Chronic depression: Medication (Nefazodone) or psychotherapy (CBASP) is effective when the other is not

Alan F. Schatzberg, A. John Rush, Bruce A. Arnow, Phillip L C Banks, Janice A. Blalock, Frances E. Borian, Robert Howland, Daniel N. Klein, James H. Kocsis, Susan G. Kornstein, Rachel Manber, John C. Markowitz, Ivan Miller, Philip T. Ninan, Barbara O. Rothbaum, Michael E. Thase, Madhukar H. Trivedi, Martin B. Keller

Research output: Contribution to journalArticle

108 Citations (Scopus)

Abstract

Context: Although various strategies are available to manage nonresponders to an initial treatment for depression, no controlled trials address the utility of switching from an antidepressant medication to psychotherapy or vice versa. Objective: To compare the responses of chronically depressed nonresponders to 12 weeks of treatment with either nefazodone or cognitive behavioral analysis system of psychotherapy (CBASP) who were crossed over to the alternate treatment (nefazodone, n = 79; CBASP, n = 61). Design: Crossover trial. Setting: Twelve academic outpatient psychiatric centers. Patients: There were 140 outpatients with chronic major depressive disorder; 92 (65.7%) were female, 126 (90.0%) were white, and the mean age was 43.1 years. Thirty participants dropped out of the study prematurely, 22 in the nefazodone group and 8 in the CBASP group. Interventions: Treatment lasted 12 weeks. The dosage of nefazodone was 100 to 600 mg/d; CBASP was provided twice weekly during weeks 1 through 4 and weekly thereafter. Main Outcome Measures: The 24-item Hamilton Rating Scale for Depression, administered by raters blinded to treatment, the Clinician Global Impressions-Severity scale, and the 30-item Inventory for Depressive Symptomatology-Self-Report. Results: Analysis of the intent-to-treat sample revealed that both the switch from nefazodone to CBASP and the switch from from CBASP to nefazodone resulted in clinically and statistically significant improvements in symptoms. Neither the rates of response nor the rates of remission were significantly different when the groups of completers were compared. However, the switch to CBASP following nefazodone therapy was associated with significantly less attrition due to adverse events, which may explain the higher intent-to-treat response rate among those crossed over to CBASP (57% vs 42%). Conclusions: Among chronically depressed individuals, CBASP appears to be efficacious for nonresponders to nefazodone, and nefazodone appears to be effective for CBASP nonresponders. A switch from an antidepressant medication to psychotherapy or vice versa appears to be useful for nonresponders to the initial treatment.

Original languageEnglish (US)
Pages (from-to)513-520
Number of pages8
JournalArchives of General Psychiatry
Volume62
Issue number5
DOIs
StatePublished - May 2005

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Cognitive Therapy
Psychotherapy
Depression
Antidepressive Agents
Outpatients
Therapeutics
nefazodone
Major Depressive Disorder
Group Psychotherapy
Cross-Over Studies
Self Report
Psychiatry
Outcome Assessment (Health Care)
Equipment and Supplies

ASJC Scopus subject areas

  • Psychiatry and Mental health

Cite this

Schatzberg, A. F., Rush, A. J., Arnow, B. A., Banks, P. L. C., Blalock, J. A., Borian, F. E., ... Keller, M. B. (2005). Chronic depression: Medication (Nefazodone) or psychotherapy (CBASP) is effective when the other is not. Archives of General Psychiatry, 62(5), 513-520. https://doi.org/10.1001/archpsyc.62.5.513

Chronic depression : Medication (Nefazodone) or psychotherapy (CBASP) is effective when the other is not. / Schatzberg, Alan F.; Rush, A. John; Arnow, Bruce A.; Banks, Phillip L C; Blalock, Janice A.; Borian, Frances E.; Howland, Robert; Klein, Daniel N.; Kocsis, James H.; Kornstein, Susan G.; Manber, Rachel; Markowitz, John C.; Miller, Ivan; Ninan, Philip T.; Rothbaum, Barbara O.; Thase, Michael E.; Trivedi, Madhukar H.; Keller, Martin B.

In: Archives of General Psychiatry, Vol. 62, No. 5, 05.2005, p. 513-520.

Research output: Contribution to journalArticle

Schatzberg, AF, Rush, AJ, Arnow, BA, Banks, PLC, Blalock, JA, Borian, FE, Howland, R, Klein, DN, Kocsis, JH, Kornstein, SG, Manber, R, Markowitz, JC, Miller, I, Ninan, PT, Rothbaum, BO, Thase, ME, Trivedi, MH & Keller, MB 2005, 'Chronic depression: Medication (Nefazodone) or psychotherapy (CBASP) is effective when the other is not', Archives of General Psychiatry, vol. 62, no. 5, pp. 513-520. https://doi.org/10.1001/archpsyc.62.5.513
Schatzberg, Alan F. ; Rush, A. John ; Arnow, Bruce A. ; Banks, Phillip L C ; Blalock, Janice A. ; Borian, Frances E. ; Howland, Robert ; Klein, Daniel N. ; Kocsis, James H. ; Kornstein, Susan G. ; Manber, Rachel ; Markowitz, John C. ; Miller, Ivan ; Ninan, Philip T. ; Rothbaum, Barbara O. ; Thase, Michael E. ; Trivedi, Madhukar H. ; Keller, Martin B. / Chronic depression : Medication (Nefazodone) or psychotherapy (CBASP) is effective when the other is not. In: Archives of General Psychiatry. 2005 ; Vol. 62, No. 5. pp. 513-520.
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abstract = "Context: Although various strategies are available to manage nonresponders to an initial treatment for depression, no controlled trials address the utility of switching from an antidepressant medication to psychotherapy or vice versa. Objective: To compare the responses of chronically depressed nonresponders to 12 weeks of treatment with either nefazodone or cognitive behavioral analysis system of psychotherapy (CBASP) who were crossed over to the alternate treatment (nefazodone, n = 79; CBASP, n = 61). Design: Crossover trial. Setting: Twelve academic outpatient psychiatric centers. Patients: There were 140 outpatients with chronic major depressive disorder; 92 (65.7{\%}) were female, 126 (90.0{\%}) were white, and the mean age was 43.1 years. Thirty participants dropped out of the study prematurely, 22 in the nefazodone group and 8 in the CBASP group. Interventions: Treatment lasted 12 weeks. The dosage of nefazodone was 100 to 600 mg/d; CBASP was provided twice weekly during weeks 1 through 4 and weekly thereafter. Main Outcome Measures: The 24-item Hamilton Rating Scale for Depression, administered by raters blinded to treatment, the Clinician Global Impressions-Severity scale, and the 30-item Inventory for Depressive Symptomatology-Self-Report. Results: Analysis of the intent-to-treat sample revealed that both the switch from nefazodone to CBASP and the switch from from CBASP to nefazodone resulted in clinically and statistically significant improvements in symptoms. Neither the rates of response nor the rates of remission were significantly different when the groups of completers were compared. However, the switch to CBASP following nefazodone therapy was associated with significantly less attrition due to adverse events, which may explain the higher intent-to-treat response rate among those crossed over to CBASP (57{\%} vs 42{\%}). Conclusions: Among chronically depressed individuals, CBASP appears to be efficacious for nonresponders to nefazodone, and nefazodone appears to be effective for CBASP nonresponders. A switch from an antidepressant medication to psychotherapy or vice versa appears to be useful for nonresponders to the initial treatment.",
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T2 - Medication (Nefazodone) or psychotherapy (CBASP) is effective when the other is not

AU - Schatzberg, Alan F.

AU - Rush, A. John

AU - Arnow, Bruce A.

AU - Banks, Phillip L C

AU - Blalock, Janice A.

AU - Borian, Frances E.

AU - Howland, Robert

AU - Klein, Daniel N.

AU - Kocsis, James H.

AU - Kornstein, Susan G.

AU - Manber, Rachel

AU - Markowitz, John C.

AU - Miller, Ivan

AU - Ninan, Philip T.

AU - Rothbaum, Barbara O.

AU - Thase, Michael E.

AU - Trivedi, Madhukar H.

AU - Keller, Martin B.

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N2 - Context: Although various strategies are available to manage nonresponders to an initial treatment for depression, no controlled trials address the utility of switching from an antidepressant medication to psychotherapy or vice versa. Objective: To compare the responses of chronically depressed nonresponders to 12 weeks of treatment with either nefazodone or cognitive behavioral analysis system of psychotherapy (CBASP) who were crossed over to the alternate treatment (nefazodone, n = 79; CBASP, n = 61). Design: Crossover trial. Setting: Twelve academic outpatient psychiatric centers. Patients: There were 140 outpatients with chronic major depressive disorder; 92 (65.7%) were female, 126 (90.0%) were white, and the mean age was 43.1 years. Thirty participants dropped out of the study prematurely, 22 in the nefazodone group and 8 in the CBASP group. Interventions: Treatment lasted 12 weeks. The dosage of nefazodone was 100 to 600 mg/d; CBASP was provided twice weekly during weeks 1 through 4 and weekly thereafter. Main Outcome Measures: The 24-item Hamilton Rating Scale for Depression, administered by raters blinded to treatment, the Clinician Global Impressions-Severity scale, and the 30-item Inventory for Depressive Symptomatology-Self-Report. Results: Analysis of the intent-to-treat sample revealed that both the switch from nefazodone to CBASP and the switch from from CBASP to nefazodone resulted in clinically and statistically significant improvements in symptoms. Neither the rates of response nor the rates of remission were significantly different when the groups of completers were compared. However, the switch to CBASP following nefazodone therapy was associated with significantly less attrition due to adverse events, which may explain the higher intent-to-treat response rate among those crossed over to CBASP (57% vs 42%). Conclusions: Among chronically depressed individuals, CBASP appears to be efficacious for nonresponders to nefazodone, and nefazodone appears to be effective for CBASP nonresponders. A switch from an antidepressant medication to psychotherapy or vice versa appears to be useful for nonresponders to the initial treatment.

AB - Context: Although various strategies are available to manage nonresponders to an initial treatment for depression, no controlled trials address the utility of switching from an antidepressant medication to psychotherapy or vice versa. Objective: To compare the responses of chronically depressed nonresponders to 12 weeks of treatment with either nefazodone or cognitive behavioral analysis system of psychotherapy (CBASP) who were crossed over to the alternate treatment (nefazodone, n = 79; CBASP, n = 61). Design: Crossover trial. Setting: Twelve academic outpatient psychiatric centers. Patients: There were 140 outpatients with chronic major depressive disorder; 92 (65.7%) were female, 126 (90.0%) were white, and the mean age was 43.1 years. Thirty participants dropped out of the study prematurely, 22 in the nefazodone group and 8 in the CBASP group. Interventions: Treatment lasted 12 weeks. The dosage of nefazodone was 100 to 600 mg/d; CBASP was provided twice weekly during weeks 1 through 4 and weekly thereafter. Main Outcome Measures: The 24-item Hamilton Rating Scale for Depression, administered by raters blinded to treatment, the Clinician Global Impressions-Severity scale, and the 30-item Inventory for Depressive Symptomatology-Self-Report. Results: Analysis of the intent-to-treat sample revealed that both the switch from nefazodone to CBASP and the switch from from CBASP to nefazodone resulted in clinically and statistically significant improvements in symptoms. Neither the rates of response nor the rates of remission were significantly different when the groups of completers were compared. However, the switch to CBASP following nefazodone therapy was associated with significantly less attrition due to adverse events, which may explain the higher intent-to-treat response rate among those crossed over to CBASP (57% vs 42%). Conclusions: Among chronically depressed individuals, CBASP appears to be efficacious for nonresponders to nefazodone, and nefazodone appears to be effective for CBASP nonresponders. A switch from an antidepressant medication to psychotherapy or vice versa appears to be useful for nonresponders to the initial treatment.

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