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BMJ. 1995 February 18; 310(6977): 441–445.
PMCID: PMC2548821

Randomised controlled trial comparing problem solving treatment with amitriptyline and placebo for major depression in primary care.


OBJECTIVE--To determine whether, in the treatment of major depression in primary care, a brief psychological treatment (problem solving) was (a) as effective as antidepressant drugs and more effective than placebo; (b) feasible in practice; and (c) acceptable to patients. DESIGN--Randomised controlled trial of problem solving treatment, amitriptyline plus standard clinical management, and drug placebo plus standard clinical management. Each treatment was delivered in six sessions over 12 weeks. SETTING--Primary care in Oxfordshire. SUBJECTS--91 patients in primary care who had major depression. MAIN OUTCOME MEASURES--Observer and self reported measures of severity of depression, self reported measure of social outcome, and observer measure of psychological symptoms at six and 12 weeks; self reported measure of patient satisfaction at 12 weeks. Numbers of patients recovered at six and 12 weeks. RESULTS--At six and 12 weeks the difference in score on the Hamilton rating scale for depression between problem solving and placebo treatments was significant (5.3 (95% confidence interval 1.6 to 9.0) and 4.7 (0.4 to 9.0) respectively), but the difference between problem solving and amitriptyline was not significant (1.8 (-1.8 to 5.5) and 0.9 (-3.3 to 5.2) respectively). At 12 weeks 60% (18/30) of patients given problem solving treatment had recovered on the Hamilton scale compared with 52% (16/31) given amitriptyline and 27% (8/30) given placebo. Patients were satisfied with problem solving treatment; all patients who completed treatment (28/30) rated the treatment as helpful or very helpful. The six sessions of problem solving treatment totalled a mean therapy time of 3 1/2 hours. CONCLUSIONS--As a treatment for major depression in primary care, problem solving treatment is effective, feasible, and acceptable to patients.

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Selected References

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  • Blacker CV, Clare AW. The prevalence and treatment of depression in general practice. Psychopharmacology (Berl) 1988;95 (Suppl):S14–S17. [PubMed]
  • Wells KB, Stewart A, Hays RD, Burnam MA, Rogers W, Daniels M, Berry S, Greenfield S, Ware J. The functioning and well-being of depressed patients. Results from the Medical Outcomes Study. JAMA. 1989 Aug 18;262(7):914–919. [PubMed]
  • Johnson DA, Mellor V. The severity of depression in patients treated in general practice. J R Coll Gen Pract. 1977 Jul;27(180):419–422. [PMC free article] [PubMed]
  • Porter AM. Depressive illness in a general practice. A demographic study and a controlled trial of imipramine. Br Med J. 1970 Mar 28;1(5699):773–778. [PMC free article] [PubMed]
  • Dunn G, Skuse D. The natural history of depression in general practice: stochastic models. Psychol Med. 1981 Nov;11(4):755–764. [PubMed]
  • Thomson J, Rankin H, Ashcroft GW, Yates CM, McQueen JK, Cummings SW. The treatment of depression in general practice: a comparison of L-tryptophan, amitriptyline, and a combination of L-tryptophan and amitriptyline with placebo. Psychol Med. 1982 Nov;12(4):741–751. [PubMed]
  • Rickels K, Gordon PE, Jenkins BW, Perloff M, Sachs T, Stepansky W. Drug treatment in depressive illness. Dis Nerv Syst. 1970 Jan;31(1):30–42. [PubMed]
  • Blashki TG, Mowbray R, Davies B. Controlled trial of amitriptyline in general practice. Br Med J. 1971 Jan 16;1(5741):133–138. [PMC free article] [PubMed]
  • Paykel ES, Hollyman JA, Freeling P, Sedgwick P. Predictors of therapeutic benefit from amitriptyline in mild depression: a general practice placebo-controlled trial. J Affect Disord. 1988 Jan-Feb;14(1):83–95. [PubMed]
  • Johnson DA. Depression: treatment compliance in general practice. Acta Psychiatr Scand Suppl. 1981;290:447–453. [PubMed]
  • Blackburn IM, Bishop S, Glen AI, Whalley LJ, Christie JE. The efficacy of cognitive therapy in depression: a treatment trial using cognitive therapy and pharmacotherapy, each alone and in combination. Br J Psychiatry. 1981 Sep;139:181–189. [PubMed]
  • Teasdale JD, Fennell MJ, Hibbert GA, Amies PL. Cognitive therapy for major depressive disorder in primary care. Br J Psychiatry. 1984 Apr;144:400–406. [PubMed]
  • Ross M, Scott M. An evaluation of the effectiveness of individual and group cognitive therapy in the treatment of depressed patients in an inner city health centre. J R Coll Gen Pract. 1985 May;35(274):239–242. [PMC free article] [PubMed]
  • Scott AI, Freeman CP. Edinburgh primary care depression study: treatment outcome, patient satisfaction, and cost after 16 weeks. BMJ. 1992 Apr 4;304(6831):883–887. [PMC free article] [PubMed]
  • Corney RH. Social work effectiveness in the management of depressed women: a clinical trial. Psychol Med. 1981 May;11(2):417–423. [PubMed]
  • Catalan J, Gath DH, Anastasiades P, Bond SA, Day A, Hall L. Evaluation of a brief psychological treatment for emotional disorders in primary care. Psychol Med. 1991 Nov;21(4):1013–1018. [PubMed]
  • Spitzer RL, Endicott J, Robins E. Research diagnostic criteria: rationale and reliability. Arch Gen Psychiatry. 1978 Jun;35(6):773–782. [PubMed]
  • Hamilton M. Development of a rating scale for primary depressive illness. Br J Soc Clin Psychol. 1967 Dec;6(4):278–296. [PubMed]
  • Fawcett J, Epstein P, Fiester SJ, Elkin I, Autry JH. Clinical management--imipramine/placebo administration manual. NIMH Treatment of Depression Collaborative Research Program. Psychopharmacol Bull. 1987;23(2):309–324. [PubMed]
  • BECK AT, WARD CH, MENDELSON M, MOCK J, ERBAUGH J. An inventory for measuring depression. Arch Gen Psychiatry. 1961 Jun;4:561–571. [PubMed]
  • Cooper P, Osborn M, Gath D, Feggetter G. Evaluation of a modified self-report measure of social adjustment. Br J Psychiatry. 1982 Jul;141:68–75. [PubMed]
  • Frank E, Prien RF, Jarrett RB, Keller MB, Kupfer DJ, Lavori PW, Rush AJ, Weissman MM. Conceptualization and rationale for consensus definitions of terms in major depressive disorder. Remission, recovery, relapse, and recurrence. Arch Gen Psychiatry. 1991 Sep;48(9):851–855. [PubMed]
  • Heaney DJ, Howie JG, Porter AM. Factors influencing waiting times and consultation times in general practice. Br J Gen Pract. 1991 Aug;41(349):315–319. [PMC free article] [PubMed]

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