title: Antidepressant and group psychosocial treatment for depression: a rater blind exploratory RCT from a low income country.
abstract: BACKGROUND
  Research in the West shows that group psychological intervention together with an antidepressant treatment leads to more effective treatment of a depressive disorder. There are no treatment trials from low income countries comparing the efficacy of antidepressant treatment with a group psychological intervention.
  
  
  OBJECTIVE
  To conduct a feasibility trial to compare the efficacy of an antidepressant to a group psychosocial intervention, for low income women attending primary health care in Karachi, Pakistan.
  
  
  METHODS
  This was a preliminary RCT in an urban primary health care clinic in Karachi, Pakistan. Consecutive eligible women scoring >12 on the CIS-R and >18 on Hamilton Depression Rating Scale (HDRS) (n = 66) were randomly assigned to antidepressants or a psychosocial treatment in group settings. The primary outcome measure was HDRS score; secondary outcome measures were disability and quality of life.
  
  
  RESULTS
  More than half of the patients in both groups improved (50% reduction in HDRS scores); at end of therapy at 3 months 19 (59.4%) vs 18 (56.2%), and at 6-month follow-up 21(67.7%) vs 20(62.5%) for antidepressants and psychosocial intervention respectively. Although HDRS, BDQ and EQ5-D scores all improved considerably in both groups from start to end of treatment, and these improvements were largely maintained after a further 3 months, the differences between the two treatments were not statistically significant.
  
  
  CONCLUSIONS
  Psychosocial intervention was as effective as antidepressants in reducing depression and in improving quality of life and disability at the end of therapy. However, these findings need further exploration through a larger trial.
authors.affiliation: University of Manchester, andLancashire Care NHS Foundation Trust,UK.
authors.forename: Nusrat
authors.initials: N
authors.lastname: Husain
authors.affiliation: University of Manchester,UK.
authors.forename: Nasim
authors.initials: N
authors.lastname: Chaudhry
authors.affiliation: Pakistan Institute of Learning and Living,Pakistan, andBoston University,USA.
authors.forename: Batool
authors.initials: B
authors.lastname: Fatima
authors.affiliation: Lancashire Care NHS Foundation Trust,UK.
authors.forename: Meher
authors.initials: M
authors.lastname: Husain
authors.affiliation: Pakistan Institute of Learning and Living,Pakistan.
authors.forename: Rizwana
authors.initials: R
authors.lastname: Amin
authors.affiliation: Lancashire Care NHS Foundation Trust, andUniversity of Manchester,UK.
authors.forename: Imran Bashir
authors.initials: IB
authors.lastname: Chaudhry
authors.affiliation: Dow University of Health Sciences,Karachi,Pakistan.
authors.forename: Raza
authors.initials: R
authors.lastname: Ur Rahman
authors.affiliation: University of Manchester,UK.
authors.forename: Barbara
authors.initials: B
authors.lastname: Tomenson
authors.affiliation: Karachi Medical and Dental College,Pakistan.
authors.forename: Farhat
authors.initials: F
authors.lastname: Jafri
authors.affiliation: Lancashire Care NHS Foundation Trust,UK.
authors.forename: Farooq
authors.initials: F
authors.lastname: Naeem
authors.affiliation: University of Manchester,UK.
authors.forename: Francis
authors.initials: F
authors.lastname: Creed
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000928:Antidepressive Agents / Q000627:therapeutic use*; D015928:Cognitive Behavioral Therapy; D003906:Developing Countries; D004185:Disability Evaluation; D005240:Feasibility Studies; D005260:Female; D005473:Fluoxetine / Q000627:therapeutic use*; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D010154:Pakistan; D010555:Personality Inventory / Q000706:statistics & numerical data; D011203:Poverty / Q000523:psychology*; D011594:Psychometrics; D011615:Psychotherapy, Group; D011788:Quality of Life / Q000523:psychology; D016037:Single-Blind Method; D055815:Young Adult
chemical_list: D000928:Antidepressive Agents; D005473:Fluoxetine