Comparing interpersonal counseling and antidepressant treatment in primary care patients with anxious and nonanxious major depression disorder : a randomized control trial

Objective: Comorbid anxiety symptoms are common in patients with major depressive disorders and contribute to poorer response to both psychotherapeutic and pharmacologic depression treatments. The aim of the present study was to compare the efficacy of Interpersonal Counseling (IPC) with antidepressant treatments in primary care patients with anxious and nonanxious major depression. Method: Participants with depression symptoms, enrolled from primary care sites, were randomized to 8 weeks treatment with either IPC or Selective Serotonin Reuptake Inhibitors (SSRIs). Participants were eligible if they met criteria for nonpsychotic Major Depression Disorder (MDD) based on the criteria of Diagnostic and Statistical Manual of Mental Disorders (5th edition). A minimum Hamilton Depression Rating Scale (HAM-D) score of ≥8 was also required. Using the Hamilton Anxiety Rating Scale (HAM-A, score > 14) patients were classified as anxious or nonanxious. Rates of remission (defined as HAM-D score of ≤7 over 3 consecutive weeks) and change from baseline in anxiety and depression symptoms were compared between patients with anxious depression and those with nonanxious depression. Results: In the nonanxious subgroup the proportion of patients who achieved remission was no significant in the IPC group compared with the SSRI group (77.78% vs 72.73%; P= 0.9). The proportion of anxious patients who achieved remission was significantly higher in the IPC group compared with the SSRI group (100% vs 87.5%; P<0.0001). Analyses based on continuous scores indicated a significant improvement over the 8 weeks in depressive symptoms in both the nonanxious and the anxious subgroups and between the initial and final scores in anxiety symptoms in the anxious subgroup. Conclusions: IPC can be as effective as medications for the treatment of mild to moderate major depression and is an effective treatment option for the proportion of patients with MDD who have prominent anxious symptoms. These results indicate the need to consider different strategies for the management of patients with anxious depression in primary care