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Short-Term Psychodynamic Psychotherapy and Fluoxetine in Major Depressive Disorder: A Randomized Comparative Study

Salminen J.K.b, c · Karlsson H.a · Hietala J.d · Kajander J.e · Aalto S.f · Markkula J.d · Rasi-Hakala H.g · Toikka T.c
aDepartment of Psychiatry, University of Helsinki, Helsinki; bDepartment of Health and Functional Capacity, Laboratory for Population Research, National Public Health Institute, cResearch Department of the Social Insurance Institution, dDepartment of Psychiatry, University of Turku, eTurku PET Center, fDepartment of Psychology, Åbo Akademi University, and gPsykiatrian erikoislääkärit, Turku, Finland Psychother Psychosom 2008;77:351–357 (DOI:10.1159/000151388)


Background: There are few studies comparing the efficacy of short-term psychodynamic psychotherapy (STPP) and pharmacotherapy in major depressive disorder. We conducted a comparative study on the efficacy of STPP versus fluoxetine treatment in patients with major depressive disorder in a primary care setting. Methods: Fifty-one patients with major depressive disorder (DSM-IV) of mild or moderate severity were recruited through occupational health services providing primary health care. Patients were randomized to receive either STPP (1 session/week) or fluoxetine treatment (20–40 mg/day) for 16 weeks. The outcome measures included the Hamilton Depression Rating Scale (HDRS), the Beck Depression Inventory (BDI), and the Social and Occupational Functioning Assessment Scale (SOFAS). Results: Intent-to-treat analyses indicated that both treatments were highly effective in reducing the HDRS (p < 0.0001) and BDI (p < 0.0001) scores, as well as in improving functional ability (SOFAS; p < 0.0001), with no statistically significant differences between the treatments. Of those 40 subjects who completed the follow-up, 57% in the psychotherapy group and 68% in the fluoxetine group showed full remission (HDRS ≤7) after 4 months. Conclusions: Both STPP and pharmacological treatment with fluoxetine are effective in reducing symptoms and in improving functional ability of primary care patients with mild or moderate depression. This study suggests no marked differences in the therapeutic effects of these two treatment forms in a primary care setting.


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