title: The efficacy of cognitive-behavioral therapy and psychodynamic therapy in the outpatient treatment of major depression: a randomized clinical trial.
abstract: OBJECTIVE
  The efficacy of psychodynamic therapies for depression remains open to debate because of a paucity of high-quality studies. The authors compared the efficacy of psychodynamic therapy with that of cognitive-behavioral therapy (CBT), hypothesizing nonsignificant differences and the noninferiority of psychodynamic therapy relative to CBT.
  
  
  METHODS
  A total of 341 adults who met DSM-IV criteria for a major depressive episode and had Hamilton Depression Rating Scale (HAM-D) scores ≥14 were randomly assigned to 16 sessions of individual manualized CBT or short-term psychodynamic supportive therapy. Severely depressed patients (HAM-D score >24) also received antidepressant medication according to protocol. The primary outcome measure was posttreatment remission rate (HAM-D score ≤7). Secondary outcome measures included mean posttreatment HAM-D score and patient-rated depression score and 1-year follow-up outcomes. Data were analyzed with generalized estimating equations and mixed-model analyses using intent-to-treat samples. Noninferiority margins were prespecified as an odds ratio of 0.49 for remission rates and a Cohen's d value of 0.30 for continuous outcome measures.
  
  
  RESULTS
  No statistically significant treatment differences were found for any of the outcome measures. The average posttreatment remission rate was 22.7%. Noninferiority was shown for posttreatment HAM-D and patient-rated depression scores but could not be demonstrated for posttreatment remission rates or any of the follow-up measures.
  
  
  CONCLUSIONS
  The findings extend the evidence base of psychodynamic therapy for depression but also indicate that time-limited treatment is insufficient for a substantial number of patients encountered in psychiatric outpatient clinics.
authors.forename: Ellen
authors.initials: E
authors.lastname: Driessen
authors.forename: Henricus L
authors.initials: HL
authors.lastname: Van
authors.forename: Frank J
authors.initials: FJ
authors.lastname: Don
authors.forename: Jaap
authors.initials: J
authors.lastname: Peen
authors.forename: Simone
authors.initials: S
authors.lastname: Kool
authors.forename: Dieuwertje
authors.initials: D
authors.lastname: Westra
authors.forename: Mariëlle
authors.initials: M
authors.lastname: Hendriksen
authors.forename: Robert A
authors.initials: RA
authors.lastname: Schoevers
authors.forename: Pim
authors.initials: P
authors.lastname: Cuijpers
authors.forename: Jos W R
authors.initials: JW
authors.lastname: Twisk
authors.forename: Jack J M
authors.initials: JJ
authors.lastname: Dekker
mesh_terms: D000328:Adult; D000553:Ambulatory Care / Q000379:methods*; D000928:Antidepressive Agents / Q000627:therapeutic use*; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D003865:Major Depressive Disorder / Q000175:diagnosis / Q000523:psychology / Q000628:therapy*; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005260:Female; D006801:Humans; D008297:Male; D008605:Mental Health Services; D008875:Middle Aged; D016017:Odds Ratio; D017063:Outcome Assessment, Health Care; D010045:Outpatients; D011569:Psychiatric Status Rating Scales; D011614:Psychotherapy, Brief / Q000379:methods*; D012074:Remission Induction; D016896:Treatment Outcome
chemical_list: D000928:Antidepressive Agents