December 1, 1981
Eli Robins, M.D. Department of Psychiatry
Dear Doctor Robins:
The treatment of depression, whether acute or chronic, is of particular interest to us in the Washington University Psychiatry Clinic. One expression of this interest is an ongoing comparison study of the relative effectiveness of cognitive behavior therapy (CBT) (a form of psychotherapy) versus a tricyclic antidepressant (TCA) in the short-term (12 weeks) treatment of moderate to severe uncomplicated (primary) depression, Both therapies have been shown in controlled clinical studies to be very substantially effective. In order to qualify for participation in this clinical study a prospective patient must have an uncomplicated depression (i.e., no other psychiatric or major medical illness or chronic medication), be free of antidepressant medication for at least four weeks prior to participation in the study and agree to accept random assignment to CBT, TCA or the combination of the two. These patients will receive extensive evaluation both before and at the end of treatment (12 weeks) as well as 1, 6 and 12 months posttreatment. Patients participating in the study will have half of their treatment visits paid for by research grant funds. Patients who are referred and fail to qualify for the study may nevertheless be treated as regular clinic patients if they so desire, but will not likely receive cognitive therapy.
Should you wish to refer a patient for the study, that patient should call 454-2773 and speak with Ms. Simons, our Research Coordinator. Others may call 454-3377 to make an appointment for general psychiatric evaluation. Clinic hours are as follows: Monday, 11:00 a.m. to 8:00p.m.; Tuesday through Friday, 10:30 a.m. to 5:00p.m.; Saturday, 9:00a.m. until noon. There is usually no waiting list. A new patient will be seen for evaluation within a week of requesting an appointment; often the same or next day. If you have any questions, please call me at 454-2289.
George E. Murphy, M.D.
Director, Psychiatry Clinic (George E. Murphy 1981)
More about Cognitive Behavioral Therapy, Murphy’s studies, the study’s 1977 antecedent, and results
“Cognitive behavioral therapy is the means by which a patient and a therapist examine the thoughts the patient has about his or her experiences, looking for misperceptions, mistaken beliefs and assumptions. By correcting his view of himself, his experiences and his future the patient can expect to feel very much better—in fact, to overcome his depression, according to Dr. Murphy.” (Patients sought for depression study, Barnes Bulletin, Volume 34, Number 4: page 3 1980)
"The cognitive behavioral therapist assumes that the important part of depression is not how it was caused, but how the patient processes his or her experiences to either maintain or relieve the depression." In cognitive behavior therapy, “a recent treatment method, developed by a psychiatrist at the University of Pennsylvania, … involves the patient in learning a process of scientific thinking so that he or she can understand the depression, identify thoughts which evoke or intensify feelings of depression, and” learn to correct negative thoughts and assumptions (“Depression study needs participants.” Scope: WUMS Community Newsletter April1981 n.d.)
George E. Murphy, Professor of Psychiatry, received “a $300, 000 grant from the National Institutes of Health to compare two treatments for depression—cognitive therapy and drug therapy.” The grant paid half of the cost for those qualified for the study. His grant was one part of a three part effor to replicate a 1977 study done at the University of Pennsylvania in 1977 comparing the effectiveness of cognitive behavioral therapy and antidepressants. (“Depression study needs participants.” Scope: WUMS Community Newsletter April1981 n.d.)(2)
The 1977 study had 41 subjects randomly assigned to only two groups with either cognitive therapy or imipramine a pharmacotherapy. Cognitive behavioral therapy resulted in significantly greater improvement than pharmacotherapy although pharmacotherapy was also effective (Rush, Augustus J., Aaron T. Beck, Maria Kovacs, and Steven Hollon. "Comparative efficacy of cognitive therapy and pharmacotherapy in the treatment of depressed outpatients." Cognitive therapy and research 1, no. 1 (1977): 17-37. n.d.)
In a 1986 paper, Simons, Murphy et al, 70 patients were randomly assigned to one of four combinations of treatments: cognitive therapy only, tricyclic antidepressant only, cognitive therapy plus placebo, and cognitive therapy plus tricyclic antidepressant. Cognitive therapy plus tricyclic antidepressant showed the best results although the worst result, antidepressant therapy alone, showed significant improvement. (Simons, Anne D., George E. Murphy, Jeffrey L. Levine, and Richard D. Wetzel. "Cognitive therapy and pharmacotherapy for depression: Sustained improvement over one year." Archives of General Psychiatry 43, no. 1 (1986): 43-48. Accessed 29 February 2016 n.d.)
1. Rush, Augustus J., Aaron T. Beck, Maria Kovacs, and Steven Hollon. "Comparative efficacy of cognitive therapy and pharmacotherapy in the treatment of depressed outpatients." Cognitive therapy and research 1, no. 1 (1977): 17-37.
2. Patients sought for depression study. Barnes Bulletin, Volume 34, Number 4 (April 1980): page 3
3. “Depression study needs participants.” Scope: WUMS Community Newsletter, April 1981: pages 2-3. VF05292 [Murphy, George E.], Vertical File Collection, Bernard Becker Medical Library Archives, Washington University School of Medicine.
4. Typed letter signed (TLS) from George E Murphy, M.D. to Eli Robins, M.D, 1 December 1981, Eli Robins Papers, Bernard Becker Medical Library Archives, Washington University School of Medicine.
5. Simons, Anne D., George E. Murphy, Jeffrey L. Levine, and Richard D. Wetzel. "Cognitive therapy and pharmacotherapy for depression: Sustained improvement over one year." Archives of General Psychiatry 43, no. 1 (1986): 43-48. Accessed 29 February 2016 http://archpsyc.jamanetwork.com/article.aspx?articleid=493720