Randomised controlled trial of non-directive counselling, cognitive-behaviour therapy, and usual general practitioner care for patients with depression. I: Clinical effectiveness

Objective To compare the clinical effectiveness of general practitioner car e and two general practice based psychological therapies for depressed pati ents. Design Prospective, controlled trial with randomised and patient preference allocation arms. Setting General practices in London and greater Manchester. Participants 464 of 627 patients presenting with depression or mixed anxiet y and depression were suitable for inclusion. Interventions Usual general practitioner care or up to 12 sessions of non-d irective counselling or cognitive-behaviour therapy provided by therapists. Main outcome measures Beck depression inventory scores, other psychiatric s ymptoms, social functioning, and satisfaction with treatment measured at ba seline and at 4 and 12 months. Results 197 patients were randomly assigned to treatment, 137 chose their t reatment, and 130 were randomised only between the two psychological therap ies. All groups improved significantly over time. At four months, patients randomised to non-directive counselling or cognitive-behaviour therapy impr oved more in terms of the Beck depression inventory (mean (SD) scores 12.9 (9.3) and 14.3 (10.8) respectively) than those randomised to usual general practitioner care (18.3 (12.4)). However, there was no significant differen ce between the two therapies. There were no significant differences between the three treatment groups at 12 months (Beck depression scores 11.8 (9.6) , 11.4 (10.8), and 12.1(10.3) for non-directive counselling, cognitive-beha viour therapy, and general practitioner care). Conclusions Psychological therapy was a more effective treatment for depres sion than usual general practitioner care in the short term, but after one year there was no difference in outcome.