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

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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., Russell, James M., Thase, Michael E., Trivedi, Madhukar H., Blalock, Janice A., Borian, Frances E., Jody, Darlene N., DeBattista, Charles, Koran, Lorrin M., Schatzberg, Alan F., Fawcett, Jan, Hirschfeld, Robert M.A., Keitner, Gabor, Miller, Ivan, Kocsis, James H., Kornstein, Susan G., Manber, Rachel, Ninan, Philip T., Rothbaum, Barbara, Rush, A. John, Vivian, Dina, Zajecka, John·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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“The CBASP is a highly structured, manual-guided therapy developed specifically to treat chronic depression and has shown value for this disorder when combined with medication.(2) However, it was unclear whether CBASP had specific efficacy for chronic depression or whether other psychotherapies would be equally efficac…”
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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: Keller, Martin B.
McCullough, James P.
Klein, Daniel N.
Arnow, Bruce
Markowitz, John C.
Nemeroff, Charles B.
Thase, Michael E.
Trivedi, Madhukar H.
Blalock, Janice A.
DeBattista, Charles
Koran, Lorrin M.
Schatzberg, Alan F.
Manber, Rachel
Ninan, Philip T.
Rothbaum, Barbara
Rush, A. John
Vivian, Dina
Zajecka, John
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: bronze
doi.org
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 (medical) › 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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A Comparison of Nefazodone, the Cognitive Behavioral-Analysis System of Psychotherapy, and Their Combination for the Treatment of Chronic Depression

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