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Nonremission has been reported in up to 70% of patients with unipolar major depression treated with cognitive-behavioral therapy (CBT) or antidepressant monotherapy. To determine whether subsequent combination therapy might help, investigators conducted a two-phase study, plus an 18-month follow-up.
In the first phase, 344 patients were randomized to 12 weeks of escitalopram (10–20 mg/day), duloxetine (30–60 mg/day), or 16 sessions of CBT; 114 patients achieved remission. The 12-week second phase involved 112 nonremitted patients (mean age, 42; men, 54%; white race, 53%; episodes lasting ≥2 years, 31%; concurrent anxiety disorder, 51%). In this phase, 75 nonremitted patients on an antidepressant additionally received 16 sessions of CBT, and …