Chronic depression is a tough disease to treat, and many people don't get better after treatment with psychotherapy or antidepressants. When that happens, a doctor might want to try another drug or another approach, but there has been little research on switching treatments. For this study, researchers looked at switching people between treatment with an antidepressant and cognitive-behavioral therapy, if the first treatment didn't work.

What the researchers wanted to know: If treatment with an antidepressant (or therapy) doesn't work, are people helped by switching to therapy (or antidepressants)?

What they did: This experiment was done as part of a larger study on chronic depression. Almost 700 patients were enrolled in the study, and randomly assigned to a group that took the drug nefazodone (Serzone), a group that received cognitive-behavioral therapy, or a group that had both the drug and therapy. This article looked only at the 156 people in the first two groups who finished 12 weeks of the treatment they were assigned to, but didn't feel better. Sixty-one patients who'd been on nefazodone stopped taking it and started therapy, and 79 who'd been getting psychotherapy stopped therapy and started taking nefazodone.

What they found: Switching treatments worked for about half the people in each group - those switching from nefazodone to therapy and from therapy to the drug. After the switch, people on nefazodone were more likely to drop out because of side effects. But before the switch, people getting therapy were just as likely to drop out as people getting the drug. The researchers speculate that people who'd already failed to improve on drugs might have been more motivated to stick with psychotherapy.

What the study means to you: It's worth trying a different treatment for depression if the first one doesn't work. This article looked only at switching between therapy and drugs, but the authors say doctors may also try different versions of the same treatment - a different drug, for example - or combine treatments, such as therapy and medications.

Caveats: This is just one antidepressant; others might give different results.

Find out more: Read basic drug information from the National Library of Medicine on nefazodone.

Read the article: Schatzberg, A.F., et al. "Chronic Depression: Medication (Nefazodone) or Psychotherapy (CBASP) is Effective When the Other is Not." Archives of General Psychiatry. May 2005, Vol. 62, pp. 513-520.

Abstract online: http://archpsyc.ama-assn.org