Assessing effectiveness of treatment of depression in primary care: Partially randomised preference trial

Abstract

Background: There is a mismatch between the wish of a patient with depression to have counselling and the prescription of antidepressants by the doctor. Aims: To determine whether counselling is as effective as antidepressants for depression in primary care and whether allowing patients to choose their treatment affects their response. Method: A partially randomised preference trial, with patients randomised to either antidepressants or counselling or given their choice of either treatment. The treatment and follow-up were identical in the randomised and patient preference arms. Results: There were 103 randomised and 220 preference patients in the trial. We found: No differences in the baseline characteristics of the randomised and preference groups; that the two treatments were equally effective at 8 weeks, both for the randomised group and when the randomised and patient preference groups for a particular treatment were combined; and that expressing a preference for either treatment conferred no additional benefit on outcome. Conclusions: These data challenge several assumptions about the most appropriate treatment for depression in a primary care setting. Declaration of interest: None. The NHS Executive, Trent, funded the study.