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The London Depression Intervention Trial

Randomised controlled trial of antidepressants v. couple therapy in the treatment and maintenance of people with depression living with a partner: clinical outcome and costs

Social Psychiatry Section

DANIEL CHISHOLM, MA

Centre for the Economics of Mental Health

BRIAN EVERITT, PhD

Department of Biostatistics & Computing, Institute of Psychiatry, London

EIA ASEN, FRCPsych

Psychotherapy Department, Bethlem & Maudsley NHS Trust, London

ELSA JONES, MA

The Family Institute, Cardiff

CHRIS R. BREWIN, PhD

Department of Psychology, Royal Holloway College, Egham

DAVID DAYSON, MRCPsych

Royal South Hants Hospital, Southampton

Correspondence: Professor Julian Leff, Head of Social Psychiatry Section, Institute of Psychiatry, De Crespigny Park, Denmark Hill, London SE5 8AF

Declaration of interest Funding from the Medical Research Council.

See editorial, pp. 93-94, this issue.

This article has been corrected post-publication, in accordance with the printed corrigendum September 2000, vol. 177, p. 284.

Background Relapse of depression is associated with a criticising attitude of the patient's partner.

Aims To compare the relative efficacy and cost of couple therapy and antidepressant drugs for the treatment and maintenance of people with depression living with a critical partner.

Method A randomised controlled trial of antidepressant drugs v. couple therapy. The subjects were 77 people meeting criteria for depression living with a critical partner.

Results Drop-outs were 56.8% from drug treatment and 15% from couple therapy. Subjects' depression improved in both groups, but couple therapy showed a significant advantage, according to the Beck Depression Inventory, both at the end of treatment and after a second year off treatment. Adding the costs of the interventions to the costs of services used showed there was no appreciable difference between the two treatments.

Conclusions For this group couple therapy is much more acceptable than antidepressant drugs and is at least as efficacious, if not more so, both in the treatment and maintenance phases. It is no more expensive overall.

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