5/11/2007 *American Journal of Psychiatry* (vol. 164, #5)
includes a study: “An Intensive Treatment Program of Interpersonal
Psychotherapy Plus Pharmacotherapy for Depressed Inpatients: Acute and
Long-Term Results.”

The article is by Elisabeth Schramm, Ph.D., Dietrich van Calker, M.D.,
Ph.D., Petra Dykierek, Ph.D., Klaus Lieb, M.D., Sabine Kech,
D.Clin.Psych., Ingo Zobel, D.Clin.Psych., Rainer Leonhart,
D.Clin.Psych., & Mathias Berger, M.D.

Here’s how the article begins:

[start excerpt]

There are numerous pharmacological and psychological alternatives for
the treatment of unipolar major depressive disorder. However, a
substantial number of depressed patients (50%-70%) either do not fully
respond to acute treatment or relapse within a year (1-4).

In recognition of the often poor response of depressed patients to
monotherapy, the use of combined pharmacological and psychotherapeutic
treatment, particularly in more severely depressed patients, is common.
Nevertheless, relatively few studies have investigated the benefits of
adding psychotherapy to medication in depression, and study results are
conflicting (5).

While in unselected outpatient cohorts only small
effects of combination treatment relative to pharmacotherapy alone have
been reported, combined approaches appear to be more effective for
severely or chronically depressed patients (5-9). In contrast to the
findings among studies of unselected depressed outpatients, two studies
of depressed inpatients (10, 11) showed improved efficacy for adding
cognitive and behavioral treatments to pharmacotherapy both at
posttreatment (10) and long-term follow-up (12). Two German trials on
inpatients, however, reported no advantage for combined treatment with
medication and cognitive behavior therapy (CBT) versus medication plus
supportive therapy (13) or medication and CBT versus both monotherapies
(14), respectively.

Despite the fact that inpatient treatment is no longer widely used in
the United States and in some other countries, it is the standard of
care in Germany and many other countries for more severely depressed
patients and is therefore still relevant worldwide. Interpersonal
psychotherapy has been shown to be effective in the outpatient treatment
of mild to more severe depression (15, 16). To our knowledge, there are
no controlled trials regarding the efficacy of interpersonal
psychotherapy for depressed, hospitalized patients, although several
factors make the approach suitable for inpatient treatment (e.g., the
medical model, the simple concept, relatively easy to learn for residents).

We examined the hypotheses that depressed inpatients treated for 5 weeks
with psychotherapy plus pharmacotherapy would have 1) a higher reduction
in depressive symptoms and 2) higher response and remission rates
compared with patients treated with pharmacotherapy plus clinical
management. For the follow-up period, we hypothesized a better
symptomatic and psychosocial long-term outcome and lower relapse rates
for patients initially treated with psychotherapy plus pharmacotherapy.

[end excerpt]

Here’s how the Discussion section begins: “Given the short time period
of acute treatment in our study and a strong comparison condition, the
short- and long-term advantage of adding psychotherapeutic intervention
to pharmacotherapy is impressive. The high response (70%) and remission
rates (49%) and the low relapse rates (13% in a 12-month period) may
reflect the high intensity of the multicomponent treatment program with
15 individual and eight additional group sessions. The intensive
delivery of therapy in the acute phase possibly conveys a unique
treatment advantage for more severely depressed patients. However, the
brevity of the intervention may have imposed a ceiling on the maximum
efficacy of the treatment. Miller et al. (35) concluded that current
treatments are not very efficacious in the aftercare of recently
discharged major depressive disorder patients. They suggest that
beginning psychotherapy while in the hospital may be more advantageous
than delaying initiation until discharge. In fact, the timing of
additional psychotherapy initiation seems to play an important role.
Frank et al. (36) also suggest not waiting for the period of disorder
stabilization to add psychotherapy. Our data clearly support this view.
Compared with previous studies with depressed inpatients (10-14), this
study differed in having utilized a larger cohort size, a more
comprehensive treatment program, and a different psychotherapy method
that may have affected treatment response more favorably.”

The author note states that reprint requests may be sent to
<Elisabeth.Schramm@uniklinik-freiburg.de>.

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