Antidepressants and counselling are similarly effective in the primary care treatment of depression
- Dowrick, Professor Christopher
BACKGROUND
Antidepressant drugs and counselling are both effective treatments for major depression. The comparative efficacy and cost-effectiveness of these options and the influence of patient choice has not previously been evaluated in a primary care setting.
OBJECTIVE
To compare antidepressant drugs, generic counselling and patient preferences in the treatment of major depression in a general practice setting.
SETTING
Thirty-one general practices; Trent health region, UK; time frame not specified.
METHOD
Randomised trial with patient preference groups.
PARTICIPANTS
Three hundred and twenty-three 17-70-year-olds with major depression (103 randomised to treatment and 220 expressing a preferred treatment).
INTERVENTION
Antidepressant drug treatment or six counselling sessions. Follow-up to 12 months.
OUTCOMES
Beck depression inventory scores; time to depression remission; quality of life scores (SF-36); patient outcome.
MAIN RESULTS
There was no difference in mean Beck depression inventory scores among the drug and counselling groups (P = 0.49 for randomised participants; P = 0.81 for all participants). Treatment preference did not influence the depression scores of the antidepressant group (mean difference = 3.1, 95% CI: −1.8 to 7.8), but people who choose counselling achieved better scores than those randomised to counselling (mean difference = 4.6, 95% CI: 0 to 9.2). Participants randomly assigned to antidepressants had shorter average time to remission (2 versus 3 months).
AUTHORS' CONCLUSIONS
Generic counselling and antidepressants are similarly effective in the treatment of major depression. Antidepressants may result in more rapid recovery and be less resource intensive.
NOTE
Only a small number of counselling sessions were involved. There is no control group.