 |
|
Cognitive Therapy vs Medications in the Treatment of Moderate to Severe Depression
Robert J. DeRubeis, PhD;
Steven D. Hollon, PhD;
Jay D. Amsterdam, MD;
Richard C. Shelton, MD;
Paula R. Young, PhD;
Ronald M. Salomon, MD;
John P. O’Reardon, MD;
Margaret L. Lovett, MEd;
Madeline M. Gladis, PhD;
Laurel L. Brown, PhD;
Robert Gallop, PhD
Arch Gen Psychiatry. 2005;62:409-416.
Background There is substantial evidence that antidepressant medications treat moderate to severe depression effectively, but there is less data on cognitive therapy’s effects in this population.
Objective To compare the efficacy in moderate to severe depression of antidepressant medications with cognitive therapy in a placebo-controlled trial.
Design Random assignment to one of the following: 16 weeks of medications (n = 120), 16 weeks of cognitive therapy (n = 60), or 8 weeks of pill placebo (n = 60).
Setting Research clinics at the University of Pennsylvania, Philadelphia, and Vanderbilt University, Nashville, Tenn.
Patients Two hundred forty outpatients, aged 18 to 70 years, with moderate to severe major depressive disorder.
Interventions Some study subjects received paroxetine, up to 50 mg daily, augmented by lithium carbonate or desipramine hydrochloride if necessary; others received individual cognitive therapy.
Main Outcome Measure The Hamilton Depression Rating Scale provided continuous severity scores and allowed for designations of response and remission.
Results At 8 weeks, response rates in medications (50%) and cognitive therapy (43%) groups were both superior to the placebo (25%) group. Analyses based on continuous scores at 8 weeks indicated an advantage for each of the active treatments over placebo, each with a medium effect size. The advantage was significant for medication relative to placebo, and at the level of a nonsignificant trend for cognitive therapy relative to placebo. At 16 weeks, response rates were 58% in each of the active conditions; remission rates were 46% for medication, 40% for cognitive therapy. Follow-up tests of a site x treatment interaction indicated a significant difference only at Vanderbilt University, where medications were superior to cognitive therapy. Site differences in patient characteristics and in the relative experience levels of the cognitive therapists each appear to have contributed to this interaction.
Conclusion Cognitive therapy can be as effective as medications for the initial treatment of moderate to severe major depression, but this degree of effectiveness may depend on a high level of therapist experience or expertise.
Author Affiliations: Departments of Psychology (Dr DeRubeis), and Psychiatry (Drs Amsterdam, Young, O’Reardon, and Gladis), University of Pennsylvania, Philadelphia; Departments of Psychology (Dr Hollon), and Psychiatry (Drs Shelton, Salomon, Lovett, and Brown), Vanderbilt University, Nashville, Tenn; Department of Mathematics and Applied Statistics, West Chester University, West Chester, Pa (Dr Gallop).
RELATED ARTICLE
Prevention of Relapse Following Cognitive Therapy vs Medications in Moderate to Severe Depression
Steven D. Hollon, Robert J. DeRubeis, Richard C. Shelton, Jay D. Amsterdam, Ronald M. Salomon, John P. O’Reardon, Margaret L. Lovett, Paula R. Young, Kirsten L. Haman, Brent B. Freeman, and Robert Gallop
Arch Gen Psychiatry. 2005;62(4):417-422.
ABSTRACT
| FULL TEXT
THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES
|
Evidence-based guidelines for treating depressive disorders with antidepressants: A revision of the 2000 British Association for Psychopharmacology guidelines
Anderson et al.
J Psychopharmacol 2008;22:343-396.
ABSTRACT
Antidepressant medications v. cognitive therapy in people with depression with or without personality disorder
Fournier et al.
Br. J. Psychiatry 2008;192:124-129.
ABSTRACT
| FULL TEXT
Bibliography for Major Depressive Disorder and Suicide
Focus 2008;6:58-62.
FULL TEXT
Abstracts For Major Depressive Disorder and Suicide
Focus 2008;6:63-68.
FULL TEXT
Uncritical positive regard? Issues in the efficacy and safety of psychotherapy
Nutt and Sharpe
J Psychopharmacol 2008;22:3-6.
Cognitive Therapy Versus Medication in Augmentation and Switch Strategies as Second-Step Treatments: A STAR*D Report
Thase et al.
Focus 2008;6:104-119.
ABSTRACT
| FULL TEXT
Psychological approach to managing irritable bowel syndrome
Hayee and Forgacs
BMJ 2007;334:1105-1109.
FULL TEXT
Utility of Observer-Rated and Self-Report Instruments for Detecting Major Depression in Women After Cardiac Surgery: A Pilot Study
Doering et al.
Am J Crit Care 2007;16:260-269.
ABSTRACT
| FULL TEXT
Cognitive Therapy Versus Medication in Augmentation and Switch Strategies as Second-Step Treatments: A STAR*D Report
Thase et al.
Am. J. Psychiatry 2007;164:739-752.
ABSTRACT
| FULL TEXT
Differences in Brain Glucose Metabolism Between Responders to CBT and Venlafaxine in a 16-Week Randomized Controlled Trial
Kennedy et al.
Am. J. Psychiatry 2007;164:778-788.
ABSTRACT
| FULL TEXT
Effects of Citalopram and Interpersonal Psychotherapy on Depression in Patients With Coronary Artery Disease: The Canadian Cardiac Randomized Evaluation of Antidepressant and Psychotherapy Efficacy (CREATE) Trial
Lesperance et al.
JAMA 2007;297:367-379.
ABSTRACT
| FULL TEXT
Three decades of antidepressant, anxiolytic and hypnotic use in a national population birth cohort
Colman et al.
Br. J. Psychiatry 2006;189:156-160.
ABSTRACT
| FULL TEXT
Depression and cardiovascular disease: healing the broken-hearted.
Whooley
JAMA 2006;295:2874-2881.
ABSTRACT
| FULL TEXT
A Cognitive-Behavioral Treatment Package for Depression in Parkinson's Disease
DeFronzo Dobkin et al.
Psychosomatics 2006;47:259-263.
FULL TEXT
Enhancing the efficacy of antidepressants with psychotherapy.
Petersen
J Psychopharmacol 2006;20:19-28.
ABSTRACT
Neurobiological Mechanisms of the Placebo Effect
Benedetti et al.
J. Neurosci. 2005;25:10390-10402.
FULL TEXT
Other articles noted
Evid. Based Ment. Health 2005;8:94-94.
FULL TEXT
The Current State of Cognitive Therapy: A 40-Year Retrospective
Beck
Arch Gen Psychiatry 2005;62:953-959.
ABSTRACT
| FULL TEXT
Cognitive Therapy Versus Antidepressants for More Severe Depressions
JWatch Psychiatry 2005;2005:3-3.
FULL TEXT
Depression Treatment: What Works? For How Long?
JWatch Women's Health 2005;2005:7-7.
FULL TEXT
Prevention of Relapse Following Cognitive Therapy vs Medications in Moderate to Severe Depression
Hollon et al.
Arch Gen Psychiatry 2005;62:417-422.
ABSTRACT
| FULL TEXT
|
