Long-term effect of combined interpersonal psychotherapy and pharmacotherapy in a randomized trial of depressed patients

• Published in: Acta psychiatrica Scandinavica 2011-04, Vol.123 (4), p.276-282
• Main Authors: Zobel, I., Kech, S., van Calker, D., Dykierek, P., Berger, M., Schneibel, R., Schramm, E.
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Adult and adolescent clinical studies; Aged; Antidepressive Agents - pharmacokinetics; Antidepressive Agents - therapeutic use; Biological and medical sciences; Child Abuse - psychology; childhood trauma; Children; Clinical trials; Combined Modality Therapy; combined treatment; Critical Pathways; Depression; Depressive Disorder, Major - etiology; Depressive Disorder, Major - psychology; Depressive Disorder, Major - therapy; Drug therapy; Female; Follow-Up Studies; Humans; Long-term effects; Male; Medical sciences; Mental depression; Middle Aged; Mood disorders; Psychiatric Status Rating Scales; Psychology. Psychoanalysis. Psychiatry; Psychopathology. Psychiatry; Psychotherapy; Psychotherapy, Group - organization & administration; Remission; Severity of Illness Index; Therapeutic Equivalency; Time; Trauma; Treatment Outcome
• ISSN: 0001-690X; 1600-0447
• DOI: 10.1111/j.1600-0447.2010.01671.x

Zobel I, Kech S, van Calker D, Dykierek P, Berger M, Schneibel R, Schramm E. Long‐term effect of combined interpersonal psychotherapy and pharmacotherapy in a randomized trial of depressed patients. Objective:  Evaluation of the long‐term benefits of combined pharmacological and psychotherapeutic depression treatment and the differential impact of early childhood trauma. Method:  A randomized trial was conducted in 124 in‐patients with a diagnosis of major depressive disorder comparing 5 weeks of interpersonal psychotherapy plus pharmacotherapy (IPT) with medication plus clinical management (CM). The study included a prospective, naturalistic follow‐up 3, 12 and 75 months after in‐patient treatment. The Hamilton Rating Scale for Depression (HRSD) served as the primary outcome measure. Results:  Patients in both treatments reduced their depressive symptoms between baseline and 5‐year follow‐up significantly with a faster decrease early in the follow‐up phase. The time rate of change and acceleration on the HRSD was higher for patients in the combination therapy group. The contrast between the conditions at year 5 was non‐significant. However, 28% of the IPT patients showed a sustained remission compared with 11% of the CM patients (P = 0.032). Early adversity was found to be a moderator of the relationship between treatment and outcome. Conclusion:  In the long‐term, a combination of psycho‐ and pharmacotherapy was superior in terms of sustained remission rates to standard psychiatric treatment. Early trauma should be assessed routinely in depressed patients.