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Psychotherapy outcome when chronic depression is a co-traveller
Abstracts / Journal of Affective Disorders 107 (2008) S21–S52
and of the ability to take the other person's perspective due to arrested maturational development. Therefore, the CBASP approach fits particularly well for chronically depressed patients with early onset and early life stress. Methods: Twenty-four outpatients with an early-onset chronic MDD (chronic MDD, dysthymia, double depression, or recurrent MDE with incomplete remission between episodes), recruited in primary care and specialty mental health settings, are randomized to either CBASP or IPT (using early – before the age of 18 – trauma as stratification variable). Eligible patients are between 18 and 58 years, free of antidepressant medication, and have a score of at least 16 on the 24item Hamilton Rating Scale of Depression (HAMD). The HAMD score is the primary outcome. In addition, the Beck Depression Inventory and measures of social adjustment are used. Results: The study is ongoing. First results will be presented at the ISAD conference in March 2008. Conclusions: Clinical implications, conclusions, and limitations of the study will be discussed. doi:10.1016/j.jad.2007.12.210
12.3 A sequential strategy for preventing relapse in recurrent depression C Ruini*, R.C. Fava University of Bologna, Italy The chronic and recurrent nature of major depressive disorders is getting increasing attention, mainly because of the unsatisfactory degree of remission that current therapeutic strategies yield. Most patients, in fact, report residual symptoms despite apparently successful treatment. These residual symptoms upon remission have a strong prognostic value, because often they progress to become prodromes of relapse. This has led to the development of new therapeutic strategies for treating these residual symptoms and improving the level of remission. In particular, a new treatment strategy is based on a sequential model, encompassing the use of pharmacotherapy in the acute phase of depression and the use of cognitive therapy in its residual phase. Particular emphasis is paid to the improvement of psychological well being as a protective factor against stress and relapse. A specific psychotherapeutic technique for enhancing psychological well being – Well-Being Therapy
S47
(WBT) – can be used to implement standard CBT and achieve a more enduring recovery. Preliminary investigations involving this sequential strategy, both in primary major depressive disorder and in recurrent depression, will be presented. Their results document the efficacy of this sequential strategy in achieving remission and preventing relapse. doi:10.1016/j.jad.2007.12.211
12.4 Psychotherapy outcome when chronic depression is a co-traveller M.K. Shear*, C. Reynolds, N. Simon Columbia University, USA
Aims: To conduct secondary analyses of two NIMHfunded psychotherapy studies, one targeting panic disorder, the other complicated grief, to compare participants with and without chronic depression on: (1) clinical and demographic characteristics, including severity and suicidality; (2) target symptom outcome (panic or complicated grief); (3) outcome on associated symptoms (e.g. depression, anxiety); and (4) functional impairment. Background: Epidemiologic and clinical studies document high rates of comorbidity of anxiety and depressive disorders. Studies of complicated grief similarly show high rates of comorbidity in community and clinical samples. Comorbid patients show more severe symptoms, however results of intervention are variable. Few investigators have focused on chronic depression. There is a need to know if comorbid chronic depression worsens outcome and/or responds to treatment provided for other disorders, including panic disorder and complicated grief. Methods: Two NIMH-funded studies will be examined, including a 4-site study of panic disorder (n = 381) in which we will evaluate the results of open treatment with CBT provided to all study participants. The second study is a randomized controlled trial comparing 2 psychotherapies for complicated grief (n = 95). Both studies had high rates of depressive comorbidity. Results: Results of these secondary analyses will be presented for the first time. Conclusions: Conclusions, clinical and research implications of these findings will be discussed. doi:10.1016/j.jad.2007.12.212
and of the ability to take the other person's perspective due to arrested maturational development. Therefore, the CBASP approach fits particularly well for chronically depressed patients with early onset and early life stress. Methods: Twenty-four outpatients with an early-onset chronic MDD (chronic MDD, dysthymia, double depression, or recurrent MDE with incomplete remission between episodes), recruited in primary care and specialty mental health settings, are randomized to either CBASP or IPT (using early – before the age of 18 – trauma as stratification variable). Eligible patients are between 18 and 58 years, free of antidepressant medication, and have a score of at least 16 on the 24item Hamilton Rating Scale of Depression (HAMD). The HAMD score is the primary outcome. In addition, the Beck Depression Inventory and measures of social adjustment are used. Results: The study is ongoing. First results will be presented at the ISAD conference in March 2008. Conclusions: Clinical implications, conclusions, and limitations of the study will be discussed. doi:10.1016/j.jad.2007.12.210
12.3 A sequential strategy for preventing relapse in recurrent depression C Ruini*, R.C. Fava University of Bologna, Italy The chronic and recurrent nature of major depressive disorders is getting increasing attention, mainly because of the unsatisfactory degree of remission that current therapeutic strategies yield. Most patients, in fact, report residual symptoms despite apparently successful treatment. These residual symptoms upon remission have a strong prognostic value, because often they progress to become prodromes of relapse. This has led to the development of new therapeutic strategies for treating these residual symptoms and improving the level of remission. In particular, a new treatment strategy is based on a sequential model, encompassing the use of pharmacotherapy in the acute phase of depression and the use of cognitive therapy in its residual phase. Particular emphasis is paid to the improvement of psychological well being as a protective factor against stress and relapse. A specific psychotherapeutic technique for enhancing psychological well being – Well-Being Therapy
S47
(WBT) – can be used to implement standard CBT and achieve a more enduring recovery. Preliminary investigations involving this sequential strategy, both in primary major depressive disorder and in recurrent depression, will be presented. Their results document the efficacy of this sequential strategy in achieving remission and preventing relapse. doi:10.1016/j.jad.2007.12.211
12.4 Psychotherapy outcome when chronic depression is a co-traveller M.K. Shear*, C. Reynolds, N. Simon Columbia University, USA
Aims: To conduct secondary analyses of two NIMHfunded psychotherapy studies, one targeting panic disorder, the other complicated grief, to compare participants with and without chronic depression on: (1) clinical and demographic characteristics, including severity and suicidality; (2) target symptom outcome (panic or complicated grief); (3) outcome on associated symptoms (e.g. depression, anxiety); and (4) functional impairment. Background: Epidemiologic and clinical studies document high rates of comorbidity of anxiety and depressive disorders. Studies of complicated grief similarly show high rates of comorbidity in community and clinical samples. Comorbid patients show more severe symptoms, however results of intervention are variable. Few investigators have focused on chronic depression. There is a need to know if comorbid chronic depression worsens outcome and/or responds to treatment provided for other disorders, including panic disorder and complicated grief. Methods: Two NIMH-funded studies will be examined, including a 4-site study of panic disorder (n = 381) in which we will evaluate the results of open treatment with CBT provided to all study participants. The second study is a randomized controlled trial comparing 2 psychotherapies for complicated grief (n = 95). Both studies had high rates of depressive comorbidity. Results: Results of these secondary analyses will be presented for the first time. Conclusions: Conclusions, clinical and research implications of these findings will be discussed. doi:10.1016/j.jad.2007.12.212