Antidepressant medications are the most popular treatment for unipolar depression in the United States, although there may be safer alternatives that are equally or more effective. This article reviews a wide range of well-controlled studies comparing psychological and pharmacological treatments for depression. The evidence suggests that the psychological interventions, particularly cognitive--behavioral therapy, are at least as effective as medication in the treatment of depression, even if severe. These conclusions hold for both vegetative and social adjustment symptoms, especially when patient-rated measures are used and long-term follow-up is considered. Some aspirational guidelines for the treatment of depression are proposed. The prevalence of unipolar depression is estimated to be between 3% and 13%, with as much as 20% of the adult population experiencing at least some depressive symptoms at any given time (Amenson & Lewinsohn, 1981; Kessler et al., 1994; Oliver & Simmons, 1985). The lifetime incidence of depression is estimated to be between 20% and 55%. Women are consistently found to have rates of depression twice as high as those of men. Somewhere between 9% and 18% of all depressions are the result of an underlying medical condition, suggesting that a physical examination is important in the comprehensive treatment of depression (Hall, Popkin, Devaul, Fallaice, & Stickney, 1978; Koranyi, 1979). However, the vast majority of depressions are not attributable to identifiable medical causes. Other data (Gatz, Pedersen, Plomin, Nesselroade, & McClearn, 1992) suggest that genetic influences account for only 16% of the variance in total depression scores and that life experiences are the most statistically important influence on self-reported depressive symptoms. Genetic influences on major depression, dysthymia, and depressive adjustment disorder appear to be weak and