Medications versus cognitive behavior therapy for severely depressed outpatients: Mega-analysis of four randomized comparisons

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.