Rj. Derubeis et al., Medications versus cognitive behavior therapy for severely depressed outpatients: Mega-analysis of four randomized comparisons, AM J PSYCHI, 156(7), 1999, pp. 1007-1013
Objective: The purpose of this study was to compare the acute outcomes of a
ntidepressant medication and cognitive behavior therapy in the severely dep
ressed outpatient subgroups of four major randomized trials. A secondary ob
jective was to compare the results obtained in the National Institute of Me
ntal Health Treatment of Depression Collaborative Research Program, upon wh
ich treatment guidelines have been based, with those obtained in the other
three studies. Method: Outcomes of antidepressant medication and cognitive
behavior therapy were compared within each of the four studies separately a
nd for patients aggregated across the four studies. In addition, the outcom
es in the antidepressant medication and cognitive behavior therapy conditio
ns of the Treatment of Depression Collaborative Research Program were compa
red with those obtained in the other three studies. Results: The overall ef
fect sizes comparing antidepressant medication to cognitive behavior therap
y favored cognitive behavior therapy, but tests comparing the two modalitie
s did not reveal a significant advantage for either modality overall. Concl
usions: Cognitive behavior therapy has fared as well as antidepressant medi
cation with severely depressed outpatients in four major comparisons. Until
findings emerge from current or future comparative trials, antidepressant
medication should not be considered, on the basis of empirical evidence, to
be superior to cognitive behavior therapy for the acute treatment of sever
ely depressed outpatients.