Re: Drugs and Despair

From: Anders Sandberg (
Date: Sat May 20 2000 - 04:04:51 MDT

Just a paper I became aware of that relates to this thread, showing
that cognitive psychotherapy and antidepressants have better effect
together than isolated:

The New England Journal of Medicine -- May 18, 2000 -- Vol. 342, No. 20
A Comparison of Nefazodone, the Cognitive Behavioral-Analysis System
of Psychotherapy, and Their Combination for the Treatment of Chronic

Martin B. Keller, James P. McCullough, Daniel N. Klein, Bruce Arnow,
David L. Dunner, Alan J. Gelenberg, John C. Markowitz, Charles B.
Nemeroff, James M. Russell, Michael E. Thase, Madhukar H. Trivedi,
John Zajecka, Janice A. Blalock, Francis E. Borian, Charles
DeBattista, Jan Fawcett, Robert M.A. Hirschfeld, Darlene N. Jody,
Gabor Keitner, James H. Kocsis, Lorrin M. Koran, Susan G. Kornstein,
Rachel Manber, Ivan Miller, Philip T. Ninan, Barbara Rothbaum, A. John
Rush, Alan F. Schatzberg, Dina Vivian


          Background. Patients with chronic forms of major depression
          are difficult to treat, and the relative efficacy of
          medications and psychotherapy is uncertain.

          Methods. We randomly assigned 681 adults with a chronic
          nonpsychotic major depressive disorder to 12 weeks of
          outpatient treatment with nefazodone (maximal dose, 600 mg
          per day), the cognitive behavioral-analysis system of
          psychotherapy (16 to 20 sessions), or both. At base line,
          all patients had scores of at least 20 on the 24-item
          Hamilton Rating Scale for Depression (indicating clinically
          significant depression). Remission was defined as a score of
          8 or less at weeks 10 and 12. For patients who did not have
          remission, a satisfactory response was defined as a
          reduction in the score by at least 50 percent from base line
          and a score of 15 or less. Raters were unaware of the
          patients' treatment assignments.

          Results. Of the 681 patients, 662 attended at least one
          treatment session and were included in the analysis of
          response. The overall rate of response (both remission and
          satisfactory response) was 48 percent in both the nefazodone
          group and the psychotherapy group, as compared with 73
          percent in the combined-treatment group (P<0.001 for both
          comparisons). Among the 519 subjects who completed the
          study, the rates of response were 55 percent in the
          nefazodone group and 52 percent in the psychotherapy group,
          as compared with 85 percent in the combined-treatment group
          (P<0.001 for both comparisons). The rates of withdrawal were
          similar in the three groups. Adverse events in the
          nefazodone group were consistent with the known side effects
          of the drug (e.g., headache, somnolence, dry mouth, nausea,
          and dizziness).

          Conclusions. Although about half of patients with chronic
          forms of major depression have a response to short-term
          treatment with either nefazodone or a cognitive
          behavioral-analysis system of psychotherapy, the combination
          of the two is significantly more efficacious than either
          treatment alone. (N Engl J Med 2000;342:1462-70.)

See also the editorial:

Anders Sandberg                                      Towards Ascension!                  
GCS/M/S/O d++ -p+ c++++ !l u+ e++ m++ s+/+ n--- h+/* f+ g+ w++ t+ r+ !y

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