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Suicidal ideation and other persisting symptoms after CBT or antidepressant medication treatment for major depressive disorder

  • Boadie W. Dunlop (a1), Philip E. Polychroniou (a2), Jeffrey J. Rakofsky (a1), Charles B. Nemeroff (a3), W. Edward Craighead (a1) (a4) and Helen S. Mayberg (a5)...



Persisting symptoms after treatment for major depressive disorder (MDD) contribute to ongoing impairment and relapse risk. Whether cognitive behavior therapy (CBT) or antidepressant medications result in different profiles of residual symptoms after treatment is largely unknown.


Three hundred fifteen adults with MDD randomized to treatment with either CBT or antidepressant medication in the Predictors of Remission in Depression to Individual and Combined Treatments (PReDICT) study were analyzed for the frequency of residual symptoms using the Montgomery Asberg Depression Rating Scale (MADRS) item scores at the end of the 12-week treatment period. Separate comparisons were made for treatment responders and non-responders.


Among treatment completers (n = 250) who responded to CBT or antidepressant medication, there were no significant differences in the persistence of residual MADRS symptoms. However, non-responders treated with medication were significantly less likely to endorse suicidal ideation (SI) at week 12 compared with those treated with CBT (non-responders to medication: 0/54, 0%, non-responders to CBT: 8/30, 26.7%; p = .001). Among patients who terminated the trial early (n = 65), residual MADRS item scores did not significantly differ between the CBT- and medication-treated groups.


Depressed adults who respond to CBT or antidepressant medication have similar residual symptom profiles. Antidepressant medications reduce SI, even among patients for whom the medication provides little overall benefit.


Corresponding author

Author for correspondence: Boadie W. Dunlop, E-mail:


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These authors contributed equally to the manuscript.



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Suicidal ideation and other persisting symptoms after CBT or antidepressant medication treatment for major depressive disorder

  • Boadie W. Dunlop (a1), Philip E. Polychroniou (a2), Jeffrey J. Rakofsky (a1), Charles B. Nemeroff (a3), W. Edward Craighead (a1) (a4) and Helen S. Mayberg (a5)...


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