EFFICACY OF COGNITIVE-BEHAVIOR THERAPY, P HARMACOTHERAPY, AND THE COMBINATION OF BOTH IN NONMELANCHOLIC, UNIPOLAR DEPRESSION

We investigated the efficacy of amitriptylin plus clinical management, cognitive behavior therapy, and the combination of both in 191 non-me lancholic unipolar depressed in- and outpatients. Two main criteria an d several other measures assessed the short- and long-term outcome as well the process of change over the eight weeks intervention and the o ne year follow-up. Results show that: all three treatments in both set tings are equally efficient in reducing depressive symptoms clinically and statistically significant at post therapy. We did not find superi or effects for the combination of tricyclics and cognitive behavior th erapy. Severety of symptomatology did nor influence the efficacy of ei ther treatment. However, patients with more severe symptomatology did not respond as well as less severely depressed patients. There was a h igher drop our rare for pharmacotherapy than for the other two therapi es. The combination of pharmacotherapy with behavior therapy reduced t he level of side effects significantly. At follow-up, the outpatient p harmacotherapy showed a much higher level of depressive symptomatology , had more relapses, and more need for treatment in between than cogni tive behavior or combination therapy. For the former inpatients these effects did not show up, because all three treatments were similar suc cessful in reducing depression and stabilizing the patients on such a low level of symptomatology. We conclude that with cognitive behavior therapy a successful, in the longterm other interventions superior psy chological treatment for unipolar depression is available.