title: Differential change in specific depressive symptoms during antidepressant medication or cognitive therapy.
abstract: Cognitive therapy and antidepressant medications are effective treatments for depression, but little is known about their relative efficacy in reducing individual depressive symptoms. Using data from a recent clinical trial comparing cognitive therapy, antidepressant medication, and placebo in the treatment of moderate-to-severe depression, we examined whether there was a relative advantage of any treatment in reducing the severity of specific depressive symptom clusters. The sample consisted of 231 depressed outpatients randomly assigned to: cognitive therapy for 16 weeks (n = 58); paroxetine treatment for 16 weeks (n = 116); or pill placebo for 8 weeks (n = 57). Differential change in five subsets of depressive symptoms was examined: mood, cognitive/suicide, anxiety, typical-vegetative, and atypical-vegetative symptoms. Medication led to a greater reduction in cognitive/suicide symptoms relative to placebo by 4 weeks, and both active treatments reduced these symptoms more than did placebo by 8 weeks. Cognitive therapy reduced the atypical-vegetative symptoms more than placebo by 8 weeks and more than medications throughout the trial. These findings suggest that medications and cognitive therapy led to different patterns of response to specific symptoms of depression and that the general efficacy of these two well-validated treatments may be driven in large part by changes in cognitive or atypical-vegetative symptoms.
authors: Department of Psychiatry, University of Pittsburgh School of Medicine, 3811 O'Hara Street, Pittsburgh, PA 15213, USA. fournierjc@upmc.edu
authors: Jay C
authors: JC
authors: Fournier
authors: Robert J
authors: RJ
authors: DeRubeis
authors: Steven D
authors: SD
authors: Hollon
authors: Robert
authors: R
authors: Gallop
authors: Richard C
authors: RC
authors: Shelton
authors: Jay D
authors: JD
authors: Amsterdam
mesh_terms: D000339:Affect / Q000187:drug effects; D000928:Antidepressive Agents / Q000627:therapeutic use*; D001007:Anxiety / Q000628:therapy; D003071:Cognition / Q000187:drug effects; D015928:Cognitive Behavioral Therapy; D003863:Depression / Q000188:drug therapy* / Q000628:therapy*; D006801:Humans; D017374:Paroxetine / Q000627:therapeutic use; D059020:Suicidal Ideation; D063189:Symptom Assessment / Q000523:psychology*
chemical_list: D000928:Antidepressive Agents; D017374:Paroxetine
references: J Clin Psychol. 2006 Jan;62(1):123-46
references: 16287149
references: Arch Gen Psychiatry. 2005 Apr;62(4):409-16
references: 15809408
references: Annu Rev Psychol. 2006;57:285-315
references: 16318597
references: J Clin Psychopharmacol. 1989 Oct;9(5):334-9
references: 2677061
references: J Affect Disord. 2008 Sep;110(1-2):161-6
references: 18276017
references: Hosp Community Psychiatry. 1985 Mar;36(3):275-82
references: 3979979
references: Am J Psychiatry. 2004 Dec;161(12):2163-77
references: 15569884
references: Ann Pharmacother. 1993 Oct;27(10):1212-22
references: 8251692
references: J Consult Clin Psychol. 1996 Feb;64(1):74-80
references: 8907086
references: J Affect Disord. 2010 Jun;123(1-3):181-7
references: 19733912
references: Acta Psychiatr Scand. 2007 Feb;115(2):89-92
references: 17244171
references: J Psychopharmacol. 2010 Apr;24(4):621-2
references: 18838496
references: Br J Psychiatry. 2009 Aug;195(2):102-8
references: 19648538
references: J Clin Psychiatry. 2005 Apr;66(4):455-68
references: 15816788
references: J Clin Psychopharmacol. 2006 Aug;26(4):373-8
references: 16855454
references: J Consult Clin Psychol. 1990 Jun;58(3):352-9
references: 2195085
references: Am J Psychiatry. 2008 Mar;165(3):342-51
references: 18172020
references: Psychiatry Res. 2002 Nov 15;112(3):195-210
references: 12450629
references: Am J Psychiatry. 1998 Sep;155(9):1247-53
references: 9734550
references: Neuropsychobiology. 2007;56(2-3):73-85
references: 18037817
references: J Consult Clin Psychol. 1990 Dec;58(6):862-9
references: 2292637
references: Arch Gen Psychiatry. 1979 Dec;36(13):1450-6
references: 518245
references: Psychol Bull. 1987 Jul;102(1):139-49
references: 3615703
references: J Clin Psychiatry. 1992 Jan;53(1):5-11
references: 1737741
references: Acta Psychiatr Scand Suppl. 2007;(433):72-84
references: 17280573
references: Int Clin Psychopharmacol. 2010 Jul;25(4):214-7
references: 20400905
references: Arch Gen Psychiatry. 2005 Apr;62(4):417-22
references: 15809409
references: J Neurol Neurosurg Psychiatry. 1960 Feb;23:56-62
references: 14399272
references: J Affect Disord. 2012 Mar;137(1-3):87-97
references: 22252094
references: J Affect Disord. 1981 Sep;3(3):221-9
references: 6456289