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Depressed Outpatients Treated With Cognitive Therapy or Pharmacotherapy: A One-Year Follow-up

Depressed Outpatients Treated With Cognitive Therapy or Pharmacotherapy: A One-Year Follow-up Abstract • Using a controlled, clinical-trial format, 44 nonpsychotic, nonbipolar, depressed outpatients were treated with cognitive therapy or imipramine hydrochloride over a 12-week period. Although both interventions were associated with significant reductions in levels of depression, the cognitive-therapy patients showed greater symptomatic improvement and a higher treatment-completion rate. A one-year naturalistic follow-up of the 35 subjects who completed the protocol revealed that although many of the patients had a variable clinical course, both original treatment groups remained generally well. Self-rated depressive symptomatology was significantly lower for those who, one year earlier, had completed cognitive therapy than for those who had been in the clinical trial's pharmacotherapy cell. While there were several other interesting trends in favor of the cognitivetherapy patients, none of the between-group differences were significant. The pragmatic and clinical implications of the followup results are discussed. References 1. Morris JB, Beck AT: The efficacy of antidepressant drugs: A review of research (1958 to 1972) . Arch Gen Psychiatry 30:667-674, 1974.Crossref 2. Hollon SD, Beck AT: Psychotherapy and drug therapy: Comparison and combinations , in Garfield SL, Bergin AE (eds): Handbook of Psychotherapy and Behavior Change: An Empirical Analysis , ed 2. New York, John Wiley & Sons Inc, 1978, pp 437-490. 3. Weissman MM: The psychological treatment of depression: Evidence for the efficacy of psychotherapy alone, in comparison with, and in combination with pharmacotherapy . Arch Gen Psychiatry 36:1261-1269, 1979.Crossref 4. Kovacs M: The efficacy of cognitive and behavior therapies for depression . Am J Psychiatry 137:1495-1501, 1980. 5. Beck AT, Rush AJ, Shaw BF, et al: Cognitive Therapy of Depression . New York, Guilford Press, 1979. 6. Weissman MM, Kasl SV, Klerman GL: Follow-up of depressed women after maintenance treatment . Am J Psychiatry 133:757-760, 1976. 7. Rush AJ, Beck AT, Kovacs M, et al: Comparative efficacy of cognitive therapy and pharmacotherapy in the treatment of depressed outpatients . Cog Ther Res 1:17-37, 1977.Crossref 8. Feighner JP, Robins E, Guze SB, et al: Diagnostic criteria for use in psychiatric research . Arch Gen Psychiatry 26:57-63, 1972.Crossref 9. Hamilton M: Development of a rating scale for primary depressive illness . Br J Soc Clin Psychol 6:278-296, 1967.Crossref 10. Beck AT, Beamesderfer A: Assessment of depression: The Depression Inventory , in Pichot P (ed): Psychological Measurements in Psychopharmacology: Modern Problems in Pharmacopsychiatry . Basel, Switzerland, S Karger AG, 1974, vol 7, pp 151-169. 11. Diagnostic and Statistical Manual of Mental Disorders, ed 2. Washington, DC, American Psychiatric Association, 1968. 12. Beck AT: Cognitive Therapy and the Emotional Disorders . New York, International Universities Press, 1976. 13. Kovacs M: Cognitive therapy in depression . J Am Acad Psychoanal 8:127-144, 1980. 14. Hamilton M: The assessment of anxiety states by rating . Br J Med Psychol 32:50-55, 1959.Crossref 15. Raskin A, Schulterbrandt JG, Reatig N, et al: Differential response to chlorpromazine, imipramine, and placebo: A study of subgroups of hospitalized depressed patients . Arch Gen Psychiatry 23:164-173, 1970.Crossref 16. Beck AT: Depression: Causes and Treatment . Philadelphia, University of Pennsylvania Press, 1972. 17. Eysenck HJ, Eysenck SBG: The Manual of the Eysenck Personality Inventory . San Diego, Educational and Industrial Testing Service, 1968. 18. Beck AT, Weissman A, Lester D, et al: The measurement of pessimism: The Hopelessness Scale . J Consult Clin Psychol 42:861-865, 1974.Crossref 19. Rush AJ, Hollon SD, Beck AT, et al: Depression: Must pharmacotherapy fail for cognitive therapy to succeed? Cog Ther Res 2:199-206, 1978.Crossref 20. Schwab J, Bialow M, Clemmons R, et al: The Beck Depression Inventory with medical inpatients . Acta Psychiatr Scand 43:255-266, 1967.Crossref 21. Davis JM: Overview: Maintenance therapy in psychiatry: I. Schizophrenia . Am J Psychiatry 132:1237-1245, 1975. 22. Weissman MM, Prusoff BA, DiMascio A, et al: The efficacy of drugs and psychotherapy in the treatment of acute depressive episodes . Am J Psychiatry 136:555-558, 1979. 23. Covi L, Lipman RS, Derogatis LR, et al: Drugs and group psychotherapy in neurotic depression . Am J Psychiatry 131:191-198, 1974. 24. Friedman AS: Interaction of drug therapy with marital therapy in depressive patients . Arch Gen Psychiatry 32:619-637, 1975.Crossref 25. Klerman GL, DiMascio A, Weissman M, et al: Treatment of depression by drugs and psychotherapy . Am J Psychiatry 131:186-191, 1974. 26. Murphy GE, Woodruff RA Jr, Herjanic M, et al: Variability of the clinical course of primary affective disorder . Arch Gen Psychiatry 30:757-761, 1974.Crossref 27. Brown GW, Harris T: Social Origins of Depression . New York, The Free Press, 1978. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of General Psychiatry American Medical Association

Depressed Outpatients Treated With Cognitive Therapy or Pharmacotherapy: A One-Year Follow-up

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Publisher
American Medical Association
Copyright
Copyright © 1981 American Medical Association. All Rights Reserved.
ISSN
0003-990X
eISSN
1598-3636
DOI
10.1001/archpsyc.1981.01780260035003
Publisher site
See Article on Publisher Site

Abstract

Abstract • Using a controlled, clinical-trial format, 44 nonpsychotic, nonbipolar, depressed outpatients were treated with cognitive therapy or imipramine hydrochloride over a 12-week period. Although both interventions were associated with significant reductions in levels of depression, the cognitive-therapy patients showed greater symptomatic improvement and a higher treatment-completion rate. A one-year naturalistic follow-up of the 35 subjects who completed the protocol revealed that although many of the patients had a variable clinical course, both original treatment groups remained generally well. Self-rated depressive symptomatology was significantly lower for those who, one year earlier, had completed cognitive therapy than for those who had been in the clinical trial's pharmacotherapy cell. While there were several other interesting trends in favor of the cognitivetherapy patients, none of the between-group differences were significant. The pragmatic and clinical implications of the followup results are discussed. References 1. Morris JB, Beck AT: The efficacy of antidepressant drugs: A review of research (1958 to 1972) . Arch Gen Psychiatry 30:667-674, 1974.Crossref 2. Hollon SD, Beck AT: Psychotherapy and drug therapy: Comparison and combinations , in Garfield SL, Bergin AE (eds): Handbook of Psychotherapy and Behavior Change: An Empirical Analysis , ed 2. New York, John Wiley & Sons Inc, 1978, pp 437-490. 3. Weissman MM: The psychological treatment of depression: Evidence for the efficacy of psychotherapy alone, in comparison with, and in combination with pharmacotherapy . Arch Gen Psychiatry 36:1261-1269, 1979.Crossref 4. Kovacs M: The efficacy of cognitive and behavior therapies for depression . Am J Psychiatry 137:1495-1501, 1980. 5. Beck AT, Rush AJ, Shaw BF, et al: Cognitive Therapy of Depression . New York, Guilford Press, 1979. 6. Weissman MM, Kasl SV, Klerman GL: Follow-up of depressed women after maintenance treatment . Am J Psychiatry 133:757-760, 1976. 7. Rush AJ, Beck AT, Kovacs M, et al: Comparative efficacy of cognitive therapy and pharmacotherapy in the treatment of depressed outpatients . Cog Ther Res 1:17-37, 1977.Crossref 8. Feighner JP, Robins E, Guze SB, et al: Diagnostic criteria for use in psychiatric research . Arch Gen Psychiatry 26:57-63, 1972.Crossref 9. Hamilton M: Development of a rating scale for primary depressive illness . Br J Soc Clin Psychol 6:278-296, 1967.Crossref 10. Beck AT, Beamesderfer A: Assessment of depression: The Depression Inventory , in Pichot P (ed): Psychological Measurements in Psychopharmacology: Modern Problems in Pharmacopsychiatry . Basel, Switzerland, S Karger AG, 1974, vol 7, pp 151-169. 11. Diagnostic and Statistical Manual of Mental Disorders, ed 2. Washington, DC, American Psychiatric Association, 1968. 12. Beck AT: Cognitive Therapy and the Emotional Disorders . New York, International Universities Press, 1976. 13. Kovacs M: Cognitive therapy in depression . J Am Acad Psychoanal 8:127-144, 1980. 14. Hamilton M: The assessment of anxiety states by rating . Br J Med Psychol 32:50-55, 1959.Crossref 15. Raskin A, Schulterbrandt JG, Reatig N, et al: Differential response to chlorpromazine, imipramine, and placebo: A study of subgroups of hospitalized depressed patients . Arch Gen Psychiatry 23:164-173, 1970.Crossref 16. Beck AT: Depression: Causes and Treatment . Philadelphia, University of Pennsylvania Press, 1972. 17. Eysenck HJ, Eysenck SBG: The Manual of the Eysenck Personality Inventory . San Diego, Educational and Industrial Testing Service, 1968. 18. Beck AT, Weissman A, Lester D, et al: The measurement of pessimism: The Hopelessness Scale . J Consult Clin Psychol 42:861-865, 1974.Crossref 19. Rush AJ, Hollon SD, Beck AT, et al: Depression: Must pharmacotherapy fail for cognitive therapy to succeed? Cog Ther Res 2:199-206, 1978.Crossref 20. Schwab J, Bialow M, Clemmons R, et al: The Beck Depression Inventory with medical inpatients . Acta Psychiatr Scand 43:255-266, 1967.Crossref 21. Davis JM: Overview: Maintenance therapy in psychiatry: I. Schizophrenia . Am J Psychiatry 132:1237-1245, 1975. 22. Weissman MM, Prusoff BA, DiMascio A, et al: The efficacy of drugs and psychotherapy in the treatment of acute depressive episodes . Am J Psychiatry 136:555-558, 1979. 23. Covi L, Lipman RS, Derogatis LR, et al: Drugs and group psychotherapy in neurotic depression . Am J Psychiatry 131:191-198, 1974. 24. Friedman AS: Interaction of drug therapy with marital therapy in depressive patients . Arch Gen Psychiatry 32:619-637, 1975.Crossref 25. Klerman GL, DiMascio A, Weissman M, et al: Treatment of depression by drugs and psychotherapy . Am J Psychiatry 131:186-191, 1974. 26. Murphy GE, Woodruff RA Jr, Herjanic M, et al: Variability of the clinical course of primary affective disorder . Arch Gen Psychiatry 30:757-761, 1974.Crossref 27. Brown GW, Harris T: Social Origins of Depression . New York, The Free Press, 1978.

Journal

Archives of General PsychiatryAmerican Medical Association

Published: Jan 1, 1981

References