Efficacy of cognitive behavior therapy, pharmacotherapy, and the combination of both in non-melancholic, unipolar depression

We investigated the efficacy of amitriptylin plus clinical management, cognitive behavior therapy, and the combination of both in 191 non-melancholic unipolar depressed in- and outpatients. Two main criteria and several other measures assessed the short- and long-term outcome as well the process of change over the eight weeks intervention and the one year follow-up. Results show that: all three treatments in both settings are equally efficient in reducing depressive symptoms clinically and statistically significant at post therapy. We did not find superior effects for the combination of tricyclics and cognitive behavior therapy. Severety of symptomatology did nor influence the efficacy of either treatment. However, patients with more severe symptomatology did not respond as well as less severely depressed patients. There was a higher drop our rare for pharmacotherapy than for the other two therapies. The combination of pharmacotherapy with behavior therapy reduced the level of side effects significantly. At follow-up, the outpatient pharmacotherapy showed a much higher level of depressive symptomatology, had more relapses, and more need for treatment in between than cognitive behavior or combination therapy. For the former inpatients these effects did not show up, because all three treatments were similar successful in reducing depression and stabilizing the patients on such a low level of symptomatology. We conclude that with cognitive behavior therapy a successful, in the longterm other interventions superior psychological treatment for unipolar depression is available.