Full Text Full Text (PDF) Data Supplement Alert me when this article is cited Alert me if a correction is posted Citation Map Email this article to a Colleague Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to My Articles & Searches Download to citation manager Citing Articles via HighWire Citing Articles via Google Scholar Articles by Thase, M. E. Articles by Rush, A. J. Search for Related Content PubMed Citation Articles by Thase, M. E. Articles by Rush, A. J. Depression Cognitive Therapy Antidepressants Related Articles

Cognitive Therapy Versus Medication in Augmentation and Switch Strategies as Second-Step Treatments: A STAR*D Report

OBJECTIVE: The authors compared the effectiveness of cognitive therapy and pharmacotherapy as second-step strategies for outpatients with major depressive disorder who had received inadequate benefit from an initial trial of citalopram. Cognitive therapy was compared with medication augmentation and switch strategies. METHOD: An equipoise-stratified randomization strategy was used to assign participants to either augmentation of citalopram with cognitive therapy (N=65) or medication (N=117; either sustained-release bupropion [N=56] or buspirone [N=61]) or switch to cognitive therapy (N=36) or another antidepressant (N=86; sertraline [N=27], sustained-release bupropion [N=28], or extended-release venlafaxine [N=31]). Treatment outcomes and the frequency of adverse events were compared. RESULTS: Less than one-third of participants consented to randomization strata that permitted comparison of cognitive therapy and pharmacotherapy. Among participants who were assigned to second-step treatment, those who received cognitive therapy (either alone or in combination with citalopram) had similar response and remission rates to those assigned to medication strategies. For those who continued on citalopram, medication augmentation resulted in significantly more rapid remission than augmentation with cognitive therapy. Among those who discontinued citalopram, there were no significant differences in outcome, although those who switched to a different antidepressant reported significantly more side effects than those who received cognitive therapy alone. CONCLUSIONS: After an unsatisfactory response to citalopram, patients who consented to random assignment to either cognitive therapy or alternative pharmacologic strategies had generally comparable outcomes. Pharmacologic augmentation was more rapidly effective than cognitive therapy augmentation of citalopram, whereas switching to cognitive therapy was better tolerated than switching to a different antidepressant.

Related Articles:

Cognitive Therapy and Interpersonal Psychotherapy: 30 Years Later

Myrna M. Weissman
Am J Psychiatry 2007 164: 693-696. [Full Text] [PDF]

This article has been cited by other articles:

				B. N. Gaynes, D. Warden, M. H. Trivedi, S. R. Wisniewski, M. Fava, and A. J. Rush What Did STAR*D Teach Us? Results From a Large-Scale, Practical, Clinical Trial for Patients With Depression Psychiatr Serv, November 1, 2009; 60(11): 1439 - 1445. [Abstract] [Full Text] [PDF]

				J. H. Kocsis, A. J. Gelenberg, B. O. Rothbaum, D. N. Klein, M. H. Trivedi, R. Manber, M. B. Keller, A. C. Leon, S. R. Wisniewski, B. A. Arnow, et al. Cognitive Behavioral Analysis System of Psychotherapy and Brief Supportive Psychotherapy for Augmentation of Antidepressant Nonresponse in Chronic Depression: The REVAMP Trial Arch Gen Psychiatry, November 1, 2009; 66(11): 1178 - 1188. [Abstract] [Full Text] [PDF]

				J Deakin and C O'Loughlin STAR*D: a summary and UK perspective J Psychopharmacol, August 1, 2009; 23(6): 605 - 612. [PDF]

				J. H. Lichtman, J. T. Bigger Jr, J. A. Blumenthal, N. Frasure-Smith, P. G. Kaufmann, F. Lesperance, D. B. Mark, D. S. Sheps, C. B. Taylor, and E. S. Froelicher Depression and Coronary Heart Disease: Recommendations for Screening, Referral, and Treatment: A Science Advisory From the American Heart Association Prevention Committee of the Council on Cardiovascular Nursing, Council on Clinical Cardiology, Council on Epidemiology and Prevention, and Interdisciplinary Council on Quality of Care and Outcomes Research: Endorsed by the American Psychiatric Association Focus, July 1, 2009; 7(3): 406 - 413. [Abstract] [Full Text] [PDF]

				L. A. Uebelacker, R. B. Weisberg, R. Haggarty, and I. W. Miller Adapted Behavior Therapy for Persistently Depressed Primary Care Patients: An Open Trial Behav Modif, May 1, 2009; 33(3): 374 - 395. [Abstract] [PDF]

				S. Hatcher The STAR*D trial: the 300 lb gorilla is in the room, but does it block all the light? Evid. Based Ment. Health, November 1, 2008; 11(4): 97 - 99. [Full Text] [PDF]

				J. H. Lichtman, J. T. Bigger Jr, J. A. Blumenthal, N. Frasure-Smith, P. G. Kaufmann, F. Lesperance, D. B. Mark, D. S. Sheps, C. B. Taylor, and E. S. Froelicher Depression and Coronary Heart Disease: Recommendations for Screening, Referral, and Treatment: A Science Advisory From the American Heart Association Prevention Committee of the Council on Cardiovascular Nursing, Council on Clinical Cardiology, Council on Epidemiology and Prevention, and Interdisciplinary Council on Quality of Care and Outcomes Research: Endorsed by the American Psychiatric Association Circulation, October 21, 2008; 118(17): 1768 - 1775. [Abstract] [Full Text] [PDF]

				G. J. Emslie, B. D. Kennard, T. L. Mayes, J. Nightingale-Teresi, T. Carmody, C. W. Hughes, A. J. Rush, R. Tao, and J. W. Rintelmann Fluoxetine Versus Placebo in Preventing Relapse of Major Depression in Children and Adolescents Focus, July 1, 2008; 6(3): 348 - 357. [Abstract] [Full Text] [PDF]

				I. Anderson, I. Ferrier, R. Baldwin, P. Cowen, L Howard, G Lewis, K Matthews, R. McAllister-Williams, R. Peveler, J Scott, et al. Evidence-based guidelines for treating depressive disorders with antidepressants: A revision of the 2000 British Association for Psychopharmacology guidelines J Psychopharmacol, June 1, 2008; 22(4): 343 - 396. [Abstract] [PDF]

				G. J. Emslie, B. D. Kennard, T. L. Mayes, J. Nightingale-Teresi, T. Carmody, C. W. Hughes, A. J. Rush, R. Tao, and J. W. Rintelmann Fluoxetine Versus Placebo in Preventing Relapse of Major Depression in Children and Adolescents Am J Psychiatry, April 1, 2008; 165(4): 459 - 467. [Abstract] [Full Text] [PDF]

				P. Rohde, S. G. Silva, S. T. Tonev, B. D. Kennard, B. Vitiello, C. J. Kratochvil, M. A. Reinecke, J. F. Curry, A. D. Simons, and J. S. March Achievement and Maintenance of Sustained Response During the Treatment for Adolescents With Depression Study Continuation and Maintenance Therapy Arch Gen Psychiatry, April 1, 2008; 65(4): 447 - 455. [Abstract] [Full Text] [PDF]

				D. Brent, G. Emslie, G. Clarke, K. D. Wagner, J. R. Asarnow, M. Keller, B. Vitiello, L. Ritz, S. Iyengar, K. Abebe, et al. Switching to Another SSRI or to Venlafaxine With or Without Cognitive Behavioral Therapy for Adolescents With SSRI-Resistant Depression: The TORDIA Randomized Controlled Trial JAMA, February 27, 2008; 299(8): 901 - 913. [Abstract] [Full Text] [PDF]

				Bibliography for Major Depressive Disorder and Suicide Focus, January 1, 2008; 6(1): 58 - 62. [Full Text] [PDF]

Get information about faster international access.

Privacy Policy

Copyright © 2007 American Psychiatric Association. All rights reserved.

Home | Search | Current Issue | Past Issues | Subscribe | All APPI Journals | Help | Contact Us