Background: Little is known about the influence of depressed patients’ preferences and expectations about treatments upon treatment outcome. We investigated whether better clinical outcome in depressed primary care patients is associated with receiving their preferred treatment. Methods: Within a randomized placebo-controlled single-centre 10-week trial with 5 arms (sertraline; placebo; cognitive-behavioral group therapy, CBT-G; moderated self-help group control; treatment with sertraline or CBT-G according to patients’ choice), outcomes for 145 primary care patients with mild-to-moderate depressive disorders according to DSM-IV criteria were investigated. Preference for medication versus psychotherapy was assessed at screening using a single item. Post-baseline difference scores for the Hamilton Depression Rating Scale (HAMD-17) were used to assess treatment outcome (mixed-model repeated-measures regression analysis). Results: Depressed patients receiving their preferred treatment (n = 63), whether sertraline or CBT-G, responded significantly better than those who did not receive their preferred therapy (n = 54; p = 0.001). The difference in outcome between both groups was 8.0 points on the HAMD-17 for psychotherapy and 2.9 points on the HAMD-17 for treatment with antidepressants. Results were not explained by differences in depression severity or dropout rates. Conclusions: Patients’ relative preference for medication versus psychotherapy should be considered when offering a treatment because receiving the preferred treatment conveys an additional and clinically relevant benefit (HAMD-17: +2.9 points for drugs; +8.0 points for CBT-G) in outcome.

Dwight-Johnson M, Sherbourne CD, Liao D, Wells KB: Treatment preferences among depressed primary care patients. J Gen Intern Med 2000;15:527–534.
Hegerl U, Althaus D, Stefanek J: Public attitudes towards treatment of depression: Effects of an information campaign. Pharmacopsychiatry 2003;36:288–291.
Jorm AF, Christensen H, Medway J, Korten AE, Jacomb PA, Rodgers B: Public belief systems about the helpfulness of interventions for depression: Associations with history of depression and professional help-seeking. Soc Psychiatry Psychiatr Epidemiol 2000;35:211–219.
Thornett A: Assessing the effect of patient and prescriber preference in trials of treatment of depression in general practice. Med Sci Monit 2001;7:1086–1091.
Bedi N, Chilvers C, Churchill R, Dewey M, Duggan C, Fielding K, Gretton V, Miller P, Harrison G, Lee A, Williams I: Assessing effectiveness of treatment of depression in primary care. Partially randomised preference trial. Br J Psychiatry 2000;177:312–318.
Ward E, King M, Lloyd M, Bower P, Sibbald B, Farrelly S, Gabbay M, Tarrier N, Addington-Hall J: Randomised controlled trial of non-directive counselling, cognitive-behaviour therapy, and usual general practitioner care for patients with depression. I: Clinical effectiveness. BMJ 2000;321:1383–1388.
King M, Nazareth I, Lampe F, Bower P, Chandler M, Morou M, Sibbald B, Lai R: Impact of participant and physician intervention preferences on randomized trials: A systematic review. Jama 2005;293:1089–1099.
Leykin Y, DeRubeis RJ, Gallop R, Amsterdam JD, Shelton RC, Hollon SD: The relation of patients’ treatment preferences to outcome in a randomized clinical trial. Behav Ther 2007;38:209–217.
DeRubeis RJ, Hollon SD, Amsterdam JD, Shelton RC, Young PR, Salomon RM, O’Reardon JP, Lovett ML, Gladis MM, Brown LL, Gallop R: Cognitive therapy vs medications in the treatment of moderate to severe depression. Arch Gen Psychiatry 2005;62:409–416.
Kocsis JH, Leon AC, Markowitz JC, Manber R, Arnow B, Klein DN, Thase ME: Patient preference as a moderator of outcome for chronic forms of major depressive disorder treated with nefazodone, cognitive behavioral analysis system of psychotherapy, or their combination. J Clin Psychiatry 2009;70:354–361.
Pyne JM, Rost KM, Farahati F, Tripathi SP, Smith J, Williams DK, Fortney J, Coyne JC: One size fits some: The impact of patient treatment attitudes on the cost-effectiveness of a depression primary-care intervention. Psychol Med 2005;35:839–854.
Raue PJ, Schulberg HC, Heo M, Klimstra S, Bruce ML: Patients’ depression treatment preferences and initiation, adherence, and outcome: A randomized primary care study. Psychiatr Serv 2009;60:337–343.
Hegerl U, Hautzinger M, Mergl R, Kohnen R, Schütze M, Scheunemann W, Allgaier AK, Coyne J, Henkel V: Effects of pharmacotherapy and psychotherapy in depressed primary-care patients: A randomized, controlled trial including a patients’ choice arm. Int J Neuropsychopharmacol 2010;13:31–44.
Hautzinger M: Kognitive Verhaltenstherapie bei Depressionen [cognitive behaviour therapy of depression], ed 6th. Weinheim, Beltz/PVU, 2003.
Hamilton M: A rating scale for depression. J Neurol Neurosurg Psychiatry 1960;23:56–62.
American Psychiatric Association: Diagnostic and statistical manual of mental disorders (dsm-iv), ed 4th. Washington, DC, American Psychiatric Association, 1994.
World Medical Association: World medical association declaration of helsinki. Recommendations guiding physicians in biomedical research involving human subjects. Jama 1997;277:925–926.
Wittchen H-U, Pfister H: Instruktionsmanual zur Durchführung von DIA-X Interviews [manual for conducting DIA-X interviews]. Frankfurt am Main, Swets Test Services, 1997.
World Health Organization: Composite international diagnostic interview, version 1.1. Geneva, World Health Organisation, 1993.
Schneider W, Basler H-D, Beisenherz B: FMP. Fragebogen zur Messung der Psychotherapiemotivation [fmp. Inventory to measure psychotherapy motivation]. Weinheim, Beltz, 1989.
Twisk J: Applied longitudinal data analysis for epidemiology: A practical guide. New York, Cambridge University Press, 2003.
Gueorguieva R, Krystal JH: Move over anova: Progress in analyzing repeated-measures data and its reflection in papers published in the archives of general psychiatry. Arch Gen Psychiatry 2004;61:310–317.
Erdfelder E, Faul F, Buchner A: Gpower: A general power analysis program. Behavior Research Methods, Instruments, & Computers 1996;28:1–11.
SPSS Inc: SPSS software, version 12.0. Chicago, Illinois, SPSS Inc., 2008.
Stata: Stata statistical software. Release 8.0. College Station, Texas, Stata Corporation, 2003.
Schneider W, Klauer T, Janssen PL, Tetzlaff M: Zum Einfluss der Psychotherapiemotivation auf den Psychotherapieverlauf [influence of psychotherapy motivation on the course of psychotherapy]. Nervenarzt 1999;70:240–249.
Bower P, King M, Nazareth I, Lampe F, Sibbald B: Patient preferences in randomised controlled trials: Conceptual framework and implications for research. Soc Sci Med 2005;61:685–695.
Allgaier AK, Kramer D, Mergl R, Hegerl U: Wissens- und Einstellungsänderung zu Depression und Suizidalitat bei Altenpflegekräften: Evaluation eines Fortbildungsprojektes. [improvement of knowledge and attitudes towards depression and suicidality in geriatric caregivers: evaluation of an advanced training program]. Z Gerontol Geriatr 2009;42:228–235.
Warden D, Trivedi MH, Wisniewski SR, Lesser IM, Mitchell J, Balasubramani GK, Fava M, Shores-Wilson K, Stegman D, Rush AJ: Identifying risk for attrition during treatment for depression. Psychother Psychosom 2009;78:372–379.
Bech P: Fifty years with the hamilton scales for anxiety and depression. A tribute to Max Hamilton. Psychother Psychosom 2009;78:202–211.
Maier W, Philipp M, Gerken A: [Dimensions of the hamilton depression scale. Factor analysis studies]. Eur Arch Psychiatry Neurol Sci 1985;234:417–422.
Howland RH, Schettler PJ, Rapaport MH, Mischoulon D, Schneider T, Fasiczka A, Delrahiem K, Maddux R, Lightfoot M, Nierenberg AA: Clinical features and functioning of patients with minor depression. Psychother Psychosom 2008;77:384–389.
Hegerl U, Mergl R: The clinical significance of antidepressant treatment effects cannot be derived from placebo-verum response differences. J Psychopharmacol 2010;24:445–448.
Ferrari S, Galeazzi GM, MacKinnon A, Rigatelli M: Frequent attenders in primary care: Impact of medical, psychiatric and psychosomatic diagnoses. Psychother Psychosom 2008;77:306–314.
Loh A, Simon D, Wills CE, Kriston L, Niebling W, Harter M: The effects of a shared decision-making intervention in primary care of depression: A cluster-randomized controlled trial. Patient Educ Couns 2007;67:324–332.
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.