Remission in major depressive disorder: a comparison of pharmacotherapy, psychotherapy, and control conditions.
OBJECTIVE
The aim of this study was to assess the percentages of full remission in studies of patients with major depressive disorder in which pharmacotherapy, psychotherapy, and control conditions were directly compared.


METHODS
Computerized searches of the MEDLINE and PsychINFO databases up to November 2000 were used to identify six multiple-cell randomized, controlled, double-blind trials for well-defined major depressive disorder in which medications, psychotherapy, and control conditions were directly compared and for which remission percentages were reported.


RESULTS
The studies included a total of 883 outpatients with mild to moderate, primarily nonmelancholic, nonpsychotic major depressive disorder. Treatment duration ranged from 10 to 34 weeks (median=16 weeks). An intent-to-treat analysis indicated that, according to measurements by independent blind raters, antidepressant medication (tricyclic antidepressants and phenelzine) and psychotherapy (primarily cognitive behavior and interpersonal therapies) were more efficacious than control conditions, but there were no differences between active treatments. The percentages of remission for all patients randomly assigned to medication, psychotherapy, and control conditions were 46.4%, 46.3%, and 24.4%, respectively. Furthermore, significantly more patients dropped out of control conditions (54.4%) than either treatment with medication (37.1%) or psychotherapy (22.2%).


CONCLUSIONS
Both antidepressant medication and psychotherapy may be considered first-line treatments for mildly to moderately depressed outpatients.
Casacalenda
Nicola
N
Institute of Community and Family Psychiatry, Department of Psychiatry, Jewish General Hospital and McGill University, Montreal, Quebec, Canada. ncasacal@icfp.jgh.mcgill.ca
Perry
J Christopher
JC
Looper
Karl
K
D000328:Adult; D000553:Ambulatory Care; D000928:Antidepressive Agents / Q000627:therapeutic use*; D000929:Antidepressive Agents, Tricyclic / Q000627:therapeutic use; D015928:Cognitive Behavioral Therapy; D019992:Databases as Topic / Q000706:statistics & numerical data; D003866:Depressive Disorder / Q000175:diagnosis / Q000188:drug therapy / Q000628:therapy*; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D008297:Male; D010555:Personality Inventory; D010624:Phenelzine / Q000627:therapeutic use; D011569:Psychiatric Status Rating Scales; D011613:Psychotherapy; D016032:Randomized Controlled Trials as Topic / Q000706:statistics & numerical data; D012044:Regression Analysis; D012720:Severity of Illness Index; D016896:Treatment Outcome
D000928:Antidepressive Agents; D000929:Antidepressive Agents, Tricyclic; D010624:Phenelzine