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Medical Sciences
Differential responses to psychotherapy versus pharmacotherapy in patients with chronic forms of major depression and childhood trauma

Charles B. Nemeroff ^*  , Christine M. Heim ^* , Michael E. Thase  , Daniel N. Klein , A. John Rush  ^¶, Alan F. Schatzberg  ^||, Philip T. Ninan ^* , James P. McCullough, Jr. ^**, Paul M. Weiss , David L. Dunner  , Barbara O. Rothbaum ^* , Susan Kornstein  , Gabor Keitner  ^¶¶, and Martin B. Keller  ^¶¶

^*Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA 30322; Department of Biostatistics, School of Public Health, Emory University, Atlanta, GA 30322; Western Psychiatric Institute and Clinic, Pittsburg, PA 15213; Department of Psychology, State University of New York, Stony Brook, NY 11794; ^¶Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX 75390; ^||Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA 94305; ^**Department of Psychology, Virginia Commonwealth University, Richmond, VA 23284; Department of Psychiatry/Ambulatory Care, Virginia Commonwealth University Health System, Richmond, VA 23284; Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA 98105; and ^¶¶Department of Psychiatry, Brown University, Providence, RI 02906

Communicated by Wylie Vale, The Salk Institute for Biological Studies, La Jolla, CA, September 23, 2003 (received for review July 2, 2003)

Major depressive disorder is associated with considerable morbidity, disability, and risk for suicide. Treatments for depression most commonly include antidepressants, psychotherapy, or the combination. Little is known about predictors of treatment response for depression. In this study, 681 patients with chronic forms of major depression were treated with an antidepressant (nefazodone), Cognitive Behavioral Analysis System of Psychotherapy (CBASP), or the combination. Overall, the effects of the antidepressant alone and psychotherapy alone were equal and significantly less effective than combination treatment. Among those with a history of early childhood trauma (loss of parents at an early age, physical or sexual abuse, or neglect), psychotherapy alone was superior to antidepressant monotherapy. Moreover, the combination of psychotherapy and pharmacotherapy was only marginally superior to psychotherapy alone among the childhood abuse cohort. Our results suggest that psychotherapy may be an essential element in the treatment of patients with chronic forms of major depression and a history of childhood trauma.

C.B.N., C.M.H., M.E.T., A.J.R., A.F.S., P.T.N., D.L.D., B.O.R., S.K., G.K., and M.B.K. consult, receive research support, and/or are on the speaker bureau for Bristol-Myers-Squibb.

To whom correspondence should be addressed at: Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, 1639 Pierce Drive, WMB, Suite 4000, Atlanta, GA 30322. E-mail: cnemero{at}emory.edu.

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