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Randomized Controlled Trial of Antidepressants vs. Couple Therapy in the Treatment and Maintenance of People with Depression Living with a Partner: Clinical Outcome and Costs

The intention of this trial was to compare the optimum regime of antidepressants with couple therapy delivered by experienced therapists. Antidepressant treatment would be maintained for a year, after which it would be discontinued. Couple therapy would be given as an alternative to drugs during the first year. The second year of the trial would represent the prophylactic phase for both treatments, which would end with a follow-up assessment. A comparison of the costs of treatment and other services received was included, in order to compare the cost-effectiveness of the two treatments.

BACKGROUND: Relapse of depression is associated with a criticizing attitude of the patient's partner.

OBJECTIVE:  To compare the relative efficacy and cost of couple therapy   and antidepressant drugs for the treatment and maintenance   of people with depression living with a critical partner.

METHOD:  A randomized controlled trial of antidepressant drugs   vs.   couple therapy. The subjects were 77 people meeting criteria for depression living with a critical partner.

RESULTS:  Drop-outs were 56.8% from drug treatment and 15% from couple therapy. Subjects' depression improved in both groups,   but couple therapy showed a significant advantage, according   to the Beck Depression Inventory, both at the end of treatment   and after a second year off treatment. Adding the costs of   the interventions to the costs of services used showed there   was no appreciable difference between the two treatments.

CONCLUSIONS:  For this group couple therapy is much more acceptable   than antidepressant drugs and is at least as efficacious,   if not more so, both in the treatment and maintenance phases.   It is no more expensive overall.

Authors: JULIAN LEFF, FRCPsych, SIMON VEARNALS, BSc, GEOFFREY WOLFF, MD and BARBARA ALEXANDER, DPsych
Social Psychiatry Section, Institute of Psychiatry, London, England

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