Moderators of remission with interpersonal counselling or drug treatment in primary care patients with depression: Randomised controlled trial

Menchetti M;Rucci P;Bortolotti Bm;Bombi A;Scosso P;Kraemer Hc;Berdardi D. And The Depics Group: Luciano C;Lia L;Manganaro D;Magnani M;Nespeca C;Succu M;Bellino S;Bogettof;Zizza M;Colombini N;Rigatellim;Simoni E;Tedeschinie;Baranzini F;Bortolaso P;Callegari P;Croci G;Diurni M;Vender S;Martinelli V;Politi P;Sciarini P;Piselli M;Quartesan R;Bellomo A;De Salvia M;Ferretti M;Iuso S;Petito A;Affatati V;Todarello O;CARPINIELLO, BERNARDO;Contu C;PINNA, FEDERICA

2014-01-01

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Abstract

Background: 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. Aims: 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 outcome. Method: 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 outcome. Results: 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. Conclusions: 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.