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Antidepressant and Group Psychosocial Treatment for Depression: A Rater Blind Exploratory RCT from a Low Income Country

Published online by Cambridge University Press:  19 July 2013

Nusrat Husain ,
Nasim Chaudhry ,
Batool Fatima ,
Meher Husain ,
Rizwana Amin ,
Imran Bashir Chaudhry ,
Raza Ur Rahman ,
Barbara Tomenson ,
Farhat Jafri  and
Farooq Naeem
...Show all authors
Nusrat Husain*
Affiliation:
University of Manchester, and Lancashire Care NHS Foundation Trust, UK
Nasim Chaudhry
Affiliation:
University of Manchester, UK
Batool Fatima
Affiliation:
Pakistan Institute of Learning and Living, Pakistan, and Boston University, USA
Meher Husain
Affiliation:
Lancashire Care NHS Foundation Trust, UK
Rizwana Amin
Affiliation:
Pakistan Institute of Learning and Living, Pakistan
Imran Bashir Chaudhry
Affiliation:
Lancashire Care NHS Foundation Trust, and University of Manchester, UK
Raza Ur Rahman
Affiliation:
Dow University of Health Sciences, Karachi, Pakistan
Barbara Tomenson
Affiliation:
University of Manchester, UK
Farhat Jafri
Affiliation:
Karachi Medical and Dental College, Pakistan
Farooq Naeem
Affiliation:
Lancashire Care NHS Foundation Trust, UK
Francis Creed
Affiliation:
University of Manchester, UK
*
Reprint requests to Nusrat Husain, University of Manchester and Lancashire Care NHS Foundation Trust, 303 Jean McFarlane Building, Oxford Road, Manchester M13 9PL, UK. E-mail: nusrat.husain@manchester.ac.uk
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Abstract

Background: Research in the West shows that group psychological intervention together with an antidepressant treatment leads to more effective treatment of a depressive disorder. There are no treatment trials from low income countries comparing the efficacy of antidepressant treatment with a group psychological intervention. Aim: To conduct a feasibility trial to compare the efficacy of an antidepressant to a group psychosocial intervention, for low income women attending primary health care in Karachi, Pakistan. Method: This was a preliminary RCT in an urban primary health care clinic in Karachi, Pakistan. Consecutive eligible women scoring >12 on the CIS-R and >18 on Hamilton Depression Rating Scale (HDRS) (n = 66) were randomly assigned to antidepressants or a psychosocial treatment in group settings. The primary outcome measure was HDRS score; secondary outcome measures were disability and quality of life. Results: More than half of the patients in both groups improved (50% reduction in HDRS scores); at end of therapy at 3 months 19 (59.4%) vs 18 (56.2%), and at 6-month follow-up 21(67.7%) vs 20(62.5%) for antidepressants and psychosocial intervention respectively. Although HDRS, BDQ and EQ5-D scores all improved considerably in both groups from start to end of treatment, and these improvements were largely maintained after a further 3 months, the differences between the two treatments were not statistically significant. Conclusion: Psychosocial intervention was as effective as antidepressants in reducing depression and in improving quality of life and disability at the end of therapy. However, these findings need further exploration through a larger trial.

Keywords

Depressionantidepressantsrandomized controlled trialtranscultural psychiatrypsychotherapy
Type
Research Article
Information
Behavioural and Cognitive Psychotherapy , Volume 42 , Issue 6 , November 2014 , pp. 693 - 705
Copyright
Copyright © British Association for Behavioural and Cognitive Psychotherapies 2013 

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