Research Evaluating the Value of Augmenting Medication With Psychotherapy

Chronic depression affects approximately 5% of adults in the United States and is associated with significant functional impairment and high health care utilization. The combination of drug treatment and psychotherapy may be most effective in treating depression. This study will determine the effects of adjunctive psychotherapy in depressed patients who have failed to respond or have responded only partially to an initial trial medication.

Participants receive an initial trial of antidepressant medication for 8 to 12 weeks. Participants who continue to have depressive symptoms are randomly assigned to add Cognitive Behavioral Analysis System of Psychotherapy (CBASP) or supportive therapy to their medication regimens or to continue pharmacotherapy alone for an additional 12 weeks. Assessments are made at 6 and 12 months post-treatment.

Inclusion criteria

• Major depressive episode
• Depressive symptoms > 2 years without remission
• Hamilton Depression Scale (HAM-D) score > 20
• Fluent in English

Exclusion criteria

• Psychotic disorders, bipolar disorder, post traumatic stress disorder, obsessive compulsive disorder, or eating disorder
• Serious, unstable, or terminal medical condition
• Axis II diagnosis of antisocial, schizotypal, or severe borderline personality disorder
• Previous treatment with CBASP
• Previous ineffective treatment with 4 of the medication treatments used in the study
• Substance abuse
• Pregnancy
• Not willing to end other psychiatric treatment