This study is designed to compare the effectiveness of pharmacotherapy, psychotherapy and the two combined in the treatment of depression in elderly outpatients. Participants will include 120 community volunteers who are in a clinical episode of definite major depressive disorder or probable major depressive disorder over the age of 60. Participants who have evidence of psychotic depression or who are in a suicidal crisis will be excluded and referred elsewhere. Participants will be randomly assigned to cognitive/behavioral therapy, drug therapy using desipramine or cognitive/behavioral therapy plus drugs. Forty subjects will be assigned to each treatment condition. The treatment will continue for 4 months on a once a week basis. At the conclusion of therapy, individuals who are no longer depressed will be assigned to one of two maintenance conditions within the respective treatment modality. For example, the successes in the Cognitive/Behavior condition will be assigned to a Lo or Hi maintenance followup condition of 1 session per month or 2 sessions per month respectively. Successes in the drug condition will be place on Lo or Hi maintenance doses (50% or 100% of treatment dose respectively). Successes in the combined condition will be continued on drug treatment or Lo maintenance psychotherapy alone. Failures in the Cognitive/Behavioral condition will continue to receive psychotherapy; in the drug treatment, psychotherapy will be added; and in the combined condition treatment failures will continue to receive both. The maintenance/failure treatment program will be continued for 4 months. Participants will be evaluated every two months throughout this treatment/maintenance program, and at 6 months and 1 year followup. Evaluations will include both self-report and interviewer ratings of symptoms, measures of functioning in family and other social situations and various measures related to models of depression. These include the Dysfunctional Attitude Scale, Learned Resourcefulness Scale, Pleasant Events Scale, and Measures of Self-Efficacy. Symptom measures include: Hamilton Depression Rating Scale, Mood Assessment Scale and the Beck Depression Inventory. Functioning is assessed with the Katz Social Adjustment Scale. Measures of Morale, Life Satisfaction, Hopelessness and Loneliness are also included. Diagnostic status is determine through use of the SADS interview (Life-time version initially, and SADS-Change subsequently), and Research Diagnostic Criteria classification system.
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