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  1. The Norwegian...
  2. The Norwegian naturalistic treatment study of depression in general practice (NORDEP)—I: randomised double blind study
General Practice

The Norwegian naturalistic treatment study of depression in general practice (NORDEP)—I: randomised double blind study

BMJ 1999; 318 doi: https://doi.org/10.1136/bmj.318.7192.1180 (Published 01 May 1999) Cite this as: BMJ 1999;318:1180
  1. Ulrik F Malt, professor (ulrik.malt{at}rh.uio.no)a,
  2. Ole Herman Robak, chief psychiatristb,
  3. H-P Madsbu, general practitionerc,
  4. O Bakke, chief psychiatristd,
  5. M Loeb, statisticiane
  1. aUniversity of Oslo, Department of Psychosomatic and Behavioural Medicine, National Hospital, N-0027 Oslo, Norway
  2. bPsychiatric Centre of Northern Vestfold Holmestrand, N-3080 Holmestrand, Norway
  3. cElverum legesenter, PO Box 173, N-2401 Elverum, Norway
  4. dDepartment of Psychiatry, Aust-Agder Central Hospital, N-4800 Arendal, Norway
  5. eNorwegian Insurance Agencies, Ullevål Hospital, N-0407 Oslo, Norway
  1. Correspondence to: Professor Malt
  • Accepted 18 February 1999

Abstract

Objective: To evaluate the efficacy of emotional support and counselling combined with placebo or antidepressants with single or dual mechanism of action in the treatment of depression in primary care.

Design: Randomised double blind study.

Setting: Several locations in Norway.

Subjects: 372 patients with depression.

Main outcome measures: Improvement (clinical remission) reported both by the patient (Montgomery Åsberg depression rating scale) and the physician (clinical global improvement and impression scales).

Results: Intention to treat analyses showed 47% remission in patients randomised to placebo compared with 61% remission in patients randomised to sertraline (odds ratio 0.56, 95% confidence interval 0.33 to 0.96) and 54% in patients randomised to mianserin (0.75, 0.44 to 1.27). Women responded better than men (1.86, 1.17 to 2.96). Subgroup analyses showed that subjects with recurrent depression (n=273) responded more frequently to sertraline than to placebo (0.43, 0.23 to 0.82) than those having their first episode of depression (1.18, 0.39 to 3.61). Statistically significant interactions between type of drug treatment and history of depression were not shown by logistic regression.

Conclusion: The combination of active drug and simple psychological treatment (counselling, emotional support, and close follow up over a 24 week period) was more effective than simple psychological treatment alone, in particular for those with recurrent depression. Overall, women may benefit more than men. If confirmed in future studies, the findings should lead to more differentiated treatment guidelines for depression in primary care.

Footnotes

  • Competing interests UFM, OHR, HPM, and OB have been reimbursed by Organon (manufacturer of mianserin) and Pfizer (manufacturer of sertraline) for attending several conferences. UFM has been paid by Organon and Pfizer for running educational programmes and has received fees from both companies for consulting. Members of UFM's staff have received research funds from both Organon and Pfizer.

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