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Two physicians and one nurse at each intervention site received training consistent with AHCPR treatment guidelines
Subjects encouraged by clinicians to seek their treatment of choice
Nurses called subjects weekly × first 5–8 weeks, assessing symptoms and promoting medication adherence
If suboptimal response, subjects encouraged by nurse to contact provider
Otherwise, providers contacted subjects on monthly basis to adjust treatment
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Statistically significant difference of intervention compared to control in the following:
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antidepressant adherence
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percentage receiving specialty counseling
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remission rates at 24 months (74% versus 41%)
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physical functioning (61 points versus 44 points on SF-36)
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Effects most pronounced in subjects willing to accept pharmacotherapy or if newly diagnosed episode
Intervention also noted to improve physical functioning (61 points versus 44 points), and 35% of improvement over baseline attributable to intervention
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Subjects assigned to medication were treated by nurse practitioners supervised by a psychiatrist
They received an empiric paroxetine trial and were switched to bupropion if unsuccessful
Psychotherapy group received 8 weekly sessions of manualized CBT (group or individual) delivered by psychotherapist supervised by clinical psychologist
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Statistically significant difference of intervention compared to control in depressive symptoms (HRSD), social functioning, and instrumental role (medication therapy only) all at 6 months
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Subjects randomized to psychotherapy much less likely to complete protocol in spite of extensive outreach (e.g., childcare, transportation)
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