the existence of psychological side effects associated with serotonin reuptake inhibitors (SSRIs) taken for depression and to determine their relationship to patients’ decisions to stop treatment, and attitudes toward taking SSRIs again. Method: We conducted 161 semi-structured telephone interviews of adults who had completed a course of treatment for depression with one of the SSRIs. We identified 29 categories of unwanted psychological effects and analyzed data in terms of responders and non-responders, the former split into those who would, and those who would not take the same drug again if depressed in the future (‘take-again responders’ and ‘not-again responders’, respectively). Results: Psychological side effects were cited just as often as physical side effects as the primary reason for quitting SSRI treatment. Non-responders cited psychological side effects rather than non-response as the primary reason for quitting, and not-again responders cited physical more than psychological side effects. Not-again responders and non-responders did not differ in the number of side effects experienced, and non-responders experienced significantly more unwanted psychological effects than either type of responder (χ² = 6.767, p = 0.009). Conclusion: Psychological side effects might well be included in measures and discussions of side effects, even though they present no known physical danger to the patient.

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This paper traces the birth, quiescence and renaissance of clinical behavior analysis (CBA). CBA is the application of radical behaviorism to outpatient adult behavior therapy. It addresses the question of how talking in the consulting room helps the client outside of the office, in his or her daily life. The answer as formulated by CBA has led to exciting and significant developments with considerable promise for improving therapeutic interventions. A brief historical account of CBA is described that involves the interplay of three strands involving clinical applications of behaviorism: behavior therapy, applied behavior analysis, and the development of the Association for the Advancement of Behavior Therapy (AABT). These strands are traced through publications in Behavior Therapy from its inception to the present. We contend that there is a need in AABT and in behavior therapy in general for what CBA has to offer. As we see it, the major problems facing the AABT membership with its current emphasis on cognitive therapy and empirically validated treatments include the lack of a coherent theoretical base that can embrace all of the techniques used by behavior therapists. Now with all the behavioral procedures that have been developed, a horrendous question arises, "When do you use which procedure for what kind of person?" We conclude that far from being a thing of the past, CBA has a bright future in answering this question. Behavior analysis of the therapeutic situation offers a unique, coherent theoretical base that can embrace all techniques used by behavior therapists, including cognitive therapy strategies.

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