Are treatment preferences relevant for response to serotonergic antidepressants and cognitive-behavioural therapy in depressed primary care patients? Results from a randomized controlled trial including a patient choice arm

Little is known about the influence on treatment outcome of patients' preferences and expectations about offered treatments for depression. We investigated in primary care depressed patients whether or not receiving the preferred treatment is associated with a better clinical outcome. Within a randomized, placebo-controlled, single-centre, 10-week trial with five arms (sertraline; placebo; cognitive-behavioural group therapy (CBT); nonspecific supportive group treatment control; treatment with sertraline or CBT according to patients' choice), 146 primary care patients with mild-to-moderate depressive disorders (acc. to DSM-IV) were investigated. Drug confidence was assessed at patients' screening using an illness-concept scale and attitudes towards psychotherapy by an inventory to measure psychotherapy motivation. To assess outcome, the post-baseline sum scores of the Hamilton Depression Rating Scale (HAMD-17) were used. Depressed patients receiving their preferred treatment (sertraline or CBT) (N=91) responded significantly better than those who did not (N=55) (p=0.011). The difference in outcome between both groups was clinically relevant for both pharmacotherapy and psychotherapy. Thus, patients' preference for pharmaco- versus psychotherapy should be considered when offering a treatment because receiving the preferred treatment conveys an additional and clinically relevant benefit (HAMD-17: + 4 points for drugs; + 2 points for CBT) in outcome.

This study was supported by the German Ministry for Education and Research in Bonn within the promotional emphasis „German Research Network on Depression and Suicidality“.