From: Anders Sandberg (asa@nada.kth.se)
Date: Sat May 20 2000 - 04:04:51 MDT
Just a paper I became aware of that relates to this thread, showing
that cognitive psychotherapy and antidepressants have better effect
together than isolated:
http://www.nejm.org/content/2000/0342/0020/1462.asp
The New England Journal of Medicine -- May 18, 2000 -- Vol. 342, No. 20
A Comparison of Nefazodone, the Cognitive Behavioral-Analysis System
of Psychotherapy, and Their Combination for the Treatment of Chronic
Depression
Martin B. Keller, James P. McCullough, Daniel N. Klein, Bruce Arnow,
David L. Dunner, Alan J. Gelenberg, John C. Markowitz, Charles B.
Nemeroff, James M. Russell, Michael E. Thase, Madhukar H. Trivedi,
John Zajecka, Janice A. Blalock, Francis E. Borian, Charles
DeBattista, Jan Fawcett, Robert M.A. Hirschfeld, Darlene N. Jody,
Gabor Keitner, James H. Kocsis, Lorrin M. Koran, Susan G. Kornstein,
Rachel Manber, Ivan Miller, Philip T. Ninan, Barbara Rothbaum, A. John
Rush, Alan F. Schatzberg, Dina Vivian
Abstract
Background. Patients with chronic forms of major depression
are difficult to treat, and the relative efficacy of
medications and psychotherapy is uncertain.
Methods. We randomly assigned 681 adults with a chronic
nonpsychotic major depressive disorder to 12 weeks of
outpatient treatment with nefazodone (maximal dose, 600 mg
per day), the cognitive behavioral-analysis system of
psychotherapy (16 to 20 sessions), or both. At base line,
all patients had scores of at least 20 on the 24-item
Hamilton Rating Scale for Depression (indicating clinically
significant depression). Remission was defined as a score of
8 or less at weeks 10 and 12. For patients who did not have
remission, a satisfactory response was defined as a
reduction in the score by at least 50 percent from base line
and a score of 15 or less. Raters were unaware of the
patients' treatment assignments.
Results. Of the 681 patients, 662 attended at least one
treatment session and were included in the analysis of
response. The overall rate of response (both remission and
satisfactory response) was 48 percent in both the nefazodone
group and the psychotherapy group, as compared with 73
percent in the combined-treatment group (P<0.001 for both
comparisons). Among the 519 subjects who completed the
study, the rates of response were 55 percent in the
nefazodone group and 52 percent in the psychotherapy group,
as compared with 85 percent in the combined-treatment group
(P<0.001 for both comparisons). The rates of withdrawal were
similar in the three groups. Adverse events in the
nefazodone group were consistent with the known side effects
of the drug (e.g., headache, somnolence, dry mouth, nausea,
and dizziness).
Conclusions. Although about half of patients with chronic
forms of major depression have a response to short-term
treatment with either nefazodone or a cognitive
behavioral-analysis system of psychotherapy, the combination
of the two is significantly more efficacious than either
treatment alone. (N Engl J Med 2000;342:1462-70.)
See also the editorial:
http://www.nejm.org/content/2000/0342/0020/1518.asp
-- ----------------------------------------------------------------------- Anders Sandberg Towards Ascension! asa@nada.kth.se http://www.nada.kth.se/~asa/ GCS/M/S/O d++ -p+ c++++ !l u+ e++ m++ s+/+ n--- h+/* f+ g+ w++ t+ r+ !y
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