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National Institute of Mental Health Treatment of Depression Collaborative Research Program. General effectiveness of treatments

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Abstract

We investigated the effectiveness of two brief psychotherapies, interpersonal psychotherapy and cognitive behavior therapy, for the treatment of outpatients with major depression disorder diagnosed by Research Diagnostic Criteria. Two hundred fifty patients were randomly assigned to one of four 16-week treatment conditions: interpersonal psychotherapy, cognitive behavior therapy, imipramine hydrochloride plus clinical management (as a standard reference treatment), and placebo plus clinical management. Patients in all treatments showed significant reduction in depressive symptoms and improvement in functioning over the course of treatment. There was a consistent ordering of treatments at termination, with imipramine plus clinical management generally doing best, placebo plus clinical management worst, and the two psychotherapies in between but generally closer to imipramine plus clinical management. In analyses carried out on the total samples without regard to initial severity of illness (the primary analyses), there was no evidence of greater effectiveness of one of the psychotherapies as compared with the other and no evidence that either of the psychotherapies was significantly less effective than the standard reference treatment, imipramine plus clinical management. Comparing each of the psychotherapies with the placebo plus clinical management condition, there was limited evidence of the specific effectiveness of interpersonal psychotherapy and none for cognitive behavior therapy. Superior recovery rates were found for both interpersonal psychotherapy and imipramine plus clinical management, as compared with placebo plus clinical management. On mean scores, however, there were few significant differences in effectiveness among the four treatments in the primary analyses. Secondary analyses, in which patients were dichotomized on initial level of severity of depressive symptoms and impairment of functioning, helped to explain the relative lack of significant findings in the primary analyses. Significant differences among treatments were present only for the subgroup of patients who were more severely depressed and functionally impaired; here, there was some evidence of the effectiveness of interpersonal psychotherapy with these patients and strong evidence of the effectiveness of imipramine plus clinical management. In contrast, there were no significant differences among treatments, including placebo plus clinical management, for the less severely depressed and functionally impaired patients.
... Bestraebelser for at tilgodese de saerlige metodologiske krav ved RCTs inden for psykoterapiens område er af nyere dato. Det første forsøg på at efterligne medicinske RCTs var den berømte komparative undersøgelse af kognitiv adfaerdsterapi, interpersonel psykoterapi, medicin (imipramin) og placebopille -det såkaldte NIMH-depressionsprojekt (egentlig NIM-HTDCRP: National Institute of Mental Health Treatment of Depression Collaborative Research Project) (Elkin et al., 1989). Undersøgelsen, der omfattede 240 patienter ved tre forskellige behandlingscentre med et anslået budget på omkring 10 millioner dollars, blev planlagt i 1977, gennemført i perioden 1980-86 med den første rapport om resultater i 1989. ...
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