Treating depression: can we talk?Treating Depression: Can We Talk?
An extensive study of depressed patients, comparing the effectiveness of two forms of brief psychotherapy with drug and placebo treatments, promises to shed some light on a question rarely addressed by such research: Which approach works best for what types of depressed patients? Preliminary results from the study, directed by psychologist Irene Elkin and her colleagues at the National Institute of Mental Health The National Institute of Mental Health (NIMH) is part of the federal government of the United States and the largest research organization in the world specializing in mental illness. (NIMH) in Rockville, Md., were presented last week in Washington, D.C., at the annual meeting of the American Psychiatric Association The American Psychiatric Association (APA) is the main professional organization of psychiatrists and trainee psychiatrists in the United States, and the most influential world-wide. Its some 148,000 members are mainly American but some are international. .
Overall, says Elkin, the "talk' therapies --cognitive behavior therapy behavior therapy or behavior modification, in psychology, treatment of human behavioral disorders through the reinforcement of acceptable behavior and suppression of undesirable behavior. and interpersonal therapy--alleviated depressive symptoms as well as the commonly prescribed antidepressant antidepressant, any of a wide range of drugs used to treat psychic depression. They are given to elevate mood, counter suicidal thoughts, and increase the effectiveness of psychotherapy. drug imipramine imipramine /imip·ra·mine/ (i-mip´rah-men) a tricyclic antidepressant of the dibenzazepine class, used as i. hydrochloride or i. pamoate. and markedly better than the pill placebo. These are "averaged' data, however, from 236 moderately to severely depressed patients treated in medical centers at George Washington University George Washington University, at Washington, D.C.; coeducational; chartered 1821 as Columbian College (one of the first nonsectarian colleges), opened 1822, became a university in 1873, renamed 1904. in Washington, D.C., the University of Oklahoma University of Oklahoma, abbreviated OU, is a coeducational public research university located in the U.S. state of Oklahoma. Founded in 1890, it existed in Oklahoma Territory near Indian Territory 17 years before the two became the state of Oklahoma. in Oklahoma City Oklahoma City (1990 pop. 444,719), state capital, and seat of Oklahoma co., central Okla., on the North Canadian River; inc. 1890. The state's largest city, it is an important livestock market, a wholesale, distribution, industrial, and financial center, and a farm and the University of Pittsburgh. The success of the psychotherapies varied significantly across the three sites, notes Elkin; further analysis of the data will examine site-specific effects, such as the patient-therapist relationship and therapist skill in carrying out the assigned treatment.
The 18 psychotherapists in the study were experienced clinicians who received special training in the therapy to be performed. Cognitive behavior therapy attempts to correct distorted thinking distorted thinking Psychology Any of a number of 'emotional traps' that prevent a person from addressing negative emotions Forms of DT All-or-nothing thinking, overgeneralization, mental filtering, personalizing blame. and overly negative views of oneself, the world and the future. Interpersonal therapy focuses on developing better ways to relate to family members, coworkers and others. In both cases, weekly one-hour sessions were conducted for 12 to 16 weeks.
Imipramine and the pill placebo were dispensed weekly by experienced psychiatrists, who also provided about a half hour of support and encouragement per week.
The patients, 70 percent of whom were women, ranged in age from 21 to 60. Each patient underwent an average of 13 weeks of treatment; 162 patients completed 16 weeks of treatment. Symptom improvement was determined through the reports of patients, therapists and independent clinicians.
More than half of all patients in both the therapy and the drug groups recovered with no serious symptoms after 16 weeks, says Elkin, compared with 29 percent of the pill placebo group. The least depressed patients did surprisingly well in the pill placebo group, she adds, indicating that this approach may significantly help many moderately depressed individuals.
Severely depressed patients, on the other hand, did not respond well to the placebo condition. Those in the imipramine and interpersonal therapy groups showed the most improvement. Patients given cognitive behavior therapy displayed slightly less improvement, although not to a statistically significant degree.
In addition, says psychiatrist Stuart Sotsky of George Washington University, there are indications that certain types of depressed patients responded best to specific treatments. For example, married patients with longer episodes of moderate depression responded best to cognitive behavior therapy. Interpersonal therapy worked best with men who had relatively high levels of social functioning social functioning,
n the ability of the individual to interact in the normal or usual way in society; can be used as a measure of quality of care. , he reports, and imipramine was most effective with married patients suffering from severe depression and work difficulties.
Crucial data on the maintenance of improvement during an 18-month follow-up have not yet been analyzed, says Elkin. Future studies, she explains, must also examine the role in treatment outcome played by patient personality characteristics and patient and therapist expectations and attitudes toward treatment.
"This project will be the standard against which all other psychotherapy research will be compared,' says psychiatrist Jerome Frank of Johns Hopkins University Johns Hopkins University, mainly at Baltimore, Md. Johns Hopkins in 1867 had a group of his associates incorporated as the trustees of a university and a hospital, endowing each with $3.5 million. Daniel C. in Baltimore, "although I'm somewhat pessimistic about psychotherapy research methods in general.' Therapy often resembles a rhetorical attempt to influence another person's attitudes and behavior, he says, rather than a "science' that can be easily evaluated.
Researchers also need to study the outcome of therapy-drug combinations, says psychiatrist David Kupfer of the University of Pittsburgh. This approach has recently been promoted as superior to either treatment alone. A depressed patient's support from friends and family also needs to be considered over the course of recovery, asserts Kupfer.
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