Assessing effectiveness of treatment of depression in primary care - Partially randomised preference trial

Background There is a mismatch between the wish of a patient with depressio n to have counselling and the prescription of antidepressants by the doctor . Aims To determine whether counselling is as effective as antidepressants fo r depression in primary care and whether allowing patients to choose their treatment affects their response. Method A partially randomised preference trial, with patients randomised to either antidepressants or counselling or given their choice of either trea tment. The treatment and follow-up were identical in the randomised and pat ient preference arms. Results There were 103 randomised and 220 preference patients in the trial. We found: no differences in the baseline characteristics of the randomised and preference groups; that the two treatments were equally effective at 8 weeks, both for the randomised group and when the randomised and patient p reference groups for a particular treatment were combined; and that express ing a preference for either treatment conferred no additional benefit on ou tcome. Conclusions These data challenge several assumptions about the most appropr iate treatment for depression in a primary care setting.