Adding group psychotherapy to medication treatment in dysthymia: A randomized prospective pilot study

Department of Psychiatry, Beth Israel Medical Center, New York, USA.
The Journal of psychotherapy practice and research 02/2001; 10(2):93-103.
Source: PubMed

ABSTRACT Patients with dysthymia have been shown to respond to treatment with antidepressant medications, and to some degree to psychotherapy. Even patients successfully treated with medication often have residual symptoms and impaired psychosocial functioning. The authors describe a prospective randomized 36-week study of dysthymic patients, comparing continued treatment with antidepressant medication (fluoxetine) alone and medication with the addition of group therapy treatment. After an 8-week trial of fluoxetine, medication-responsive subjects were randomly assigned to receive either continued medication only or medication plus 16 sessions of manualized group psychotherapy. Results provide preliminary evidence that group therapy may provide additional benefit to medication-responding dysthymic patients, particularly in interpersonal and psychosocial functioning.

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Available from: John Christopher Muran, Jul 17, 2015
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    • "0.77 0.01 0.02 0.29 0.59 0.64 0.00 0.23 0.23 0.86 0.11 0.00 0.21 1.00 0.47 0.01 0.89 0.93 0.36 0.38 1.00 0.35 0.00 0.09 0.20 0.00 –0.78 0.26 0.10 –0.23 –0.32 –0.35 0.25 –0.32 –0.21 –0.58 –0.08 0.31 –0.12 –0.88 –0.45 0.34 –0.55 –0.70 –0.34 –0.26 –0.57 –0.33 0.24 –0.07 –0.23 0.20 Study Bellack et al 9 (1981) Bellino et al 6 (2006) Blackburn et al 8 (1981) Blom et al 20 (2007) Browne et al 10 (2002) Burnand et al 21 (2002) de Jonghe et al 22 (2001) deMello et al 23 (2001) Hautzinger et al 24 (1996) Hellerstein et al 25 (2001) Hollon et al 26 (1992) Keller et al 27 (2000) Lesperance et al 28 (2007) Lopez et al 29 (2004) Lynch et al 30 (2003) "
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    ABSTRACT: A considerable number of studies has examined whether adding psychotherapy to pharmacotherapy results in stronger effects than pharmacotherapy alone. However, earlier meta-analyses in this field have included only a limited number of available studies and did not conduct extended subgroup analyses to examine possible sources of heterogeneity. We used a database derived from a comprehensive literature search in PubMed, PsycINFO, EMBASE, and the Cochrane Central Register of Controlled Trials for studies published from 1966 to January 2008 that examined the psychological treatment of depression. The abstracts of these studies were identified by combining terms indicative of psychological treatment and depression. We included randomized trials in which the effects of a pharmacologic treatment were compared to the effects of a combined pharmacologic and psychological treatment in adults with a depressive disorder. For each of the studies, we calculated a standardized mean effect size indicating the difference between pharmacotherapy and the combined treatment at posttest. We also coded major characteristics of the population, the interventions, and the quality and design of the study. Twenty-five randomized trials, with a total of 2,036 patients, were included. A mean effect size of d = 0.31 (95% CI, 0.20 approximately 0.43) was found for the 25 included studies, indicating a small effect in favor of the combined treatment over pharmacotherapy alone. Studies aimed at patients with dysthymia resulted in significantly lower effect sizes compared to studies aimed at patients with major depression, a finding that suggests that the added value of psychotherapy is less in patients with dysthymia. The dropout rate was significantly lower in the combined treatment group compared to the pharmacotherapy only group (OR = 0.65; 95% CI, 0.50 approximately 0.83). Psychotherapy seems to have an additional value compared to pharmacotherapy alone for depression.
    The Journal of Clinical Psychiatry 09/2009; 70(9):1219-29. DOI:10.4088/JCP.09r05021 · 5.14 Impact Factor
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    • "Combined psychotherapy and medication-treatment studies are addressed in another article in this issue. Two recent small combined-treatment studies have addressed the question of whether IPT adds to the efficacy of pharmacotherapy for chronic depression (de Mello, Myczcowisk, & Menezes, 2001; Hellerstein et al., 2001). "
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    ABSTRACT: Interpersonal psychotherapy (IPT) is a time-limited, manualized, life-event-based treatment of demonstrated efficacy for acute major depression. This article describes its adaptation and application to chronic forms of unipolar depression. The interpersonal difficulties of chronically depressed patients present a potentially good fit for a therapy that builds interpersonal functioning, but the chronicity of illness and paucity of life events of dysthymic patients complicate the use of IPT. Recent outcome research is reviewed. A case example illustrates the clinical approach and potential benefits. Based on a limited number of studies, the benefits of acute IPT for chronic depression appear non-specific and modest.
    Journal of Clinical Psychology 08/2003; 59(8):847-58. DOI:10.1002/jclp.10177 · 2.12 Impact Factor
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    ABSTRACT: In der vorliegenden Arbeit wurden 80 stationär behandelte Patienten mit Major Depression (DSM-IV) hinsichtlich der möglichen Beziehung zwischen dem Depressionsverlauf und der Persönlichkeit und Persönlichkeitsstörungen der Patienten geprüft. Dazu wurden die Patienten während der stationären Behandlung wiederholt mit Fragebögen und Interviews untersucht. Das zentrale Ergebnis war, dass depressive Patienten mit Persönlichkeitsstörungen zu Beginn der Behandlung eher stärker depressiv waren, ihre Depression später auf die Therapie ansprach und die Patienten bei der Entlassung immer noch schwerer depressiv waren als depressive Patienten ohne Persönlichkeitsstörungen. Dennoch remittierten die Depressionen auch bei den meisten der Patienten mit Persönlichkeitsstörungen. In vielen der untersuchten Variablen fanden sich keine statistisch signifikanten Unterschiede zwischen den depressiven Patienten mit und denen ohne Persönlichkeitsstörungen. Eine Schlussfolgerung ist, dass zukünftige Studien einzelne Persönlichkeitsstörungen untersuchen sollten, anstatt alle Persönlichkeitsstörungen zusammen, da sich die verschiedenen Persönlichkeitsstörungen möglicherweise in ihrer Bedeutung für den Depressionsverlauf voneinander unterscheiden. The present study examined 80 in-patients with Major Depression (DSM-IV) concerning possible associations between the course of the depression and personality characteristics as well as personality disorders of the patients. Therefore patients were examined at different times by interviews and questionnaires during their treatment in hospital. The main result was that depressive patients with personality disorders tended to be more depressive at the beginning of their treatment, their depression responded later to the therapy and these patients were still more depressive at hospital discharge than depressive patients without personality disorders. Nevertheless the depression remitted in most of the patients with personality disorders. In many of the examined variables there were no statistically significant differences between depressive patients with and without personality disorders. One conclusion is that further studies ought to examine each personality disorder alone instead of all personality disorders together, because the personality disorders might differ in their relevance for the course of depression.
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