Management of depression in rheumatoid arthritis: a combined pharmacologic and cognitive-behavioral approach.
OBJECTIVE
To examine the effectiveness of cognitive-behavioral and pharmacologic treatment of depression in rheumatoid arthritis (RA).


METHODS
Subjects (n = 54) with confirmed diagnoses of both major depression and RA were randomly assigned to 1 of 3 groups: 1) cognitive-behavioral/pharmacologic group (CB-PHARM), 2) attention-control/pharmacologic group, or 3) pharmacologic control group. Measures of depression, psychosocial status, health status, pain, and disease activity were collected at baseline, posttreatment (10 weeks), 6-month followup, and 15-month followup. Data were analyzed to compare the treatment effectiveness of the groups; data also were aggregated to examine the effects of antidepressive medication over time. Lastly, a no-treatment control group was defined from a cohort of persons who declined participation.


RESULTS
Baseline comparisons on demographic and dependent measures revealed a need to assess covariates on age and education; baseline scores on dependent measures also were entered as covariates. Analyses of covariance revealed no statistically significant group differences at postintervention, 6-month followup, or 15-month followup, except higher state and trait anxiety scores for the CB-PHARM group at the 15-month followup. In the longitudinal analyses of the effects of antidepressive medication, significant improvement in psychological status and health status were found at posttreatment, 6-month followup, and 15-month followup, but no significant improvements were shown for pain or disease activity. In addition, the comparison of the aggregated pharmacologic group with a no-treatment group revealed a statistically significant benefit for the 3 groups that received the antidepressive medication.


CONCLUSIONS
In persons with RA, cognitive-behavioral approaches to the management of depression were not found to be additive to antidepressant medication alone, but antidepressant intervention was superior to no treatment.
Parker
Jerry C
JC
Behavioral Health Service Line, Harry S Truman Memorial Veterans' Hospital, 800 Hospital Drive, Columbia, MO 65201, USA.
Smarr
Karen L
KL
Slaughter
James R
JR
Johnston
Sandra K
SK
Priesmeyer
Marydeth L
ML
Hanson
Kathleen Donovan
KD
Johnson
Gail E
GE
Hewett
James E
JE
Hewett
John E
JE
Irvin
William S
WS
Komatireddy
Geetha R
GR
Walker
Sara E
SE
D000928:Antidepressive Agents / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000150:complications* / Q000503:physiopathology / Q000523:psychology; D015928:Cognitive Behavioral Therapy; D003131:Combined Modality Therapy; D003865:Major Depressive Disorder / Q000209:etiology* / Q000628:therapy*; D005260:Female; D006304:Health Status; D006801:Humans; D008297:Male; D008603:Mental Health; D008875:Middle Aged; D059408:Pain Management; D011446:Prospective Studies; D012720:Severity of Illness Index; D016896:Treatment Outcome
D000928:Antidepressive Agents