Are Treatment Preferences Relevant in Response to Serotonergic Antidepressants and Cognitive-Behavioral Therapy in Depressed Primary Care Patients? Results from a Randomized Controlled Trial Including a Patients' Choice Arm

Background Little is known about the influence of depressed
patients' preferences and expectations about treatments upon
treatment outcome We investigated whether better clinical outcome
in depressed primary care patients is associated with receiving
their preferred treatment Methods Within a randomized
placebo-controlled single-centre 10-week trial with 5 arms
(sertraline, placebo, cognitive-behavioral group therapy, CBT-G,
moderated self-help group control, treatment with sertraline or
CBT-G according to patients' choice), outcomes for 145 primary care
patients with mild-to-moderate depressive disorders according to
DSM-IV criteria were investigated Preference for medication versus
psychotherapy was assessed at screening using a single item
Post-baseline difference scores for the Hamilton Depression Rating
Scale (HAMD-17) were used to assess treatment outcome (mixed-model
repeated-measures regression analysis) Results Depressed patients
receiving their preferred treatment (n = 63), whether sertraline or
CBT-G, responded significantly better than those who did not
receive their preferred therapy (n = 54, p = 0 001) The difference
in outcome between both groups was 8 0 points on the HAMD-17 for
psychotherapy and 2 9 points on the HAMD-17 for treatment with
antidepressants Results were not explained by differences in
depression severity or dropout rates Conclusions Patients' relative
preference for medication versus psychotherapy should be considered
when offering a treatment because receiving the preferred treatment
conveys an additional and clinically relevant benefit (HAMD-17 +2 9
points for drugs, +8 0 points for CBT-G) in outcome Copyright (C)
2010 S Karger AG Basel