Management of depression in rheumatoid arthritis: A combined pharmacologic and cognitive‐behavioral approach

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Abstract
Objective To examine the effectiveness of cognitive‐behavioral and pharmacologic treatment of depression in rheumatoid arthritis (RA). Methods Subjects (n = 54) with confirmed diagnoses of both major depression and RA were randomly assigned to 1 of 3 groups: 1) cognitive‐behavioral/pharmacologic group (CB‐PHARM), 2) attention‐control/pharmacologic group, or 3) pharmacologic control group. Measures of depression, psychosocial status, health status, pain, and disease activity were collected at baseline, posttreatment (10 weeks), 6‐month followup, and 15‐month followup. Data were analyzed to compare the treatment effectiveness of the groups; data also were aggregated to examine the effects of antidepressive medication over time. Lastly, a no‐treatment control group was defined from a cohort of persons who declined participation. Results Baseline comparisons on demographic and dependent measures revealed a need to assess covariates on age and education; baseline scores on dependent measures also were entered as covariates. Analyses of covariance revealed no statistically significant group differences at postintervention, 6‐month followup, or 15‐month followup, except higher state and trait anxiety scores for the CB‐PHARM group at the 15‐month followup. In the longitudinal analyses of the effects of antidepressive medication, significant improvement in psychological status and health status were found at posttreatment, 6‐month followup, and 15‐month followup, but no significant improvements were shown for pain or disease activity. In addition, the comparison of the aggregated pharmacologic group with a no‐treatment group revealed a statistically significant benefit for the 3 groups that received the antidepressive medication. Conclusion In persons with RA, cognitive‐behavioral approaches to the management of depression were not found to be additive to antidepressant medication alone, but antidepressant intervention was superior to no treatment.