Rational-emotive therapy plus pharmacotherapy versus pharmacotherapy alone in the treatment of high cognitive dysfunction depression

Abstract

A pilot study was conducted with 20 unipolar depressed outpatients with high levels of cognitive dysfunction. They were treated with either Lofepramine or Lofepramine plus rational-emotive therapy (RET) for 24 weeks. Previous studies of combined treatment versus pharmacotherapy have been criticized for selecting untypical clinical cases and for delivery of suboptimal pharmacotherapy. The present study was designed to address these issues as a preliminary to conducting a larger trial. The treatment protocol permitted a maximum of 30 RET sessions and 280 mg/day of Lofepramine. Ellis's rational-emotive therapy was used. There were significantly more responders in the combined-treatment group than in the pharmacotherapy group. At treatment termination, combined treatment similarly produced significantly greater changes in both depression measures and improvement in social adjustment. Furthermore, at termination in the combined-treatment group there were significantly more improvers and remitters on the Hamilton Depression Scale and on the Global Index of Improvement and more improvers on the target problems ratings. The overall attrition rate in this study was low at 5%. The population studied was more severely depressed and dysfunctional than populations previously included in cognitive therapy/pharmacotherapy trials. Despite utilizing a more severely depressed and dysfunctional sample than previous trials, combined treatment was found to produce more improvement than pharmacotherapy alone.