Hostname: page-component-84b7d79bbc-c654p Total loading time: 0 Render date: 2024-07-25T10:52:39.476Z Has data issue: false hasContentIssue false

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*
University of Manchester, and Lancashire Care NHS Foundation Trust, UK
Nasim Chaudhry
University of Manchester, UK
Batool Fatima
Pakistan Institute of Learning and Living, Pakistan, and Boston University, USA
Meher Husain
Lancashire Care NHS Foundation Trust, UK
Rizwana Amin
Pakistan Institute of Learning and Living, Pakistan
Imran Bashir Chaudhry
Lancashire Care NHS Foundation Trust, and University of Manchester, UK
Raza Ur Rahman
Dow University of Health Sciences, Karachi, Pakistan
Barbara Tomenson
University of Manchester, UK
Farhat Jafri
Karachi Medical and Dental College, Pakistan
Farooq Naeem
Lancashire Care NHS Foundation Trust, UK
Francis Creed
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:


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.

Research Article
Copyright © British Association for Behavioural and Cognitive Psychotherapies 2013 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)


Araya, R., Rojas, G., Fritsch, R., Gaete, J., Rojas, M., Simon, G., et al. (2003). Treating depression in primary care in low-income women in Santiago, Chile: a randomized controlled trial. The Lancet, 361, 9951000.Google Scholar
Bolton, P., Bass, J., Neugebauer, R., Verdeli, H., Cloughterty, F. K., Wickramaratne, P., et al. (2003). Group interpersonal psychotherapy for depression in rural Uganda. Journal of the American Medical Association, 289, 31173124.Google Scholar
Brooks, R. (1996). EuroQol: the current state of play. Health Policy, 37, 5372.CrossRefGoogle ScholarPubMed
Chaudhry, I. B., Rahman, R., Minhas, M. H., Chaudhry, N., Taylor, D., Ansari, M., et al. (2011). Which antidepressant would psychiatrists and nurses from a developing country choose for themselves? International Journal of Psychiatry in Clinical Practice, 15, 15.Google Scholar
Dowrick, C., Dunn, G., Ayuso-Mateos, J., Dalgard, O. S., Page, H., Lehtinen, V., et al. (2000). Problem solving treatment and group psychoeducation for depression: multicentre randomised controlled trial. British Medical Journal, 321, 14501450.Google Scholar
Duddu, V., Husain, N. and Dickens, C. (2008). Medically unexplained presentations and quality of life: a study of a predominantly South Asian primary care population in England. Journal of Psychosomatic Research, 65, 311317.Google Scholar
Gater, R., Waheed, W., Husain, N., Tomenson, B., Aseem, S. and Creed, F. (2010). Social intervention for British Pakistani women with depression: randomised controlled trial. The British Journal of Psychiatry, 197, 227233.Google Scholar
Hamilton, M. (1967). Development of a rating scale for primary depressive illness. British Journal of Social and Clinical Psychology, 6, 278296.CrossRefGoogle ScholarPubMed
Harding, T. W., de Arango, V., Baltazar, J., Climent, C. E., Ibrahim, H. A., Ladrido-Ignacio, L., et al. (1980). Mental disorders in primary health care: a study of their frequency and diagnosis in four developing countries. Psychological Medicine, 10, 231241.Google Scholar
Husain, N., Chaudhry, I. B., Afridi, A. M., Tomenson, B. and Creed, F. (2007). Life stress and depression in a tribal area of Pakistan. British Journal of Psychiatry, 190, 3641.Google Scholar
Husain, N., Chaudhry, I. B., Jafri, F., Niaz, S. K., Tomenson, B. and Creed, F. (2008). A population based study of irritable bowel syndrome in a non-Western population. Neurogastroenterology Motility, 20, 10221029.CrossRefGoogle Scholar
Husain, N., Creed, F. and Tomenson, B. (2000). Depression and social stress in Pakistan. Psychological Medicine, 30, 395402.Google Scholar
Jamison, D., Breman, J. G., Measham, A. R., Allyene, G., Claeson, M., Evans, D. B., et al. (2006). Disease Control Priorities in Developing Countries (2nd edn). Washington, DC: World Bank.Google Scholar
Kessler, R. C. (2003). Epidemiology of women and depression. Journal of Affective Disorders, 74, 513.Google Scholar
Lewis, G., Pelosi, A. J., Araya, R. and Dunn, G. (1992). Measuring psychiatric disorder in the community: a standardized assessment for use by lay interviewers. Psychological Medicine, 22, 465486.Google Scholar
Mathers, C. D. and Loncar, D. (2006). Projections of global mortality and burden of disease from 2002 to 2030. PLoS Medicine, 3, 442.Google Scholar
Miranda, J., Chung, J. Y., Green, B. L., Krupnick, J. K., Siddique, J., Revicki, D. A., et al. (2003). Treating depression in predominantly low-income young minority women. Journal of the American Medical Association, 290, 5765.CrossRefGoogle ScholarPubMed
Miranda, J., Woo, S., Lagomasino, I., Hepner, K. A., Wiseman, S. B. A. and Munoz, R. (2006). Group Cognitive Behaviour Therapy for Depression: thoughts and your mood. San Francisco: San Francisco General Hospital Depression Clinic.Google Scholar
Misajon, R., Manderson, L., Pallant, J. F., Omar, Z., Bennett, E. and Rahim, R. B. A. (2006). Impact, distress and HRQoL among Malaysian men and women with a mobility impairment. Health and Quality of Life Outcomes, 4, 9595.Google Scholar
Munoz, R. F. and Miranda, J. (1986). Group Therapy for Cognitive Behavioural Treatment of Depression. San Francisco: San Francisco General Hospital Depression Clinic.Google Scholar
Mynors-Wallis, L. M., Gath, D. H., Lloyd-Thomas, A. R. and Tomlinson, D. (1995). Randomised controlled trial comparing problem solving treatment with amitriptyline and placebo for major depression in primary care. British Medical Journal, 310, 441445.Google Scholar
Mynors-Wallis, L. M., Gath, D. H., Lloyd-Thomas, A. R. and Tomlinson, D. (2000). Randomised controlled trial of problem solving treatment, antidepressant medication, and combined treatment for major depression in primary care. British Medical Journal, 320, 2630.CrossRefGoogle ScholarPubMed
Naeem, F., Waheed, W., Gobbi, M., Ayub, M. and Kingdon, D. (2011). Preliminary evaluation of culturally sensitive CBT for depression in Pakistan: findings from a developing culturally sensitive CBT project (DCCP). Behavioural and Cognitive Psychotherapy, 39, 165173.Google Scholar
National Institute for Health and Clinical Excellence (2004). Depression: management of depression in primary and secondary care. Guideline No. 23, London: NICE.Google Scholar
Patel, V., Araya, R., Chatterjee, S., Chisholm, D., Cohen, A., De Silva, M., et al. (2007). Treatment and prevention of mental disorders in low-income and middle-income countries. Lancet, 370, 9911005.Google Scholar
Patel, V., Chisholm, D., Rabe-Hesketh, S., Dias-Saxena, F., Andrew, G. and Mann, A. (2003). Efficacy and cost-effectiveness of drug and psychological treatments for common mental disorders in general health care in Goa, India: a randomised, controlled trial. Lancet, 361, 3339.Google Scholar
Rahman, A., Iqbal, Z., Roberts, C. and Husain, N. (2009). Cluster randomized trial of a parent-based intervention to support early development of children in a low-income country. Child: Care, Health and Development, 35, 5662.Google Scholar
Rahman, A., Malik, A., Sikander, S., Roberts, C. and Creed, F. (2008). Cognitive behaviour therapy-based intervention by community health workers for mothers with depression and their infants in rural Pakistan: a cluster-randomised controlled trial. Lancet, 372, 902909.Google Scholar
Rojas, G., Fritsch, R. and Solis, J. (2007). Treatment of postnatal depression in low-income mothers in primary-care clinics in Santiago, Chile: a randomised controlled trial. Lancet, 370, 16291637 CrossRefGoogle ScholarPubMed
Ruggeri, M. and Dall’Agnola, R. (1993). The development and use of the Verona Expectations for Care Scale (VECS) and the Verona Service Satisfaction Scale (VSSS) for measuring expectations and satisfaction with community-based psychiatric services in patients, relatives and professionals. Psychological Medicine, 23, 511523.CrossRefGoogle ScholarPubMed
Saxena, S., Thornicroft, G., Knapp, M. and Whiteford, H. (2007). Resources for mental health: scarcity, inequity, and inefficiency. The Lancet, 370, 878889.Google Scholar
Von Korff, M., Ustun, T. B., Ormel, J., Kaplan, I. and Simon, G. E. (1996). Self-report disability in an international primary care study of psychological illness. Journal of Clinical Epidemiology, 49, 297303.Google Scholar
Ware, J. E. and Sherbourne, C. D. (1992). The MOS 36-Item Short-Form Health Survey (SF-36): I. conceptual framework and item selection. Medical Care, 30, 473483.Google Scholar
World Health Organization (1994). A User's Guide to the Self Reporting Questionnaire (SRQ). Geneva: World Health Organization.Google Scholar
Submit a response


No Comments have been published for this article.