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Citalopram-resistant depression: cognitive therapy and medication similarly effective as second line treatments

Dr Thase

Correspondence to: Dr Thase, University of Pittsburgh Medical Center, 3811 O’Hara Street, Pittsburgh, PA 15213-2593, USA; thaseme@upmc.edu

QUESTION
Question:
Cognitive therapy or pharmacotherapy as second-line for people with citalopram-resistant depression—which is more effective?

Patients:
304 out-patients with non-psychotic major depressive disorder (clinically established diagnosis verified through DSM-IV criteria) enrolled in the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) study who did not achieve remission (remission defined as Quick Inventory of Depressive Symptomatology score 5) with first-line citalopram treatment. This analysis included only those people who agreed to be randomised to treatment strategies (augmentations, switches or both) which would allow cognitive therapy to be compared with pharmacotherapy.

Setting:
Primary care and psychiatric care practice settings across the USA; recruitment July 2001 to April 2004.

Intervention:
Participants who did not achieve remission were randomised to one of seven second-line treatments: ongoing citalopram with sustained-release bupropion, buspirone, or cognitive therapy (augmentation strategies; n = 182); or . . . [Full text of this article]

Sagar V Parikh

University Health Network and University of Toronto, Toronto, Canada