Moderators of remission with interpersonal counselling or drug treatment in primary care patients with depression: randomised controlled trial

Br J Psychiatry. 2014 Feb;204(2):144-50. doi: 10.1192/bjp.bp.112.122663. Epub 2013 Dec 5.

Abstract

Background: Despite depressive disorders being very common there has been little research to guide primary care physicians on the choice of treatment for patients with mild to moderate depression.

Aims: To evaluate the efficacy of interpersonal counselling compared with selective serotonin reuptake inhibitors (SSRIs), in primary care attenders with major depression and to identify moderators of treatment outcome.

Method: A randomised controlled trial in nine centres (DEPICS, Australian New Zealand Clinical Trials Registry number: ACTRN12608000479303). The primary outcome was remission of the depressive episode (defined as a Hamilton Rating Scale for Depression score ≤7 at 2 months). Daily functioning was assessed using the Work and Social Adjustment Scale. Logistic regression models were used to identify moderators of treatment outcome.

Results: The percentage of patients who achieved remission at 2 months was significantly higher in the interpersonal counselling group compared with the SSRI group (58.7% v. 45.1%, P = 0.021). Five moderators of treatment outcome were found: depression severity, functional impairment, anxiety comorbidity, previous depressive episodes and smoking habit.

Conclusions: We identified some patient characteristics predicting a differential outcome with pharmacological and psychological interventions. Should our results be confirmed in future studies, these characteristics will help clinicians to define criteria for first-line treatment of depression targeted to patients' characteristics.

Publication types

  • Multicenter Study
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Activities of Daily Living
  • Adult
  • Anxiety / epidemiology
  • Counseling*
  • Depressive Disorder, Major / drug therapy
  • Depressive Disorder, Major / epidemiology*
  • Depressive Disorder, Major / therapy
  • Effect Modifier, Epidemiologic
  • Female
  • Humans
  • Intention to Treat Analysis
  • Logistic Models
  • Male
  • Middle Aged
  • Outcome Assessment, Health Care / statistics & numerical data*
  • Patient Selection
  • Practice Guidelines as Topic
  • Primary Health Care / methods*
  • Psychiatric Status Rating Scales / statistics & numerical data
  • Psychotherapy, Brief / methods*
  • Remission Induction
  • Serotonin Uptake Inhibitors / therapeutic use*
  • Severity of Illness Index
  • Smoking / epidemiology
  • Social Adjustment

Substances

  • Serotonin Uptake Inhibitors