Treatment of men with major depression: A comparison of sequential cohortstreated with either cognitive-behavioral therapy or newer generation antidepressants

This report compares response to cognitive-behavioral therapy (CBT) and pha rmacotherapy in sequential cohorts of men with DSM-III-R major depression. Method: Patients were enrolled in consecutive standardized 16-week treatmen t protocols conducted in the same research clinic. The first group (N = 52) was treated with Beck's model of CBT, whereas the second group (N = 23) re ceived randomized but open-label treatment with either fluoxetine (N = 10) or bupropion (N = 13). Crossover to the alternate medication was permitted after 8 weeks of treatment for antidepressant nonresponders. The patient gr oups were well matched prior to treatment. Outcomes included remission and nonresponse rates, as well as both independent clinical evaluations and sel f-reported measures of depressive symptoms. Results: Despite limited statistical power to detect differences between tr eatments, depressed men treated with pharmacotherapy had significantly grea ter improvements on 4 of 6 continuous dependent measures and a significantl y lower rate of nonresponse (i.e., 13% vs. 46%). The difference favoring ph armacotherapy was lateemerging and partially explained by crossing over non responders to the alternate medication. The advantage of pharmacotherapy ov er CBT also tended to be larger among the subgroup of patients with chronic depression. Conclusion: Results of prior research comparing pharmacotherapy and CBT may have been influenced by the composition of study groups, particularly the gender composition, the choice of antidepressant comparators, or an interac tion of these factors. Prospective studies utilizing flexible dosing of mod ern antidepressants and, if necessary, sequential trials of dissimilar medi cations are needed to confirm these findings.