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Three-Year Outcomes for Maintenance Therapies in Recurrent Depression

Three-Year Outcomes for Maintenance Therapies in Recurrent Depression Abstract • We conducted a randomized 3-year maintenance trial in 128 patients with recurrent depression who had responded to combined short-term and continuation treatment with imipramine hydrochloride and interpersonal psychotherapy. A five-cell design was used to determine whether a maintenance form of interpersonal psychotherapy alone or in combination with medication could play a significant role in the prevention of recurrence. A second question was whether maintaining antidepressant medication at the dosage used to treat the acute episode rather than decreasing to a "maintenance" dosage would provide prophylaxis superior to that observed in earlier trials in which a maintenance dosage strategy was employed. Survival analysis demonstrated a highly significant prophylactic effect for active imipramine hydrochloride maintained at an average dose of 200 mg and a modest prophylactic effect for monthly interpersonal psychotherapy. We conclude that active imipramine hydrochloride maintained at an average dose of 200 mg is an effective means of preventing recurrence and that monthly interpersonal psychotherapy serves to lengthen the time between episodes in patients not receiving active medication. References 1. Angst J. The course of monopolar depression and bipolar psychoses . Psychiatr Neurol Neurochir . 1973;76:489-500. 2. Keller MB, Shapiro RW, Lavori PW, Wolfe N. Relapse in major depressive disorder: analysis with the life table . Arch Gen Psychiatry . 1982;39:911-915.Crossref 3. Wells KB, Steward A, Hayes RD, Burnam A, Rogers W, Daniels M, Berry S, Greenfield S, Ware J. The functioning and well-being of depressed patients: results from the Medical Outcomes Study . JAMA . 1989;262:914-919.Crossref 4. Prien RF, Kupfer DJ, Mansky PA, Small JG, Tuason VB, Voss CB, Johnson WE. Drug therapy in the prevention of recurrences in unipolar and bipolar affective disorders: a report of the NIMH Collaborative Study Group comparing lithium carbonate, imipramine, and a lithium carbonate-imipramine combination . Arch Gen Psychiatry . 1984;41:1096-1104.Crossref 5. Glen AIM, Johnson AL, Shepherd M. Continuation therapy with lithium and amitriptyline in unipolar depressive illness: a randomized, double-blind, controlled trial . Psychol Med . 1984;14:37-50.Crossref 6. NIMH/NIH Consensus Development Conference Statement. Mood disorders: pharmacologic prevention of recurrences . Am J Psychiatry . 1985;142:469-476. 7. Montgomery SA, Dufour H, Brion S, Gailledreau J, Laqueille X, Ferrey G, Moron P, Parant-Lucena N, Singer L, Danion JM, Benzen JN, Pierredon MA. The prophylactic efficacy of fluoxetine in unipolar depression . Br J Psychiatry . 1988;153( (suppl) ):69-76. 8. Klerman GL, Dimascio A, Weissman M, Prusoff B, Paykel ES. Treatment of depression by drugs and psychotherapy . Am J Psychiatry . 1974;131:186-191. 9. Weissman MM, Klerman GL, Paykel ES, Prusoff B, Hanson B. Treatment effects on the social adjustment of depressed patients . Arch Gen Psychiatry . 1974;30:771-778.Crossref 10. Simons AD, Murphy GE, Levine JL, Wetzel RD. Cognitive therapy and pharmacotherapy for depression: sustained improvement over one year . Arch Gen Psychiatry . 1986;43:43-48.Crossref 11. Klerman GL, Weissman MM, Rounsaville BJ, Chevron ES. Interpersonal Psychotherapy of Depression . New York, NY: Basic Books Inc Publishers; 1984. 12. Frank E, Kupfer DJ. Maintenance treatment of recurrent unipolar depression: pharmacology and psychotherapy . In: Kemali D, Racagni G, eds. Chronic Treatments in Neuropsychiatry . New York, NY: Raven Press; 1985;139-151. 13. Hamilton M. A rating scale for depression . J Neurol Neurosurg Psychiatry . 1960;23:56-62.Crossref 14. Raskin A, Schulterbrandt J, Reatig N, McKeon JJ. Replication of factors of psychopathology in interview, word behavior and self-report ratings of hospitalized depressives . J Nerv Ment Dis . 1969;148:87-98.Crossref 15. Endicott J, Spitzer RL. A diagnostic interview: the Schedule for Affective Disorders and Schizophrenia . Arch Gen Psychiatry . 1978;35:837-844.Crossref 16. Spitzer R, Endicott J, Robins E. Research Diagnostic Criteria: rationale and reliability . Arch Gen Psychiatry . 1978;35:773-782.Crossref 17. Byar DP. Analysis of survival data in heterogenous populations . In: Recent Developments in Statistics . New York, NY: North-Holland Publishing Co; 1977:51-68. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of General Psychiatry American Medical Association

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Publisher
American Medical Association
Copyright
Copyright © 1990 American Medical Association. All Rights Reserved.
ISSN
0003-990X
eISSN
1598-3636
DOI
10.1001/archpsyc.1990.01810240013002
Publisher site
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Abstract

Abstract • We conducted a randomized 3-year maintenance trial in 128 patients with recurrent depression who had responded to combined short-term and continuation treatment with imipramine hydrochloride and interpersonal psychotherapy. A five-cell design was used to determine whether a maintenance form of interpersonal psychotherapy alone or in combination with medication could play a significant role in the prevention of recurrence. A second question was whether maintaining antidepressant medication at the dosage used to treat the acute episode rather than decreasing to a "maintenance" dosage would provide prophylaxis superior to that observed in earlier trials in which a maintenance dosage strategy was employed. Survival analysis demonstrated a highly significant prophylactic effect for active imipramine hydrochloride maintained at an average dose of 200 mg and a modest prophylactic effect for monthly interpersonal psychotherapy. We conclude that active imipramine hydrochloride maintained at an average dose of 200 mg is an effective means of preventing recurrence and that monthly interpersonal psychotherapy serves to lengthen the time between episodes in patients not receiving active medication. References 1. Angst J. The course of monopolar depression and bipolar psychoses . Psychiatr Neurol Neurochir . 1973;76:489-500. 2. Keller MB, Shapiro RW, Lavori PW, Wolfe N. Relapse in major depressive disorder: analysis with the life table . Arch Gen Psychiatry . 1982;39:911-915.Crossref 3. Wells KB, Steward A, Hayes RD, Burnam A, Rogers W, Daniels M, Berry S, Greenfield S, Ware J. The functioning and well-being of depressed patients: results from the Medical Outcomes Study . JAMA . 1989;262:914-919.Crossref 4. Prien RF, Kupfer DJ, Mansky PA, Small JG, Tuason VB, Voss CB, Johnson WE. Drug therapy in the prevention of recurrences in unipolar and bipolar affective disorders: a report of the NIMH Collaborative Study Group comparing lithium carbonate, imipramine, and a lithium carbonate-imipramine combination . Arch Gen Psychiatry . 1984;41:1096-1104.Crossref 5. Glen AIM, Johnson AL, Shepherd M. Continuation therapy with lithium and amitriptyline in unipolar depressive illness: a randomized, double-blind, controlled trial . Psychol Med . 1984;14:37-50.Crossref 6. NIMH/NIH Consensus Development Conference Statement. Mood disorders: pharmacologic prevention of recurrences . Am J Psychiatry . 1985;142:469-476. 7. Montgomery SA, Dufour H, Brion S, Gailledreau J, Laqueille X, Ferrey G, Moron P, Parant-Lucena N, Singer L, Danion JM, Benzen JN, Pierredon MA. The prophylactic efficacy of fluoxetine in unipolar depression . Br J Psychiatry . 1988;153( (suppl) ):69-76. 8. Klerman GL, Dimascio A, Weissman M, Prusoff B, Paykel ES. Treatment of depression by drugs and psychotherapy . Am J Psychiatry . 1974;131:186-191. 9. Weissman MM, Klerman GL, Paykel ES, Prusoff B, Hanson B. Treatment effects on the social adjustment of depressed patients . Arch Gen Psychiatry . 1974;30:771-778.Crossref 10. Simons AD, Murphy GE, Levine JL, Wetzel RD. Cognitive therapy and pharmacotherapy for depression: sustained improvement over one year . Arch Gen Psychiatry . 1986;43:43-48.Crossref 11. Klerman GL, Weissman MM, Rounsaville BJ, Chevron ES. Interpersonal Psychotherapy of Depression . New York, NY: Basic Books Inc Publishers; 1984. 12. Frank E, Kupfer DJ. Maintenance treatment of recurrent unipolar depression: pharmacology and psychotherapy . In: Kemali D, Racagni G, eds. Chronic Treatments in Neuropsychiatry . New York, NY: Raven Press; 1985;139-151. 13. Hamilton M. A rating scale for depression . J Neurol Neurosurg Psychiatry . 1960;23:56-62.Crossref 14. Raskin A, Schulterbrandt J, Reatig N, McKeon JJ. Replication of factors of psychopathology in interview, word behavior and self-report ratings of hospitalized depressives . J Nerv Ment Dis . 1969;148:87-98.Crossref 15. Endicott J, Spitzer RL. A diagnostic interview: the Schedule for Affective Disorders and Schizophrenia . Arch Gen Psychiatry . 1978;35:837-844.Crossref 16. Spitzer R, Endicott J, Robins E. Research Diagnostic Criteria: rationale and reliability . Arch Gen Psychiatry . 1978;35:773-782.Crossref 17. Byar DP. Analysis of survival data in heterogenous populations . In: Recent Developments in Statistics . New York, NY: North-Holland Publishing Co; 1977:51-68.

Journal

Archives of General PsychiatryAmerican Medical Association

Published: Dec 1, 1990

References