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Cited by 2,300Psychotherapy Techniques and ApplicationsAnxiety, Depression, Psychometrics, Treatment, Cognitive ProcessesTreatment of Major Depression

National Institute of Mental Health Treatment of Depression Collaborative Research Program: General Effectiveness of Treatments

Elkin, Irene·1989·Archives of General Psychiatry
DOI 10.1001/archpsyc.1989.01810110013002
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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.

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Crossref · 10.1001/archpsyc.1989.01810110013002

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Authors
Elkin, I.
Affiliations
National Institutes of Health (US)
Corresponding author
Elkin, Irene
Venue
Archives of General Psychiatry
Publisher
American Medical Association (AMA)
Published
1989-11-01
Volume
46
Issue
11
Pages
971
ISSN
0003-990X (ISSN-L)
DOI
10.1001/archpsyc.1989.01810110013002
OpenAlex
W2169217816
Cited by
2,300
References
36
Citations by year
2026: 14 · 2025: 17 · 2024: 22 · 2023: 19 · 2022: 17 · 2021: 23 · 2020: 71 · 2019: 29 · 2018: 30 · 2017: 34 · 2016: 74 · 2015: 71 · 2014: 52 · 2013: 84 · 2012: 80
FWCI
71.65
Type
journal article
Language
en
Open access
closed
Locations
  • Archives of General Psychiatry (publishedVersion)
  • PubMed (publishedVersion)
Funders
National Institute of Mental Health (MH 33762, MH-33760, MH33753)
Topics
  • Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
  • Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
  • Health Sciences › Medicine › Pharmacology › Treatment of Major Depression
Keywords
major depressive disorder, interpersonal psychotherapy, cognitive behavioral therapy, imipramine, antidepressant treatment, brief psychotherapy, outpatients, treatment effectiveness, depression severity, functional disability, placebo response, subgroup analysis
MeSH terms
Adult, Ambulatory Care, Combined Modality Therapy, Depressive Disorder, Female, Humans, Imipramine, Male, National Institute of Mental Health (U.S.), Outcome and Process Assessment, Health Care, Placebos, Psychiatric Status Rating Scales, Psychotherapy, United States, Multicenter Studies as Topic, Cognitive Behavioral Therapy, Randomized Controlled Trials as Topic

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