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Despite depressive disorders being very common there has been little
research to guide primary care physicians on the choice of treatment for
patients with mild to moderate depression.
To evaluate the efficacy of interpersonal counselling compared with
selective serotonin reuptake inhibitors (SSRIs), in primary care
attenders with major depression and to identify moderators of treatment
A randomised controlled trial in nine centres (DEPICS, Australian New
Zealand Clinical Trials Registry number: ACTRN12608000479303). The
primary outcome was remission of the depressive episode (defined as a
Hamilton Rating Scale for Depression score 7 at 2 months). Daily
functioning was assessed using the Work and Social Adjustment Scale.
Logistic regression models were used to identify moderators of treatment
The percentage of patients who achieved remission at 2 months was
significantly higher in the interpersonal counselling group compared with
the SSRI group (58.7% v. 45.1%, P =
0.021). Five moderators of treatment outcome were found: depression
severity, functional impairment, anxiety comorbidity, previous depressive
episodes and smoking habit.
We identified some patient characteristics predicting a differential
outcome with pharmacological and psychological interventions. Should our
results be confirmed in future studies, these characteristics will help
clinicians to define criteria for first-line treatment of depression
targeted to patients' characteristics.
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