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Cited by 1,331Treatment of Major DepressionPsychotherapy Techniques and ApplicationsAnxiety, Depression, Psychometrics, Treatment, Cognitive Processes

A Comparison of Nefazodone, the Cognitive Behavioral-Analysis System of Psychotherapy, and Their Combination for the Treatment of Chronic Depression

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Keller, Martin B., McCullough, James P., Klein, Daniel N., Arnow, Bruce, Dunner, David L., Gelenberg, Alan J., Markowitz, John C., Nemeroff, Charles B. +21 more·2000·New England Journal of Medicine
DOI 10.1056/nejm200005183422001
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Abstract

BACKGROUND: Patients with chronic forms of major depression are difficult to treat, and the relative efficacy of medications and psychotherapy is uncertain. METHODS: We randomly assigned 681 adults with a chronic nonpsychotic major depressive disorder to 12 weeks of outpatient treatment with nefazodone (maximal dose, 600 mg per day), the cognitive behavioral-analysis system of psychotherapy (16 to 20 sessions), or both. At base line, all patients had scores of at least 20 on the 24-item Hamilton Rating Scale for Depression (indicating clinically significant depression). Remission was defined as a score of 8 or less at weeks 10 and 12. For patients who did not have remission, a satisfactory response was defined as a reduction in the score by at least 50 percent from base line and a score of 15 or less. Raters were unaware of the patients' treatment assignments. RESULTS: Of the 681 patients, 662 attended at least one treatment session and were included in the analysis of response. The overall rate of response (both remission and satisfactory response) was 48 percent in both the nefazodone group and in the psychotherapy group, as compared with 73 percent in the combined-treatment group. (P<0.001 for both comparisons). Among the 519 subjects who completed the study, the rates of response were 55 percent in the nefazodone group and 52 percent in the psychotherapy group, as compared with 85 percent in the combined-treatment group (P<0.001 for both comparisons). The rates of withdrawal were similar in the three groups. Adverse events in the nefazodone group were consistent with the known side effects of the drug (e.g., headache, somnolence, dry mouth, nausea, and dizziness). CONCLUSIONS: Although about half of patients with chronic forms of major depression have a response to short-term treatment with either nefazodone or a cognitive behavioral-analysis system of psychotherapy, the combination of the two is significantly more efficacious than either treatment alone.

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  1. [9]9. Howland RH. Chronic depression. Hosp Community Psychiatry 1993; 44:633-9.
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  7. [34]34. First MB, Spitzer RL, Gibbon M, et al. Structured clinical interview for Axis-I DSM-IV disorders: patient edition (SCID-II, version 2.0). New York: New York State Psychiatric Institute Biometrics Research Depart- ment, 1994.

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Authors
Keller, M. B., McCullough, J. P., Klein, D. N., Arnow, B., Dunner, D. L., Gelenberg, A. J., Markowitz, J. C., Nemeroff, C. B., Russell, J. M., Thase, M. E., Trivedi, M. H., Blalock, J. A., Borian, F. E., Jody, D. N., DeBattista, C., Koran, L. M., Schatzberg, A. F., Fawcett, J., Hirschfeld, R. M. A., Keitner, G., Miller, I., Kocsis, J. H., Kornstein, S. G., Manber, R., Ninan, P. T., Rothbaum, B., Rush, A. J., Vivian, D., & Zajecka, J.
Affiliations
  • Brown University (US)
  • Virginia Commonwealth University (US)
  • State University of New York (US)
  • Stanford University (US)
  • University of Arizona (US)
  • Cornell University (US)
  • Emory University (US)
  • The University of Texas Medical Branch at Galveston (US)
  • University of Pittsburgh (US)
  • The University of Texas Southwestern Medical Center (US)
  • Rush University Medical Center (US)
ORCID
Venue
New England Journal of Medicine
Publisher
Massachusetts Medical Society
Published
2000-05-18
Volume
342
Issue
20
Pages
1462-1470
ISSN
  • 0028-4793 (ISSN-L)
  • 1533-4406
DOI
10.1056/nejm200005183422001
OpenAlex
W2326556724
Cited by
1,331
References
34
Citations by year
2026: 14 · 2025: 10 · 2024: 17 · 2023: 17 · 2022: 22 · 2021: 25 · 2020: 35 · 2019: 29 · 2018: 24 · 2017: 39 · 2016: 51 · 2015: 59 · 2014: 58 · 2013: 63 · 2012: 67
FWCI
49.18
Type
journal article
Language
en
Open access
Locations
  • New England Journal of Medicine (publishedVersion)
  • PubMed (publishedVersion)
  • VCU Scholars Compass (Virginia Commonwealth University) (submittedVersion)
Funders
National Institute of Mental Health (U01MH061590)
Topics
  • Health Sciences › Medicine › Pharmacology › Treatment of Major Depression
  • Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
  • Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
Keywords
nefazodone, CBASP, antidepressant efficacy, treatment response, remission, adverse drug reactions
MeSH terms
Adult, Behavior Therapy, Chronic Disease, Combined Modality Therapy, Depressive Disorder, Female, Humans, Male, Piperazines, Triazoles, Cognitive Behavioral Therapy, Treatment Outcome, Antidepressive Agents, Second-Generation

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