Treatment of Men With Major Depression: A Comparison of Sequential Cohorts Treated With Either Cognitive-Behavioral Therapy or Newer Generation Antidepressants

Objective: This report compares response tocognitive-behavioral therapy (CBT) and pharmacotherapy insequential cohorts of men with DSM-III-R major depression.

Method: Patients were enrolled in consecutivestandardized 16-week treatment protocols conducted in the sameresearch clinic. The first group (N = 52) was treated with Beck’smodel of CBT, whereas the second group (N = 23) receivedrandomized but open-label treatment with either fluoxetine (N =10) or bupropion (N = 13). Crossover to the alternate medicationwas permitted after 8 weeks of treatment for antidepressantnonresponders. The patient groups were well matched prior totreatment. Outcomes included remission and nonresponse rates, aswell as both independent clinical evaluations and self-reportedmeasures of depressive symptoms.

Results: Despite limited statistical power todetect differences between treatments, depressed men treated withpharmacotherapy had significantly greater improvements on 4 of 6continuous dependent measures and a significantly lower rate ofnonresponse (i.e., 13% vs. 46%). The difference favoringpharmacotherapy was late-emerging and partially explained bycrossing over nonresponders to the alternate medication. Theadvantage of pharmacotherapy over CBT also tended to be largeramong the subgroup of patients with chronic depression.

Conclusion: Results of prior research comparingpharmacotherapy and CBT may have been influenced by thecomposition of study groups, particularly the gender composition,the choice of antidepressant comparators, or an interaction ofthese factors. Prospective studies utilizing flexible dosing ofmodern antidepressants and, if necessary, sequential trials ofdissimilar medications are needed to confirm these findings.