Depressed patients who received an effective anti-depressant, combined with psychotherapy, experienced significant improvement over patients who received the anti-depressant or the psychotherapy alone, according to a study published in the May 18 edition of the New England Journal of Medicine. Rush-Presbyterian-St. Luke's Medical Center in Chicago was the only Chicago medical center involved in the study. Dr. John Zajecka, associate professor of psychiatry at Rush, served as the main investigator for Rush in the trial. The multi-center trial randomized 681 patients into one of three treatment groups: one group received nefazodone, which has demonstrated effectiveness as an anti-depressant for both initial and maintenance treatment for chronic depression; one group of patients received cognitive behavioral-analysis system of psychotherapy; and the third group was given both treatments.
The study found that, while 55 percent of the patients with chronic depression responded positively to short-term treatment with nefazadone and 52 percent responded to cognitive-behavioral therapy, 85 percent responded positively when the two therapies were used in combination.
According to psychiatrists, approximately 3 percent of the population suffers from chronic depression, which includes marked impairments in psychosocial function, work performance, increased health care utilization and more frequent suicide attempts.
Of the patients enrolled in the study, 226 were assigned to receive nafazodone, 228 received therapy and 227 were treated with both the medication and the therapy. The nafazodone group began the study taking 200 milligrams per day for the first week before gradually increasing to a maximum of 600 milligrams per day by the end of the 12-week trial. Patients in the therapy-only group saw a therapist twice a week for the first four weeks and once a week for the rest of the study.
Patients' improvement was measured on the Hamilton Rating Scale for Depression (HRSD). For the purposes of this trial, patients needed a score of 20 on the 24-itemt HRSD scale or higher to be eligible to participate.
Mean HRSD scores for patients in the nefazodone group were 26.8 at base line and 14.7 after the 12-week trial was complete. Patients in the therapy group recorded HSRD scores of 26.4 at the beginning of the study and 15.1 after 12 weeks. Patients who received both nefazodone and therapy had HSRD measures of 27.4 at base line but 9.7 after 12 weeks of treatment.
"The rates of response and remission in the combined treatment group were substantially higher than those that might have been anticipated on the basis of the outcome of previous trials in similar patients," the authors wrote.
Rush-Presbyterian-St. Luke's Medical Center includes the 809-bed Presbyterian-St. Luke's Hospital; 154-bed Johnston R. Bowman Health Center for the Elderly; Rush University (Rush Medical College, College of Nursing, College of Health Sciences and Graduate College); and seven Rush Institutes providing diagnosis, treatment and research into leading health problems. The medical center is the tertiary hub of the Rush System for Health, a comprehensive healthcare system capable of serving about three million people through its outpatient facilities and seven member hospitals.