Cognitive therapy versus medication in augmentation and switch strategies as second-step treatments: A STAR*D report

Michael E. Thase, Edward S. Friedman, Melanie M. Biggs, Stephen R. Wisniewski, Madhukar H. Trivedi, James F. Luther, Maurizio Fava, Andrew A. Nierenberg, Patrick J. McGrath, Diane Warden, George Niederehe, Steven D. Hollon, A. John Rush

Research output: Contribution to journalArticle

245 Citations (Scopus)

Abstract

Objective: The authors compared the effectiveness of cognitive therapy and pharmacotherapy as second-step strategies for outpatients with major depressive disorder who had received inadequate benefit from an initial trial of citalopram. Cognitive therapy was compared with medication augmentation and switch strategies. Method: An equipoise-stratified randomization strategy was used to assign participants to either augmentation of citalopram with cognitive therapy (N=65) or medication (N=117; either sustained-release bupropion [N=56] or buspirone [N=61]) or switch to cognitive therapy (N=36) or another antidepressant (N=86; sertraline [N=27], sustained-release bupropion [N=28], or extended-release venlafaxine [N=31]). Treatment outcomes and the frequency of adverse events were compared. Results: Less than one-third of participants consented to randomization strata that permitted comparison of cognitive therapy and pharmacotherapy. Among participants who were assigned to second-step treatment, those who received cognitive therapy (either alone or in combination with citalopram) had similar response and remission rates to those assigned to medication strategies. For those who continued on citalopram, medication augmentation resulted in significantly more rapid remission than augmentation with cognitive therapy. Among those who discontinued citalopram, there were no significant differences in outcome, although those who switched to a different antidepressant reported significantly more side effects than those who received cognitive therapy alone. Conclusions: After an unsatisfactory response to citalopram, patients who consented to random assignment to either cognitive therapy or alternative pharmacologic strategies had generally comparable outcomes. Pharmacologic augmentation was more rapidly effective than cognitive therapy augmentation of citalopram, whereas switching to cognitive therapy was better tolerated than switching to a different antidepressant.

Original languageEnglish (US)
Pages (from-to)739-752
Number of pages14
JournalAmerican Journal of Psychiatry
Volume164
Issue number5
DOIs
StatePublished - May 2007

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Cognitive Therapy
Citalopram
Therapeutics
Antidepressive Agents
Bupropion
Random Allocation
Buspirone
Sertraline
Drug Therapy
Major Depressive Disorder
Outpatients

ASJC Scopus subject areas

  • Psychiatry and Mental health

Cite this

Cognitive therapy versus medication in augmentation and switch strategies as second-step treatments : A STAR*D report. / Thase, Michael E.; Friedman, Edward S.; Biggs, Melanie M.; Wisniewski, Stephen R.; Trivedi, Madhukar H.; Luther, James F.; Fava, Maurizio; Nierenberg, Andrew A.; McGrath, Patrick J.; Warden, Diane; Niederehe, George; Hollon, Steven D.; Rush, A. John.

In: American Journal of Psychiatry, Vol. 164, No. 5, 05.2007, p. 739-752.

Research output: Contribution to journalArticle

Thase, ME, Friedman, ES, Biggs, MM, Wisniewski, SR, Trivedi, MH, Luther, JF, Fava, M, Nierenberg, AA, McGrath, PJ, Warden, D, Niederehe, G, Hollon, SD & Rush, AJ 2007, 'Cognitive therapy versus medication in augmentation and switch strategies as second-step treatments: A STAR*D report', American Journal of Psychiatry, vol. 164, no. 5, pp. 739-752. https://doi.org/10.1176/appi.ajp.164.5.739
Thase, Michael E. ; Friedman, Edward S. ; Biggs, Melanie M. ; Wisniewski, Stephen R. ; Trivedi, Madhukar H. ; Luther, James F. ; Fava, Maurizio ; Nierenberg, Andrew A. ; McGrath, Patrick J. ; Warden, Diane ; Niederehe, George ; Hollon, Steven D. ; Rush, A. John. / Cognitive therapy versus medication in augmentation and switch strategies as second-step treatments : A STAR*D report. In: American Journal of Psychiatry. 2007 ; Vol. 164, No. 5. pp. 739-752.
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AU - Luther, James F.

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