Cognitive therapy augmentation versus CT switch treatment: A Star*D report

Objective: This report compares the effectiveness of cognitive therapy (CT) as an augmentation to citalopram vs. CT as a switch from citalopram as a second-step treatment for outpatients with non-psychotic major depressive disorder (MDD) who had received unsatisfactory benefit from an initial trial of citalopram. Methods: Participants who experienced intolerance to or who did not reach remission with an optimal trial of citalopram, and who accepted randomization only to one of the two CT options, were randomized to a second-step treatment of either CT switch or CT augmentation of citalopram. Treatment outcomes, side effects, and serious adverse events were compared between the two groups. Results: As a second-step treatment following an optimal trial of citalopram, discontinuing medication and switching to CT (n=32) was as effective as augmenting citalopram with CT (n=26). Unlike the CT switch subjects, most individuals in the CT augmentation group endorsed mild-to-marked levels of side effect frequency, intensity, and burden. Conclusions: This is the first study to compare CT as a switch or augmentation strategy following unsatisfactory benefit or intolerance to an SSRI antidepressant medication. In these individuals with highly recurrent and chronic depression, there was no apparent benefit to continuing the citalopram and augmenting with CT vs. switching to CT in terms of acute phase treatment features and outcomes, or probability of relapse over one year. Implications for clinical practice are discussed.