title: Gains in employment status following antidepressant medication or cognitive therapy for depression.
abstract: BACKGROUND
  Depression can adversely affect employment status.
  
  
  OBJECTIVE
  To examine whether there is a relative advantage of cognitive therapy or antidepressant medication in improving employment status following treatment, using data from a previously reported trial.
  
  
  METHODS
  Random assignment to cognitive therapy (n = 48) or the selective serotonin reuptake inhibitor paroxetine (n = 93) for 4 months; treatment responders were followed for up to 24 months. Differential effects of treatment on employment status were examined.
  
  
  RESULTS
  At the end of 28 months, cognitive therapy led to higher rates of full-time employment (88.9%) than did antidepressant medication among treatment responders (70.8%), χ(2) 1 = 5.78, P = 0.02, odds ratio (OR) = 5.66, 95% CI 1.16-27.69. In the shorter-term, the main effect of treatment on employment status was not significant following acute treatment (χ(2) 1 = 1.74, P = 0.19, OR = 1.77, 95% CI 0.75-4.17); however, we observed a site×treatment interaction (χ(2) 1 = 6.87, P = 0.009) whereby cognitive therapy led to a higher rate of full-time employment at one site but not at the other.
  
  
  CONCLUSIONS
  Cognitive therapy may produce greater improvements in employment v. medication, particularly over the longer term.
authors.affiliation: Jay C. Fournier, PhD, Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania; Robert J. DeRubeis, PhD, Department of Psychology, University of Pennsylvania, Philadelphia, Pennsylvania; Jay Amsterdam, MD, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Richard C. Shelton, MD, Department of Psychiatry and Behavioral Neurobiology, The University of Alabama at Birmingham, Birmingham, Alabama; Steven D. Hollon, PhD, Department of Psychology, Vanderbilt University, Nashville, Tennessee, USA.
authors.forename: Jay C
authors.initials: JC
authors.lastname: Fournier
authors.affiliation: Jay C. Fournier, PhD, Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania; Robert J. DeRubeis, PhD, Department of Psychology, University of Pennsylvania, Philadelphia, Pennsylvania; Jay Amsterdam, MD, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Richard C. Shelton, MD, Department of Psychiatry and Behavioral Neurobiology, The University of Alabama at Birmingham, Birmingham, Alabama; Steven D. Hollon, PhD, Department of Psychology, Vanderbilt University, Nashville, Tennessee, USA.
authors.forename: Robert J
authors.initials: RJ
authors.lastname: DeRubeis
authors.affiliation: Jay C. Fournier, PhD, Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania; Robert J. DeRubeis, PhD, Department of Psychology, University of Pennsylvania, Philadelphia, Pennsylvania; Jay Amsterdam, MD, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Richard C. Shelton, MD, Department of Psychiatry and Behavioral Neurobiology, The University of Alabama at Birmingham, Birmingham, Alabama; Steven D. Hollon, PhD, Department of Psychology, Vanderbilt University, Nashville, Tennessee, USA.
authors.forename: Jay
authors.initials: J
authors.lastname: Amsterdam
authors.affiliation: Jay C. Fournier, PhD, Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania; Robert J. DeRubeis, PhD, Department of Psychology, University of Pennsylvania, Philadelphia, Pennsylvania; Jay Amsterdam, MD, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Richard C. Shelton, MD, Department of Psychiatry and Behavioral Neurobiology, The University of Alabama at Birmingham, Birmingham, Alabama; Steven D. Hollon, PhD, Department of Psychology, Vanderbilt University, Nashville, Tennessee, USA.
authors.forename: Richard C
authors.initials: RC
authors.lastname: Shelton
authors.affiliation: Jay C. Fournier, PhD, Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania; Robert J. DeRubeis, PhD, Department of Psychology, University of Pennsylvania, Philadelphia, Pennsylvania; Jay Amsterdam, MD, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Richard C. Shelton, MD, Department of Psychiatry and Behavioral Neurobiology, The University of Alabama at Birmingham, Birmingham, Alabama; Steven D. Hollon, PhD, Department of Psychology, Vanderbilt University, Nashville, Tennessee, USA.
authors.forename: Steven D
authors.initials: SD
authors.lastname: Hollon
mesh_terms: D000928:Antidepressive Agents / Q000627:therapeutic use*; D015928:Cognitive Behavioral Therapy; D003863:Depression / Q000628:therapy*; D003865:Major Depressive Disorder / Q000628:therapy*; D004651:Employment / Q000706:statistics & numerical data*; D005500:Follow-Up Studies; D006801:Humans; D016017:Odds Ratio; D017374:Paroxetine / Q000627:therapeutic use*; D017367:Selective Serotonin Reuptake Inhibitors / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D000928:Antidepressive Agents; D017374:Paroxetine; D017367:Selective Serotonin Reuptake Inhibitors