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Am Fam Physician. 1999;60(9):2640

Treatment of depression is a common problem facing physicians. The debate concerning appropriate treatment regimens has been marked by conflicting results in studies of medication and cognitive behavior therapy. Earlier studies suggested that cognitive behavior therapy was as effective as medication. However, later studies have suggested that it is less effective. DeRubeis and associates compared the outcomes of treatment of severe depression using medication or cognitive behavior therapy.

The study consisted of a mega-analysis of four previously published studies. These four studies enrolled adults who were severely depressed. Severe depression was established in each study following strict criteria, and participants were treated on an outpatient basis. They were then randomly assigned to receive medication or cognitive behavior therapies. Hamilton and Beck depression scales were administered before and after the studies. The medications used in the study were imipramine and nortriptyline.

The demographics in each of the four studies were analyzed and found to be similar. Medication and cognitive behavior therapies improved the depression scores on the Hamilton and Beck scales for severely depressed patients. There was no statistically significant difference between the medication and the cognitive behavior therapies in the improvement of the depression scores. Also, none of the demographic variables had any impact on improvement in the depression scores.

The authors conclude that medication is not superior to cognitive behavior therapy in treating severe depression in the outpatient setting. New treatment guidelines should be established to reflect the finding that the efficacy of medication and cognitive behavior therapy in the treatment of severe depression does not differ.

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