title: The superiority of antidepressant medication to cognitive behavior therapy in melancholic depressed patients: a 12-week single-blind randomized study.
abstract: OBJECTIVE
  To pursue the previously long-standing but formally untested clinical view that melancholia is preferentially responsive to antidepressant medication in comparison with psychotherapy [specifically Cognitive Behavior Therapy (CBT)]. Second, to determine whether a broader action antidepressant medication sequencing regimen is superior to a Selective Serotonin Reuptake Inhibitor (SSRI) alone.
  
  
  METHODS
  We sought to recruit a large sample of participants with melancholic depression for a 12-week trial but inclusion criteria compromised recruitment and testing the second hypothesis. The first hypothesis was evaluated by comparing 18 participants receiving antidepressant medication to 11 receiving CBT. Primary study measures were the Hamilton Rating Scale for Depression (HAM-D) and the Hamilton Endogenous Subscale (HES), rated blindly, while several secondary measures also evaluated outcome.
  
  
  RESULTS
  Participants receiving medication had a superior 12-week outcome to those receiving CBT, with significant differences present on primary measures as early as 4 weeks. At trial conclusion, the percentage improvement in HAM-D scores was 61.1% vs. 34.4%, respectively [Number Needed to Treat (NNT) = 3.7] and with those in receipt of medication returning non-significantly higher HAM-D responder (66.6% vs. 36.4%, NNT = 2.8) and remission (66.7% vs. 45.4%, NNT = 4.7) rates.
  
  
  CONCLUSIONS
  As the sample size was small and participants evidenced only moderate levels of depression severity, the study risked being underpowered and idiosyncratic. Despite the small sample, the superiority of antidepressant medication to CBT in those with a melancholic depression was distinctive in this pilot study.
authors.affiliation: School of Psychiatry, University of New South Wales, Sydney, Australia.
authors.forename: G
authors.initials: G
authors.lastname: Parker
authors.forename: B
authors.initials: B
authors.lastname: Blanch
authors.forename: A
authors.initials: A
authors.lastname: Paterson
authors.forename: D
authors.initials: D
authors.lastname: Hadzi-Pavlovic
authors.forename: E
authors.initials: E
authors.lastname: Sheppard
authors.forename: V
authors.initials: V
authors.lastname: Manicavasagar
authors.forename: H
authors.initials: H
authors.lastname: Synnott
authors.forename: R K
authors.initials: RK
authors.lastname: Graham
authors.forename: P
authors.initials: P
authors.lastname: Friend
authors.forename: D
authors.initials: D
authors.lastname: Gilfillan
authors.forename: T
authors.initials: T
authors.lastname: Perich
mesh_terms: D000328:Adult; D000928:Antidepressive Agents / Q000008:administration & dosage / Q000494:pharmacology*; D000929:Antidepressive Agents, Tricyclic / Q000008:administration & dosage / Q000494:pharmacology; D015283:Citalopram / Q000008:administration & dosage / Q000494:pharmacology; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D003511:Cyclohexanols / Q000008:administration & dosage / Q000494:pharmacology; D003866:Depressive Disorder / Q000188:drug therapy / Q000628:therapy*; D000069468:Desvenlafaxine Succinate; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D016037:Single-Blind Method; D016896:Treatment Outcome
chemical_list: D000928:Antidepressive Agents; D000929:Antidepressive Agents, Tricyclic; D003511:Cyclohexanols; D015283:Citalopram; D000069468:Desvenlafaxine Succinate