Similar Long-term Effects for Sertraline and Group CBT for Depression

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Individuals taking sertraline had improved Global Assessment of Functioning scores compared with individuals in group cognitive behavior therapy.
Individuals taking sertraline had improved Global Assessment of Functioning scores compared with individuals in group cognitive behavior therapy.

Sertraline and group cognitive behavioral therapy (CBT) have similar long-term antidepressant effects in the treatment of mild to moderate depression, although sertraline seems to be “slightly superior” to CBT in terms of long-term global functioning, according to a study published in the Journal of Affective Disorders.

Researchers based in Germany and Holland conducted a 12-month longitudinal interval follow-up evaluation (LIFE) of 77 patients with mild to moderate depression who had participated in a previous randomized controlled 10-week trial that compared sertraline to group-based CBT over a 10-week period during the acute phase of depression.

The primary outcome of the study was the number of weeks during the one-year follow-up period in which participants were completely free of all depressive symptoms.

The researchers measured functional outcome (the secondary outcome) using the Global Assessment of Functioning (GAF) scale. Additional outcomes were relapse and remission rates (based on weekly psychiatric rating scales) and the number of weeks in the follow-up period during which patients experienced a depressive disorder or subthreshold depressive symptoms.

The sertraline group and the CBT group did not differ significantly in the number of weeks during the follow-up period they were completely free of depressive symptoms (31.6 weeks standard deviation [SD],23.7; 27.8 weeks SD, 24.3, respectively).

Sertraline was superior to CBT with respect to GAF scores by trend, “as indicated by a statistical tendency for higher monthly GAF scores during the follow-up period [P =.06],” the researchers reported.

“Possible moderators of the long-term course of mild-to-moderate depressive disorders in primary care patients treated with a SSRI [selective serotonin reuptake inhibitor] or CBT need further investigations,” they concluded.

There were significant differences between the sertraline and CBT groups in the percentage of patients who received the same treatment during the 1-year follow-up period as they did during the initial trial: 61.4% of patients from the sertraline group received corresponding treatment compared with 27.3% of patients from the CBT group.

“The higher rate of continuation in the sertraline arm as compared to the CBT arm suggests that continuing a drug treatment is more convenient than continuing [a] CBT in primary care patients with mild-to-moderate depressive disorders,” the researchers suggested.

Another possible explanation is that this difference may have reflected the frequently communicated advice patients received to take antidepressant drugs for several months to relapse, while patients who had received CBT for 10 weeks were frequently encouraged to use the acquired skills in their daily lives without continuing group CBT.

The researchers noted that their findings were limited by the “moderate” sample size and some missing data. Nevertheless, the results have important implications for patients in the primary care setting, suggesting that both interventions are effective in the long- as well as the short-term.


Mergl M, Allgaier AK, Hautzinger M, Coyne JC, Hegerl U, Henkel V. One-year follow-up of a randomized controlled trial of sertraline and cognitive behavior group therapy in depressed primary care patients (MIND study). J Affect Disord. 2018; 230:15-21. doi:10.1016/j.jad.2017.12.084

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