The British Journal of Psychiatry
Moderators of remission with interpersonal counselling or drug treatment in primary care patients with depression: randomised controlled trial
Marco Menchetti, Paola Rucci, Biancamaria Bortolotti, Annarosa Bombi, Paolo Scocco, Helena Chmura Kraemer, Domenico Berardi,
  • Declaration of interest

    None.

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.

Footnotes

  • Funding

    This study was funded by the Italian Ministry for University and Research as Research Program of National Interest in 2005 (Prot. 2005063749).

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