Sequence of improvement in depressive symptoms across cognitive therapy and pharmacotherapy

Sunil S. Bhar, Lois A. Gelfand, Sabine P. Schmid, Robert Gallop, Robert J. DeRubeis, Steven D. Hollon, Jay D. Amsterdam, Richard C. Shelton, Aaron T. Beck

Research output: Contribution to journalArticlepeer-review

26 Scopus citations


Background: The authors examined the patterns of improvement in cognitive and vegetative symptoms of major depression in individuals treated with cognitive therapy (CT) or pharmacotherapy (PT). Method: Outpatients diagnosed with major depressive disorder (n = 180) were randomized to receive either CT or PT. Cognitive and vegetative symptoms of major depression were measured by the Beck Depression Inventory-II at baseline and regularly throughout 16 weeks of treatment. Results: Multivariate hierarchical linear modeling demonstrated the same patterns of change over time for cognitive and vegetative symptoms within CT and within PT. Limitations: Self-report measures may not be sufficiently specific to capture subtle differences in improvements between vegetative and cognitive symptoms. Conclusions: These results are consistent with Beck's [Beck, A.T., 1984, November. Cognition and theory [Letter to the editor]. Arch. Gen. Psychiatry 41, 1112-1114.] hypothesis that CT and PT have a similar site of action, which when targeted, results in changes in both cognitive and vegetative features.

Original languageEnglish (US)
Pages (from-to)161-166
Number of pages6
JournalJournal of Affective Disorders
Issue number1-2
StatePublished - Sep 2008
Externally publishedYes

Bibliographical note

Funding Information:
Funding for this study was provided by NIMH Grants MH50129 (R10) (Dr. DeRubeis), MS55875 (R10) and MH01697 (K02) (Dr. Hollon). The preparation of this article was supported in part by NIMH Grant MH45178 (P30). GlaxoSmithKline, Brentford, Middlesex, United Kingdom, provided medications and pill placebos for the trial. The NIMH and GlaxoSmithKline had no further role in study design; in the collection, analysis and interpretation of data; in the writing of the report; and in the decision to submit the paper for publication.

Funding Information:
Dr. Amsterdam currently receives research grant support from the NIMH, NIH/NCCAM, Stanley Medical Research institute, Lilly Research Laboratories, and Sanofi Aventis. He is currently a consultant to Cephalon, Inc. He is on the speaker's bureau of Wyeth and Bristol–Myers–Squibb.


  • Cognitive therapy
  • Depression
  • Pharmacotherapy
  • Symptom change


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