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

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.