The effectiveness of evidence-based treatments for major depressive disorder in a routine clinical setting: results from an observational study

The efficacy of some acute-phase treatments for major depressive disorder (MDD) is well established in randomized controlled trials (RCT's). However, for over a decade concerns have been expressed about the utility of generalizing the results of RCT's to daily clinical practice. A major doubt among many scientists and clinicians is if depressed patients respond to and remit equally well in evidence-based treatments outside the realm of a highly controlled study.

The present naturalistic study was designed to examine the effectiveness of pharmacotherapy (PHT), IPT, and CBT (either alone or in combination with PHT) in the treatment of MDD in a community mental health center in the city of Maastricht, The Netherlands. After a diagnostic work-up, consisting of an open interview and the SCID-I, patients (n=166) were informed about treatment options in the mood disorders program. Typically as in a naturalistic treatment setting, choice of treatment was made in agreement by patient and therapist but predominantly patient-preference guided. The clinical course during treatment was assessed at 8, 16, and 26 weeks. In comparison, the effectiveness of these evidence-based treatments appeared to be equal and overall approached the effect-sizes reported in RCT's. In this presentation, we will (1) present these clinical outcomes in this naturalistic study, and (2) address possible predictors of outcome in the various treatments.

Implementation of evidence-based treatments for MDD to routine daily practice is possible and seems, given it's good effectiveness, well justified.