Study Finds Psychotherapy And Anti-Depressants Equally Effective In Treating Severely Depressed Primary-Care Patients

November 23, 1998

WASHINGTON - Researchers comparing the effectiveness of treating major depression with either antidepressant medication or psychotherapy noted no difference in the success of the two treatment methods after an eight-month clinical investigation. The research will be published in the December issue of the American Psychological Association's (APA) Journal of Consulting and Clinical Psychology.

Psychologists Herbert C. Schulberg, Ph.D., Paul A. Pilkonis, Ph.D., and graduate student Patricia Houck, MS, of the University of Pittsburgh School of Medicine examined the relationship between the severity of a primary care patient's major depression, treatment of the episode with either an antidepressant (nortriptyline hydrochloride [NT]) or interpersonal psychotherapy [IPT] and level of depression over an eight-month period. Patients prescribed NT (N=91) were treated in the primary care setting by family practitioners or general internists, while those who received psychotherapy (N=93) were also treated in the primary care setting by a psychiatrist or psychologist. The researchers further divided the treatment groups into those with a lower level of severe depression (N=53) and those with a higher level of severe depression (N=131) based on a clinician-rated measure of depression.

The researchers noted significant clinical improvement by patients who received either antidepressants or psychotherapy. Treatment type was unrelated to rate of clinical improvement in those with a higher level of major depression, since both samples had identical scores on the depression measurement test throughout the eight-month study. There were, however, differences among the two treatment methods among those with less severe depression. Participants who were less severely depressed improved more rapidly when treated with antidepressants than those in psychotherapy, but most improvement among those prescribed NT occurred during the first two months of treatment. Psychotherapy among those less severely depressed patients produced a more gradual improvement, but after four months both groups showed similar clinical improvement.

A major purpose of this study was to assess the recommendations of the American Psychiatric Association (1993) and the Depression Guideline Pane (1993) of the Agency for Health Care Policy and Research (ACHPR) that designated antidepressant medications the first-time treatment for moderate to severe major depression while restricting psychotherapy as the sole treatment for depressive episodes of mild-moderate severity. Since the study analysis did not find significantly different outcomes when comparing psychotherapy and treatment with antidepressants, the authors suggest primary care physicians recommend interpersonal psychotherapy for severe major depression in certain situations. They recommend IPT for severe major depression when a patient prefers it, when a patient refuses or cannot tolerate medications.

Dr. Schulberg, lead author of the study, notes that "since severely depressed patients demonstrated equal improvement in a similar time frame with either treatment, primary care physicians now have greater flexibility in selecting a proper treatment for their patients." The authors conclude this analysis "was the first to compare outcomes for a medical population experiencing major depression of varying severity that was treated with either an antidepressant medication or psychotherapy." They suggest that future researchers should attempt to determine whether interpersonal psychotherapy techniques should differ when treating milder, compared with more severe, depressive episodes.
"The Severity of Major Depression and Choice of Treatment in Primary Care Practice"
by Herbert C. Schulberg, Ph.D., of the Western Psychiatric Institute and Clinic, Paul A. Pilkonis, Ph.D., and Patricia Houck, MS, of the University of Pittsburgh School of Medicine,
in Journal of Consulting and Clinical Psychology, Vol. 66, No. 6.

(Full Text available from the APA Public Affairs Office or on the Internet at

Herbert C. Schulberg, Ph.D. can be reached at 412-624-2867 or

The American Psychological Association (APA), in Washington, DC is the largest scientific and professional organization representing psychology in the United States and is the world's largest association of psychologists. APA's membership includes more than 155,000 researchers, educators, clinicians, consultants and students. Through its divisions in 50 subfields of psychology and affiliations with 59 state, territorial and Canadian provincial associations, APA works to advance psychology as a science, as a profession and as a means of promoting human welfare.

American Psychological Association

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