For Initial Treatment Of Moderate To Severe Major Depression, Cognitive Therapy And Medication May Be Equally Effective

"Antidepressant medications are the most widely used treatment for major depressive disorder in the United States," according to background information in the article. The effectiveness of antidepressant medications has been upheld in randomized placebo-controlled trials, especially in individuals with more severe depression. Cognitive therapy has also shown potential in treating major depressive disorder.

Robert J. DeRubeis, Ph.D., from the University of Pennsylvania, Philadelphia, and colleagues compared the efficacy of antidepressant medications with cognitive therapy in 240 moderately to severely depressed patients. Study participants were randomly assigned to receive antidepressant medication (n = 120), pill placebo (n = 60), or cognitive therapy (n = 60). Those in the medication group were given paroxetine or placebo for eight weeks, with doses increasing as tolerated. After eight weeks of treatment, for those unresponsive to paroxetine, treatment was augmented with lithium carbonate or desipramine hydrochloride. Patients in the cognitive therapy group attended 50-minute sessions twice weekly for the first four weeks, once or twice weekly for the middle eight weeks, and then once weekly for the final four weeks.

At eight weeks of treatment, response rates were 50 percent in the medication group, 43 percent in the cognitive therapy group, and 25 percent in the placebo group. Of the 47 patients who received an augmented medication treatment, 32 (64 percent) were given lithium, 28 (56 percent) were prescribed desipramine, and one (two percent) was treated with venlafaxine. At sixteen weeks of treatment, response rates were 58 percent for patients receiving antidepressant medications and for those receiving cognitive therapy. Remission rates were 46 percent in antidepressant medications patients and 40 percent in cognitive therapy patients.

"On the whole, these findings do not support the current American Psychiatric Association guideline, based on the TDCRP [The Treatment of Depression Collaborative Research Program], that 'most (moderately and severely depressed) patients will require medication,' " the researchers state. "It appears that cognitive therapy can be as effective as medications, even among more severely depressed outpatients, at least when provided by experienced cognitive therapists."

(Arch Gen Psychiatry. 2005;62:409-416. Available post-embargo at archgenpsychiatry.com)

Editor's Note: This study was supported by grants from the National Institute of Mental Health, Bethesda, Md. GlaxoSmithKline, Brentford, U.K., provided medications and pill placebos for the trial.