Antidepressant drugs and generic counselling for treatment of major depression in primary care: randomised trial with patient preference arms

Objectives To compare the efficacy of antidepressant drugs and generic coun selling for treating mild to moderate depression in general practice. To de termine whether the outcomes were similar for patients with randomly alloca ted treatment and those expressing a treatment preference. Design Randomised controlled trial, with patient preference arms. Follow up at 8 weeks and 12 months and abstraction of GP case notes. Setting 31 general practices in Trent region. Participants Patients aged 18-70 who met research diagnostic criteria for m ajor depression; 103 patients were randomised and 220 patients were recruit ed to the preference arms. Main outcome measures Difference in mean Beck depression inventory score; t ime to remission; global outcome assessed by a psychiatrist using all data sources; and research diagnostic criteria. Results At 12 months there was no difference between the mean Beck scores i n the randomised arms. Combining the randomised and patient preference grou ps, the difference in Beck scores was 0.4 (95% confidence interval -2.7 to 3.5). Patients choosing: counselling did better than those randomised to it (mean difference in Beck score 4.6, 0.0 to 9.2). There was no difference i n the psychiatrist's overall assessment of outcome between any of the group s. 221/265(83%) of participants with a known outcome had a remission. Media n time to remission was shorter in the group randomised to antidepressants than the other three groups (2 months v 3 months). 33/221 (15%) patients ha d a relapse. Conclusions Genetic counselling seems to be as effective as antidepressant treatment for mild to moderate depressive illness, although patients receiv ing antidepressants may recover more quickly. General practitioners should allow patients to have their preferred treatment.