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General Effectiveness of Treatments

Irene Elkin, PhD; M. Tracie Shea, PhD; John T. Watkins, PhD; Stanley D. Imber, PhD; Stuart M. Sotsky, MD; Joseph F. Collins, ScD; David R. Glass, PhD; Paul A. Pilkonis, PhD; William R. Leber, PhD; John P. Docherty, MD; Susan J. Fiester, MD; Morris B. Parloff, PhD

Arch Gen Psychiatry. 1989;46(11):971-982.

Abstract
• We investigated the effectiveness of two brief psychotherapies, interpersonal psychotherapy and cognitive behavior therapy, for the treatment of outpatients with major depressive disorder diagnosed by Research Diagnostic Criteria. Two hundred fifty patients were randomly assigned to one of four 16-week treatment conditions: interpersonal psychotherapy, cognitive behavior therapy, imipramine hydrochloride plus clinical management (as a standard reference treatment), and placebo plus clinical management. Patients in all treatments showed signifi-cant reduction in depressive symptoms and improvement in functioning over the course of treatment. There was a consistent ordering of treatments at termination, with imipramine plus clinical management generally doing best, placebo plus clinical management worst, and the two psychotherapies in between but generally closer to imipramine plus clinical management. In analyses carried out on the total samples without regard to initial severity of illness (the primary analyses), there was no evidence of greater effectiveness of one of the psychotherapies as compared with the other and no evidence that either of the psychotherapies was significantly less effective than the standard reference treatment, imipramine plus clinical management.

Comparing each of the psychotherapies with the placebo plus clinical management condition, there was limited evidence of the specific effectiveness of interpersonal psychotherapy and none for cognitive behavior therapy. Superior recovery rates were found for both interpersonal psychotherapy and imipramine plus clinical management, as compared with placebo plus clinical management. On mean scores, however, there were few significant differences in effectiveness among the four treatments in the primary analyses. Secondary analyses, in which patients were dichotomized on intial level of severity of depressive symptoms and impairment of functioning, helped to explain the relative lack of significant findings in the primary analyses. Significant differences among treatments were present only for the subgroup of patients who were more severely depressed and functionally impaired; here, there was some evidence of the effectiveness of interpersonal psychotherapy with these patients and strong evidence of the effectiveness of imipramine plus clinical management. In contrast, there were no significant differences among treatments, including placebo plus clinical management, for the less severely depressed and functionally impaired patients.

Author Affiliations
From the Mood, Anxiety and Personality Disorders Research Branch, National Institute of Mental Health, Bethesda, Md (Drs Elkin and Shea); Department of Psychiatry and Behavioral Sciences, University of Oklahoma Health Sciences Center, Oklahoma City (Drs Watkins and Leber); University of Pittsburgh (Pa) School of Medicine and Western Psychiatric Institute and Clinic (Drs Imber and Pilkonis); Department of Psychiatry and Behavioral Sciences, George Washington University Medical Center, Washington, DC (Drs Sotsky and Glass); Cooperative Studies Program Coordinating Center, Veterans Administration Medical Center, Perry Point, Md (Dr Collins); Nashua Brookside Hospital, Nashua, NH (Drs Docherty and Fiester); and The American University, Washington, DC (Dr Parloff).

Footnotes
Accepted for publication March 2, 1989.

Reprint requests to National Institute of Mental Health Treatment of Depression Collaborative Research Program, 5600 Fishers Ln, Room 10C-26, Rockville, MD 20857 (Dr Elkin).

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