Patterns of attrition for psychosocial and pharmacologic treatments of depression

Patient characteristics associated with early termination from psychosocial and pharmacologic treatments of depression were delineated. Patients were 125 female primary nonbipolar depressives randomly assigned to 12 weeks of protocol treatment in one of four conditions: social skills training plus placebo; short-term psychotherapy plus placebo; amitriptyline alone; and social skills training plus amitriptyline. Results indicated that premature terminators from pharmacotherapy tended to be mildly depressed and intolerant of medication side effects. In contrast, dropouts from psychosocial treatment were more severely depressed and dissatisfied with the lack of early response which often accompanies interventions of this type. These findings may support the use of short-term psychosocial approaches in lieu of pharmacotherapy in mild nonendogenous depressions. However, antidepressant medication, either alone or in conjunction with psychosocial treatment, should continue to be considered the treatment of choice in more severely depressed melancholic patients.