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

Statistically significant difference of intervention compared to control in the following:

  • antidepressant adherence

  • percentage receiving specialty counseling

  • remission rates at 24 months (74% versus 41%)

  • physical functioning (61 points versus 44 points on SF-36)

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

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

Statistically significant difference of intervention compared to control in depressive symptoms (HRSD), social functioning, and instrumental role (medication therapy only) all at 6 months

Subjects randomized to psychotherapy much less likely to complete protocol in spite of extensive outreach (e.g., childcare, transportation)

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