Kind ears help some depressed patients.
Sympathetic attention may help moderately depressed people as much as treatment with the antidepressant drug imipramine or two major forms of psychotherapy, according to a multicenter study described in the November ARCHIVES OF GENERAL PSYCHIATRY. Severely depressed individuals in the study benefited most from the imipramine, although psychotherapy also showed positive effects in these individuals.
Psychologist Irene Elkin and her colleagues at the National Institute of Mental Health in Rockville, Md., say their study is the first to compare interpersonal psychotherapy with cognitive behavior therapy. Cognitive behavior therapy aims to correct patients' overly negative, distorted views of themselves and the world. Interpersonal psychotherapy seeks to help patients identify and resolve problems with other people.
To standardize clinical care, psychotherapists in the study also provided "clinical management" to imipramine and placebo patients -- offering minimal support, encouragement and advice but not psychotherapeutic interventions. Elkin's group found that moderately depressed patients on the placebo improved just as much as those receiving imipramine or psychotherapy, suggesting that the sympathetic attention itself offered benefits in such patients.
The study involved 250 individuals diagnosed with moderate to severe depression but not psychosis or manic depression. The volunteers were randomly assigned for 16 weeks to one of the treatments or placebo. In combining results from all patients, the researchers found no statistically significant advantage for any one treatment, confirming preliminary results (SN:5/24/86, p.324). But Elkin says they did discern that in general, imipramine worked best and the placebo worked worst, with the two talk therapies falling in between.
"It's important to look at follow-up studies of those patients," says Elkin. "We don't know whether the improvements will carry forward." The researchers plan to conduct three evaluations at six-month intervals after the treatment period.
Aaron T. Beck of the University of Pennsylvania in Philadelphia, who originated the concept of cognitive therapy, notes that the three main research sites (in Oklahoma City, Pittsburgh and Washington, D.C.) yielded different outcomes. These varitions, he argues, could have stemmed in part from differences in the training of therapists at each center. Beck also emphasizes the need for follow-up, noting that a recent analysis of 28 studies of cognitive therapy found it more effective than medication in the long run.