Prediction of response to medication and cognitive therapy in the treatment of moderate to severe depression

J Consult Clin Psychol. 2009 Aug;77(4):775-87. doi: 10.1037/a0015401.


A recent randomized controlled trial found nearly equivalent response rates for antidepressant medications and cognitive therapy in a sample of moderate to severely depressed outpatients. In this article, the authors seek to identify the variables that were associated with response across both treatments as well as variables that predicted superior response in one treatment over the other. The sample consisted of 180 depressed outpatients: 60 of whom were randomly assigned to cognitive therapy; 120 were assigned to antidepressant medications. Treatment was provided for 16 weeks. Chronic depression, older age, and lower intelligence each predicted relatively poor response across both treatments. Three prescriptive variables-marriage, unemployment, and having experienced a greater number of recent life events-were identified, and each predicted superior response to cognitive therapy relative to antidepressant medications. Thus, 6 markers of treatment outcome were identified, each of which might be expected to carry considerable clinical utility. The 3 prognostic variables identify subgroups that might benefit from alternative treatment strategies; the 3 prescriptive variables identify groups who appear to respond particularly well to cognitive therapy.

Publication types

  • Comparative Study
  • Randomized Controlled Trial
  • Research Support, N.I.H., Extramural

MeSH terms

  • Adult
  • Age of Onset
  • Antidepressive Agents / therapeutic use*
  • Chronic Disease
  • Cognitive Behavioral Therapy*
  • Combined Modality Therapy
  • Depressive Disorder, Major / diagnosis
  • Depressive Disorder, Major / psychology
  • Depressive Disorder, Major / therapy*
  • Dysthymic Disorder / diagnosis
  • Dysthymic Disorder / psychology
  • Dysthymic Disorder / therapy*
  • Female
  • Humans
  • Male
  • Middle Aged
  • Personality Inventory
  • Prognosis
  • Randomized Controlled Trials as Topic
  • Recurrence


  • Antidepressive Agents