Abstract
Objective: This report compares the effectiveness of cognitive therapy (CT) as an augmentation to citalopram vs. CT as a switch from citalopram as a second-step treatment for outpatients with non-psychotic major depressive disorder (MDD) who had received unsatisfactory benefit from an initial trial of citalopram. Methods: Participants who experienced intolerance to or who did not reach remission with an optimal trial of citalopram, and who accepted randomization only to one of the two CT options, were randomized to a second-step treatment of either CT switch or CT augmentation of citalopram. Treatment outcomes, side effects, and serious adverse events were compared between the two groups. Results: As a second-step treatment following an optimal trial of citalopram, discontinuing medication and switching to CT (n=32) was as effective as augmenting citalopram with CT (n=26). Unlike the CT switch subjects, most individuals in the CT augmentation group endorsed mild-to-marked levels of side effect frequency, ...
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