Studio di comparazione tra terapia farmacologica e counselling interpersonale nel trattamento della depressione in medicina generale

Abstract

Background. All statistical data show that 12% of patients, in primary care, suffer from the major depression. A meta-analytic review has revealed how few the randomized controlled traials are that compare psychological interventions for major depression with an antidepressant drug in primary care. Objective. To compare the effectiveness of antidepressant drug (SSRI-Citalopram) and a brief psychological intervention (interpersonal counseling-IPC) in the treatment of major depression in primary care. Design. This randomized controlled trial compares 12 months of IPC and continued pharmacotherapy. Follow-up at 2 months, 6 months, 12 months. Participants. Depressed patients with a current major depressive episode (HAM-D ≥13) randomized to the two treatment patterns (interpersonal counseling and SSRIs). Main Outcome Measures. Remission of the depressive symptoms (Hamilton Depression Rating Scale). Improvement of the social and working functioning (Work and Social Adjustment Scale). Results. 35 patients were recruited, 18 randomized to IPC and 17 to antidepressant drug. There had been 4 drop-out (all in the pharmacological arm). The initial scores of the two scales were similar showing a mild/moderate depression and a significant social/working impairment. In 12 months, in both groups, there has been a resolute improvement of the symptomatology and social activities. In fact, mean HAM-D scores dropped from 18.06 to 6.27 in IPC group and from 16.86 to 6.50 in SSRI group. Similar result has been found in WSAS score. No statistically significant differences emerged among the 2 treatment groups. Conclusion. Interpersonal Counseling has an efficacy that can be compared to the antidepressant’s one, in the cure of mild depression in the primary care.