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Depression therapy gets interpersonal.

A year ago, psychologists reported that three-quarters of severely depressed individuals who received high doses of an antidepressant drug for three years--after initially responding well to a combination of the medication and a form of short-term psychotherapy--suffered no return bouts of the psychiatric disorder (SN: 1/26/91, p.56). But another finding from the same study intrigued the investigators: Half of those whose depression cleared with the drug-psychotherapy approach, and who then received only one hour of psychotherapy per month with no medication, also remained depression-free for three years.

A closer analysis of these participants and their therapists now indicates that most of the long-term improvement was sparked by a consistent focus on improving social skills and relations with others, rather than by other techniques or "nonspecific" influences such as the mere presence of an understanding therapist, report Ellen Frank and her colleagues at the University of Pittsburgh School of Medicine.

If confirmed in a larger sample of volunteers, the new finding would herald a powerful and cost-effective way to quell severe depression over the long haul, especially among the many people who cannot or will not take anti-depressants for years at a time, the researchers conclude in the December ARCHIVES OF GENERAL PSYCHIATRY. Various studies have indicated that one-third to one-half of all severely depressed individuals prescribed anti-depressants either reduce or halt use of the drugs because of side effects, which may include blurred vision, weight gain, drowsiness, lowered blood pressure and impotence.

The Pittsburgh scientists studied 36 depressed adults treated by one of six therapists trained in interpersonal therapy, which examines how conflicts with others and disturbed relationships contribute to depression. Trained raters evaluated audiotapes of the monthly sessions to establish the extent to which each therapist focused on interpersonal issues, as opposed to other factors, such as depressed mood, distorted thinking about the self, or unconscious conflicts.

The 11 patients who received therapy rated as "highly specific" for interpersonal concerns stayed depression-free for a median of nearly two years; the remainder suffered a relapse after a median of just under five months.

No overall differences in technique or success turned up among the individual therapists. However, each therapist applied interpersonal therapy better with some patients than with others. This underscores the importance of learning what aspects of a therapist-patient match will best enhance a psychotherapy's effectiveness, the Pittsburgh researchers assert.

The data do not show that only interpersonal therapy prevents recurrences of depression, they add. But whatever the therapeutic approach, a focus on the patient's social world appears critical. For instance, cognitive-behavioral therapists - who try to correct distorted thinking, attitudes and behavior - may often focus on a depressed person's unrealistic expectations about social relations and on his or her pessimism concerning intimacy with others, the scientists note.
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Author:Bower, B.
Publication:Science News
Date:Dec 21, 1991
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