Treatment preference, engagement, and clinical improvement in pharmacotherapy versus psychotherapy for depression

Behav Res Ther. 2010 Aug;48(8):799-804. doi: 10.1016/j.brat.2010.04.003. Epub 2010 Apr 24.


Pharmacotherapy and psychotherapy are generally effective treatments for major depressive disorder (MDD); however, research suggests that patient preferences may influence outcomes. We examined the effects of treatment preference on attrition, therapeutic alliance, and change in depressive severity in a longitudinal randomized clinical trial comparing pharmacotherapy and psychotherapy. Prior to randomization, 106 individuals with MDD reported whether they preferred psychotherapy, antidepressant medication, or had no preference. A mismatch between preferred and actual treatment was associated with greater likelihood of attrition, fewer expected visits attended, and a less positive working alliance at session 2. There was a significant indirect effect of preference match on depression outcomes, primarily via effects of attendance. These findings highlight the importance of addressing patient preferences, particularly in regard to patient engagement, in the treatment of MDD.

Publication types

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

MeSH terms

  • Adult
  • Antidepressive Agents / therapeutic use*
  • Depressive Disorder, Major / drug therapy
  • Depressive Disorder, Major / psychology*
  • Depressive Disorder, Major / therapy
  • Female
  • Humans
  • Male
  • Patient Acceptance of Health Care / statistics & numerical data*
  • Patient Preference / statistics & numerical data*
  • Professional-Patient Relations
  • Psychotherapy / methods*
  • Treatment Outcome


  • Antidepressive Agents