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October 1992

Cognitive Therapy and Pharmacotherapy for DepressionSingly and in Combination

Author Affiliations

From the Department of Psychology, University of Minnesota, Minneapolis (Drs Hollon, DeRubeis, Evans, and Grove), and Department of Psychiatry, St Paul (Minn)-Ramsey Medical Center (Drs Wiemer, Garvey, and Tuason). Dr Hollon is now with the Department of Psychology, Vanderbilt University, Nashville, Tenn; Dr DeRubeis, with the Department of Psychology, University of Pennsylvania, Philadelphia; Dr Garvey, with the Veterans Affairs Medical Center and the Department of Psychiatry, University of Iowa College of Medicine, Iowa City; and Dr Tuason, with the Veterans Affairs Medical Center and the Department of Psychiatry, University of New Mexico, Albuquerque.

Arch Gen Psychiatry. 1992;49(10):774-781. doi:10.1001/archpsyc.1992.01820100018004

• Cognitive therapy and imipramine hydrochloride tricyclic pharmacotherapy, each singly and in combination, were compared in the treatment of nonpsychotic, nonbipolar depressed outpatients. One hundred seven patients were randomly assigned to 12 weeks of active treatment; 64 patients completed the full course of treatment. Rates of attrition were high but not differential. Cognitive therapy and pharmacotherapy did not differ in terms of symptomatic response, either in the primary analyses or in secondary analyses restricted to more severely depressed outpatients. Initial severity did predict response within pharmacotherapy alone, but not within cognitive therapy. Combining cognitive therapy with pharmacotherapy did not markedly improve response over that observed for either modality alone, although such nonsignificant differences as were evident did favor the combined treatment. Two patients died as a consequence of suicide attempts, both of which involved study medication.