Responding to Medication and Therapy in Depression

A study reported in the August 2009 issue of Journal of Consulting and Clinical Psychology examined the relative success rates for medication and cognitive therapy in depression. Previous research has shown the two treatments to be roughly equivalent in alleviating chronic depression although evidence suggests that patient factors may affect relative treatment success. A randomized controlled trial found nearly equivalent response rates for antidepressant medications and cognitive therapy in a sample of moderate to severely depressed outpatients. In the study, the authors attempted to identify the variables that were associated with response across both treatments as well as variables that predicted superior response in one treatment over the other. The sample consisted of 180 depressed outpatients: 60 of whom were randomly assigned to cognitive therapy; 120 were assigned to antidepressant medications. Treatment was provided for 16 weeks in both groups. Factors such as chronic depression, older age, and lower intelligence each predicted relatively poor response across both treatments. Three patient variables—being married, unemployment, and having experienced a greater number of recent life events—were identified, and each predicted superior response to cognitive therapy relative to antidepressant medications. Overall, six 6 markers of treatment outcome were identified, each of which might be expected to carry considerable clinical utility. The 3 prognostic variables identify subgroups that might benefit from alternative treatment strategies; the 3 client variables identify groups who appear to respond particularly well to cognitive therapy. The authors suggest that there are different mechanisms at work in both treatment modalities which can interact with client factors to affect outcome.

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