In the current issue of Psychotherapy and Psychosomatics, a group of German investigators presents new data on role of patient treatment preferences in the outcome of depression. This study demonstrates that patients’ relative preference for medication versus psychotherapy should be considered when offering a treatment to depressed patients because receiving the preferred treatment conveys an additional and clinically relevant benefit in outcome.
Little is known about the influence of depressed patients’ preferences and expectations about treatments upon treatment outcome. In this study the researchers investigated whether improved clinical outcome in depressed primary care patients is associated with receiving their preferred treatment.
Within a randomized, placebo-controlled, single-center, 10-week trial, outcomes for 145 primary care patients with mild-to-moderate depressive disorders according to DSM-IV criteria were investigated. Participants were assigned to 1 of 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.
Results
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). 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.
Summary
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.
Material adapted from Journal of Psychotherapy and Psychosomatics.
Reference
Mergl, R., Henkel, V., Allgaier, A.K., Kramer, D., Hautzinger, M., Kohnen, R., Coyne, J., & Hegerl, U. (2011). 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. Psychother Psychosom, 80, 39-47.
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