Depressed Outpatients: Results One Year After Treatment With Drugs and/or Interpersonal Psychotherapy
TL;DR: While most patients were functioning reasonably well, there were some main effects of IPT on social functioning at the one-year follow-up and patients who received IPT with or without pharmacotherapy were doing significantly better on some measures of social functioning.
Abstract: • A one-year follow-up was conducted on ambulatory nonbipolar, nonpsychotic, acutely depressed patients who received amitriptyline hydrochloride and/or interpersonal psychotherapy (IPT), each alone and in combination, as part of a four-month clinical trial. There were no differential long-term effects of the initially randomized treatment on clinical symptoms one year later since most of the patients were asymptomatic. While most patients were functioning reasonably well, there were some main effects of IPT on social functioning at the one-year follow-up. Patients who received IPT with or without pharmacotherapy were doing significantly better on some measures of social functioning.
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TL;DR: Findings from the review confirm that depressed clients benefit substantially from psychotherapy, and these gains appear comparable to those observed with pharmacotherapy.
Abstract: Previous quantitative reviews of research on the efficacy of psychotherapy for depression have included only a subset of the available research or limited their focus to a single outcome measure. The present review offers a more comprehensive quantitative integration of this literature. Using studies that compared psychotherapy with either no treatment or another form of treatment, this article assesses (a) the overall effectiveness of psychotherapy for depressed clients, (b) its effectiveness relative to pharmacotherapy, and (c) the clinical significance of treatment outcomes. Findings from the review confirm that depressed clients benefit substantially from psychotherapy, and these gains appear comparable to those observed with pharmacotherapy. Initial analysis suggested some differences in the efficacy of various types of treatment; however, once the influence of investigator allegiance was removed, there remained no evidence for the relative superiority of any 1 approach. In view of these results, the focus of future research should be less on differentiating among psychotherapies for depression than on identifying the factors responsible for improvement.
679 citations
Journal Article•
TL;DR: The evaluation of postpartum mood disturbance is discussed and guidelines for the treatment of affective illness during the puerperium are offered.
Abstract: Mood disturbance occurs commonly during the postpartum period. The symptoms may be transient and relatively mild (as in postpartum blues) or may be associated with significant impairment of functioning (as in postpartum depression and puerperal psychosis). Despite the prevalence of postpartum mood disorders, depressive symptoms that emerge during the puerperium are often overlooked. Puerperal affective illness places the mother at risk for the development of recurrent depression and has also been associated with significant long-term effects on child development and behavior. Therefore, the prompt recognition and efficacious treatment of puerperal mood disorders are essential in order to avoid adverse outcomes for both mother and infant. This article discusses the evaluation of postpartum mood disturbance and offers guidelines for the treatment of affective illness during the puerperium.
602 citations
Cites methods from "Depressed Outpatients: Results One ..."
...IPT has been used successfully in nonpuerperal cohorts with major depression to prevent recurrence.(63,80) Though not yet studied in the puerperal population, IPT and similar techniques may be performed prophylactically during the postpartum period and may be of some value....
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TL;DR: The background of the TDCRP, the rationale for the choice of patient population and treatment conditions, and the research plan for both the training/pilot phase and the outcome study currently in progress are presented and the potential contributions of the program to the field of psychotherapy research are discussed.
Abstract: The National Institute of Mental Health (NIMH) Treatment of Depression Collaborative Research Program (TDCRP) is the first multisite coordinated study initiated by the NIMH in the field of psychotherapy research. Three research sites, using an identical research protocol, are investigating the effectiveness of two forms of brief psychotherapy (cognitive behavior therapy and interpersonal psychotherapy) in the treatment of outpatient depression. Three training sites have trained experienced therapists in a standard fashion for each of the psychotherapies and the comparison pharmacotherapy conditions. This report presents the background of the TDCRP, the rationale for the choice of patient population and treatment conditions, and the research plan for both the training/pilot phase and the outcome study currently in progress, and discusses the potential contributions of the program to the field of psychotherapy research.
516 citations
TL;DR: The major finding of this study is that 16 weeks of these specific forms of treatment is insufficient for most patients to achieve full recovery and lasting remission.
Abstract: • We studied the course of depressive symptoms during an 18-month naturalistic follow-up period for outpatients with Major Depressive Disorder treated in the National Institute of Mental Health Treatment of Depression Collaborative Research Program. The treatment phase consisted of 16 weeks of randomly assigned treatment with the following: cognitive behavior therapy, interpersonal therapy, imipramine hydrochloride plus clinical management (CM), or placebo plus CM. Follow-up assessments were conducted at 6,12, and 18 months after treatment. Of all patients entering treatment and having follow-up data, the percent who recovered (8 weeks of minimal or no symptoms following the end of treatment) and remained well during follow-up (no Major Depressive Disorder relapse) did not differ significantly among the four treatments: 30% (14/46) for those in the cognitive behavior therapy group, 26% (14/53) for those in the interpersonal therapy group, 19% (9/48) for those in the imipramine plus CM group, and 20% (10/51) for those in the placebo plus CM group. Among patients who had recovered, rates of Major Depressive Disorder relapse were 36% (8/22) for those in the cognitive behavior therapy group, 33% (7/21) for those in the interpersonal therapy group, 50% (9/18) for those in the imipramine plus CM group, and 33% (5/15) for those in the placebo plus CM group. The major finding of this study is that 16 weeks of these specific forms of treatment is insufficient for most patients to achieve full recovery and lasting remission. Future research should be directed at improving success rates of initial and maintenance treatments for depression.
511 citations
TL;DR: Combined treatment with medication and CBT appears to be as efficacious as treatment with medications alone and to retain the enduring effects of CBT, and there are indications that the same strategies used to reduce risk in psychiatric patients following successful treatment can be used to prevent the initial onset of depression in persons at risk.
Abstract: Depression is one of the most common and debilitating psychiatric disorders and is a leading cause of suicide. Most people who become depressed will have multiple episodes, and some depressions are chronic. Persons with bipolar disorder will also have manic or hypomanic episodes. Given the recurrent nature of the disorder, it is important not just to treat the acute episode, but also to protect against its return and the onset of subsequent episodes. Several types of interventions have been shown to be efficacious in treating depression. The antidepressant medications are relatively safe and work for many patients, but there is no evidence that they reduce risk of recurrence once their use is terminated. The different medication classes are roughly comparable in efficacy, although some are easier to tolerate than are others. About half of all patients will respond to a given medication, and many of those who do not will respond to some other agent or to a combination of medications. Electro-convulsive therapy is particularly effective for the most severe and resistant depressions, but raises concerns about possible deleterious effects on memory and cognition. It is rarely used until a number of different medications have been tried. Although it is still unclear whether traditional psychodynamic approaches are effective in treating depression, interpersonal psychotherapy (IPT) has fared well in controlled comparisons with medications and other types of psychotherapies. It also appears to have a delayed effect that improves the quality of social relationships and interpersonal skills. It has been shown to reduce acute distress and to prevent relapse and recurrence so long as it is continued or maintained. Treatment combining IPT with medication retains the quick results of pharmacotherapy and the greater interpersonal breadth of IPT, as well as boosting response in patients who are otherwise more difficult to treat. The main problem is that IPT has only recently entered clinical practice and is not widely available to those in need. Cognitive behavior therapy (CBT) also appears to be efficacious in treating depression, and recent studies suggest that it can work for even severe depressions in the hands of experienced therapists. Not only can CBT relieve acute distress, but it also appears to reduce risk for the return of symptoms as long as it is continued or maintained. Moreover, it appears to have an enduring effect that reduces risk for relapse or recurrence long after treatment is over. Combined treatment with medication and CBT appears to be as efficacious as treatment with medication alone and to retain the enduring effects of CBT. There also are indications that the same strategies used to reduce risk in psychiatric patients following successful treatment can be used to prevent the initial onset of depression in persons at risk. More purely behavioral interventions have been studied less than the cognitive therapies, but have performed well in recent trials and exhibit many of the benefits of cognitive therapy. Mood stabilizers like lithium or the anticonvulsants form the core treatment for bipolar disorder, but there is a growing recognition that the outcomes produced by modern pharmacology are not sufficient. Both IPT and CBT show promise as adjuncts to medication with such patients. The same is true for family-focused therapy, which is designed to reduce interpersonal conflict in the family. Clearly, more needs to be done with respect to treatment of the bipolar disorders. Good medical management of depression can be hard to find, and the empirically supported psychotherapies are still not widely practiced. As a consequence, many patients do not have access to adequate treatment. Moreover, not everyone responds to the existing interventions, and not enough is known about what to do for people who are not helped by treatment. Although great strides have been made over the past few decades, much remains to be done with respect to the treatment of depression and the bipolar disorders.
500 citations
Cites result from "Depressed Outpatients: Results One ..."
...This result is reminiscent of the delayed effect that IPT had on the quality of interpersonal life following acutephase treatment in the study by Weissman et al. (1981)....
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References
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TL;DR: The development and initial reliability studies of a set of specific diagnostic criteria for a selected group of functional psychiatric disorders, the Research Diagnostic Criteria (RDC), indicate high reliability for diagnostic judgments made using these criteria.
Abstract: • A crucial problem in psychiatry, affecting clinical work as well as research, is the generally low reliability of current psychiatric diagnostic procedures. This article describes the development and initial reliability studies of a set of specific diagnostic criteria for a selected group of functional psychiatric disorders, the Research Diagnostic Criteria (RDC). The RDC are being widely used to study a variety of research issues, particularly those related to genetics, psychobiology of selected mental disorders, and treatment outcome. The data presented here indicate high reliability for diagnostic judgments made using these criteria.
6,238 citations
TL;DR: Initial scale development and reliability studies of the items and the scale scores are reported on.
Abstract: • The Schedule for Affective Disorders and Schizophrenia (SADS) was developed to reduce information variance in both the descriptive and diagnostic evaluation of a subject. The SADS is unique among rating scales in that it provides for (1) a detailed description of the features of the current episode of illness when they were at their most severe; (2) a description of the level of severity of manifestations of major dimensions of psychopathology during the week preceding the evaluation, which can then be used as a measure of change; (3) a progression of questions and criteria, which provides information for making diagnoses; and (4) a detailed description of past psychopathology and functioning relevant to an evaluation of diagnosis, prognosis, and overall severity of disturbance. This article reports on initial scale development and reliability studies of the items and the scale scores.
5,623 citations
TL;DR: Cognitive therapy resulted in significantly greater improvement than did pharmacotherapy on both a self-administered measure of depression (Beck Depression Inventory) and clinical ratings (Hamilton Rating Scale for Depression and Raskin Scale) and follow-up contacts indicate that treatment gains evident at termination were maintained over time.
Abstract: Forty-one unipolar depressed outpatients were randomly assigned to individual treatment with either cognitive therapy (N =19)or imipramine (N =22).As a group, the patients had been intermittently or chronically depressed with a mean period of 8.8 years since the onset of their first episode of depression, and 75%were suicidal. For the cognitive therapy patients, the treatment protocol specified a maximum of 20 interviews over a period of 12 weeks. The pharmacotherapy patients received up to 250 mg/day of imipramine for a maximum of 12 weeks. Patients who completed cognitive therapy averaged 10.90 weeks in treatment; those in pharmacotherapy averaged 10.86 weeks. Both treatment groups showed statistically significant decreases in depressive symptomatology. Cognitive therapy resulted in significantly greater improvement than did pharmacotherapy on both a self-administered measure of depression (Beck Depression Inventory)and clinical ratings (Hamilton Rating Scale for Depression and Raskin Scale).Moreover, 78.9%of the patients in cognitive therapy showed marked improvement or complete remission of symptoms as compared to 22.7%of the pharmacotherapy patients. In addition, both treatment groups showed substantial decrease in anxiety ratings. The dropout rate was significantly higher with pharmacotherapy (8 Ss)than with cognitive therapy (1 S).Even when these dropouts were excluded from data analysis, the cognitive therapy patients showed a significantly greater improvement than the pharmacotherapy patients. Follow-up contacts at three and six months indicate that treatment gains evident at termination were maintained over time. Moreover, while 68%of the pharmacotherapy group re-entered treatment for depression, only 16%of the psychotherapy patients did so.
789 citations
Book•
01 Jan 1974546 citations
TL;DR: Patients receiving amitriptyline and little psychotherapy had a 12-percent relapse rate, compared to a 16-percent rate for those receiving more psychotherapy and no medication, and psychotherapy was beneficial to patients with problems of social adjustment and interpersonal relations.
Abstract: Prevention of relapse following depression is a pressing research problem. The authors tested the efficacy of the tricyclic antidepressant amitriptyline and psychotherapy, alone and in combination, in preventing the relapse of 150 neurotic depressed female patients. They found that patients receiving amitriptyline and little psychotherapy had a 12-percent relapse rate, compared to a 16-percent rate for those receiving more psychotherapy and no medication. There was no significant difference between drug therapy alone or drug therapy in combination with psychotherapy. However, psychotherapy was beneficial to patients with problems of social adjustment and interpersonal relations. The need for further research and implications for treatment are discussed.
431 citations