title: Cognitive Behavioral Analysis System of Psychotherapy versus Escitalopram in Chronic Major Depression.
abstract: BACKGROUND
  A specific psychotherapy for chronic depression, the Cognitive Behavioral Analysis System of Psychotherapy (CBASP), was compared to escitalopram (ESC).
  
  
  METHODS
  Sixty patients with chronic major depression were randomized to 'CBASP' (22 sessions) or 'ESC plus clinical management' (ESC/CM) at two treatment sites. The primary outcome measure was the score on the Montgomery-Asberg Depression Rating Scale (MADRS) after 8 weeks of acute treatment assessed by blinded raters. In the case of nonimprovement (<20% reduction in the MADRS score), the other condition was augmented for the following 20 weeks of extended treatment. Secondary end points were, among others, depressive symptoms, remission (MADRS score of ≤9) and response rates (reduction of MADRS score of ≥50%) 28 weeks after randomization.
  
  
  RESULTS
  An intent-to-treat analysis revealed that clinician-rated depression scores decreased significantly after 8 and 28 weeks with no significant differences between the groups. The response rates after 28 weeks of treatment were high (CBASP: 68.4%, ESC/CM: 60.0%), and the remission rates were moderate (CBASP: 36.8%, ESC/CM: 50.0%) with neither group being superior. Nonimprovers to the initial treatment caught up with the initial improvers in terms of depression scores and response and remission rates by the end of the treatment after being augmented with the respective other condition.
  
  
  CONCLUSIONS
  CBASP and ESC/CM appear to be equally effective treatment options for chronically depressed outpatients. For nonimprovers to the initial treatment, it is efficacious to augment with medication in the case of nonresponse to CBASP and vice versa.
authors.affiliation: Department of Psychiatry and Psychotherapy, University Medical Center Freiburg, Freiburg, Germany.
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Schramm
authors.forename: Ingo
authors.initials: I
authors.lastname: Zobel
authors.forename: Dieter
authors.initials: D
authors.lastname: Schoepf
authors.forename: Thomas
authors.initials: T
authors.lastname: Fangmeier
authors.forename: Knut
authors.initials: K
authors.lastname: Schnell
authors.forename: Henrik
authors.initials: H
authors.lastname: Walter
authors.forename: Sarah
authors.initials: S
authors.lastname: Drost
authors.forename: Paul
authors.initials: P
authors.lastname: Schmidt
authors.forename: Eva-Lotta
authors.initials: EL
authors.lastname: Brakemeier
authors.forename: Mathias
authors.initials: M
authors.lastname: Berger
authors.forename: Claus
authors.initials: C
authors.lastname: Normann
mesh_terms: D000328:Adult; D018687:Antidepressive Agents, Second-Generation / Q000627:therapeutic use*; D002908:Chronic Disease; D015283:Citalopram / Q000627:therapeutic use*; D003865:Major Depressive Disorder / Q000188:drug therapy* / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011569:Psychiatric Status Rating Scales; D011613:Psychotherapy / Q000379:methods*
chemical_list: D018687:Antidepressive Agents, Second-Generation; D015283:Citalopram