Table 40-3 Randomized controlled clinical trials comparing depression-focused psychotherapies and pharmacotherapy as acute-phase treatments of major depressive disorder

Table 40-3 Randomized controlled clinical trials comparing depression-focused psychotherapies and pharmacotherapy as acute-phase treatments of major depressive disorder
Treatment	Study	N	Duration (weeks)	Comparison of efficacy
Interpersonal
	Weissman et al. (1979)	96	16	Combined > IPT = amitriptyline
	Schneider et al. (1986)	26	16	IPT = nortriptyline
	Elkin et al. (1989)	239	16	IPT ≤ imipramine^a
	Schulberg et al. (1996)	276	32	IPT = nortriptyline > TAU
	Reynolds et al. (1999b)	80	16	Nortriptyline > IPT = placebo
Behavioral
	McLean and Hakstian (1979)	178	10	BT > amitriptyline
	Roth et al. (1982)	26	12	Combined (desipramine) ≥ BT^b
	Wilson (1982)	64	8	Combined ≥ BT = amitriptyline^b
	Hersen et al. (1984)	120	12	Combined = BT = amitriptyline
	Mynors-Wallis et al. (1995)	91	12	BT = amitriptyline > placebo
Cognitive
	Rush et al. (1977)	41	12	CT > imipramine
	Rush and Watkins (1981)	39	12	Combined (tricyclic)^c ≥ CT
	Blackburn et al. (1981)	64	12	Combined = CT > tricyclic^c (general practice clinic setting)
				Combined^d ≥ CT = tricyclic^c (psychiatric clinic setting)
	Teasdale et al. (1984)	34	15	CT + TAU > TAU^e
	Murphy et al. (1984)	70	12	Combined = CT = nortriptyline
	Beck et al. (1985)	33	12	Combined (amitriptyline) = CT
	Beutler et al. (1987)	56	20	CT (group) + alprazolam > alprazolam alone
	Covi and Lipman (1987)	70	14	combined (imipramine) = CT (group)
	Elkin et al. (1989)	239	16	CT ≤ imipramine^a
	Hollon et al. (1992a)	106	12	Combinedd ≥ CT = imipramine
	McKnight et al. (1992)	43	8	CT = amitriptyline^f
	Murphy et al. (1995)	37	16	CT = RT > desipramine
	Blackburn and Moore (1997)	75	16	CT = antidepressants^c
	Jarrett et al. (1999)	108	10	CT = phenelzine > placebo
	M. B. Keller et al. (2000)	681	12	Combined > CT = nefazodone
Note. IPT = interpersonal psychotherapy; BT = behavior therapy; CT = cognitive therapy; RT = relaxation training; TAU = treatment as usual. ">" indicates more efficacy; "≥" indicates at least as much efficacy and sometimes more; "=" indicates equal efficacy.
^a Imipramine was more rapidly effective than either form of psychotherapy. Also, imipramine was more effective than cognitive therapy in patients with Hamilton Rating Scale for Depression (Hamilton 1960) scores > 20.
^b Combined treatment was more rapidly effective, but groups were not statistically different at protocol completion.
^c This indicates doctor's choice of medication.
^d Advantage of combined treatment was limited to selected measures.
^eTreatment as usual (TAU) was provided by primary care physician.
^fMelancholic and hypercortisolemic patients in both cells had significantly poorer outcomes.
Source. Adapted and updated from Shea et al. 1988.

Table 40-3 Randomized controlled clinical trials comparing depression-focused psychotherapies and pharmacotherapy as acute-phase treatments of major depressive disorder
Treatment	Study	N	Duration (weeks)	Comparison of efficacy
Interpersonal
	Weissman et al. (1979)	96	16	Combined > IPT = amitriptyline
	Schneider et al. (1986)	26	16	IPT = nortriptyline
	Elkin et al. (1989)	239	16	IPT ≤ imipramine^a
	Schulberg et al. (1996)	276	32	IPT = nortriptyline > TAU
	Reynolds et al. (1999b)	80	16	Nortriptyline > IPT = placebo
Behavioral
	McLean and Hakstian (1979)	178	10	BT > amitriptyline
	Roth et al. (1982)	26	12	Combined (desipramine) ≥ BT^b
	Wilson (1982)	64	8	Combined ≥ BT = amitriptyline^b
	Hersen et al. (1984)	120	12	Combined = BT = amitriptyline
	Mynors-Wallis et al. (1995)	91	12	BT = amitriptyline > placebo
Cognitive
	Rush et al. (1977)	41	12	CT > imipramine
	Rush and Watkins (1981)	39	12	Combined (tricyclic)^c ≥ CT
	Blackburn et al. (1981)	64	12	Combined = CT > tricyclic^c (general practice clinic setting)
				Combined^d ≥ CT = tricyclic^c (psychiatric clinic setting)
	Teasdale et al. (1984)	34	15	CT + TAU > TAU^e
	Murphy et al. (1984)	70	12	Combined = CT = nortriptyline
	Beck et al. (1985)	33	12	Combined (amitriptyline) = CT
	Beutler et al. (1987)	56	20	CT (group) + alprazolam > alprazolam alone
	Covi and Lipman (1987)	70	14	combined (imipramine) = CT (group)
	Elkin et al. (1989)	239	16	CT ≤ imipramine^a
	Hollon et al. (1992a)	106	12	Combinedd ≥ CT = imipramine
	McKnight et al. (1992)	43	8	CT = amitriptyline^f
	Murphy et al. (1995)	37	16	CT = RT > desipramine
	Blackburn and Moore (1997)	75	16	CT = antidepressants^c
	Jarrett et al. (1999)	108	10	CT = phenelzine > placebo
	M. B. Keller et al. (2000)	681	12	Combined > CT = nefazodone
Note. IPT = interpersonal psychotherapy; BT = behavior therapy; CT = cognitive therapy; RT = relaxation training; TAU = treatment as usual. ">" indicates more efficacy; "≥" indicates at least as much efficacy and sometimes more; "=" indicates equal efficacy.
^a Imipramine was more rapidly effective than either form of psychotherapy. Also, imipramine was more effective than cognitive therapy in patients with Hamilton Rating Scale for Depression (Hamilton 1960) scores > 20.
^b Combined treatment was more rapidly effective, but groups were not statistically different at protocol completion.
^c This indicates doctor's choice of medication.
^d Advantage of combined treatment was limited to selected measures.
^eTreatment as usual (TAU) was provided by primary care physician.
^fMelancholic and hypercortisolemic patients in both cells had significantly poorer outcomes.
Source. Adapted and updated from Shea et al. 1988.