Short-Term Psychodynamic Psychotherapy and Fluoxetine in Major Depressive Disorder: A Randomized Comparative Study

Department of Psychiatry, University of Helsinki, Helsinki, Finland.
Psychotherapy and Psychosomatics (Impact Factor: 9.2). 09/2008; 77(6):351-7. DOI: 10.1159/000151388
Source: PubMed


There are few studies comparing the efficacy of short-term psychodynamic psychotherapy (STPP) and pharmacotherapy in major depressive disorder. We conducted a comparative study on the efficacy of STPP versus fluoxetine treatment in patients with major depressive disorder in a primary care setting.
Fifty-one patients with major depressive disorder (DSM-IV) of mild or moderate severity were recruited through occupational health services providing primary health care. Patients were randomized to receive either STPP (1 session/week) or fluoxetine treatment (20-40 mg/day) for 16 weeks. The outcome measures included the Hamilton Depression Rating Scale (HDRS), the Beck Depression Inventory (BDI), and the Social and Occupational Functioning Assessment Scale (SOFAS).
Intent-to-treat analyses indicated that both treatments were highly effective in reducing the HDRS (p < 0.0001) and BDI (p < 0.0001) scores, as well as in improving functional ability (SOFAS; p < 0.0001), with no statistically significant differences between the treatments. Of those 40 subjects who completed the follow-up, 57% in the psychotherapy group and 68% in the fluoxetine group showed full remission (HDRS <or=7) after 4 months.
Both STPP and pharmacological treatment with fluoxetine are effective in reducing symptoms and in improving functional ability of primary care patients with mild or moderate depression. This study suggests no marked differences in the therapeutic effects of these two treatment forms in a primary care setting.

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    • " A fluoxetina foi escolhida pela sua excelente relação custo-benefício em comparação com os custos de tratamento da depressão (Salminen et al., 2008). Na primeira consulta psiquiátrica, os pacientes receberam explicações sobre o tratamento medicamentoso e receberam fluoxetina suficiente para duas semanas de tratamento, quando , então, tiveram a segunda consulta. "
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    ABSTRACT: A depressão é uma doença grave, com repercussões importantes no humor e na cognição. Tratamentos farmacológicos e/ou psicoterápicos estão comumente indicados. O presente estudo objetivou avaliar e comparar a cognição de pacientes deprimidos antes e após 12 meses de tratamento com fluoxetina ou psicoterapia psicodinâmica. Cento e oitenta pacientes foram divididos em dois grupos, e avaliados por meio da WAIS-III. Os resultados mostraram uma melhora significativa em diferentes subtestes da WAIS-III. A MANOVA indicou que há uma diferença significativa entre os grupos nas pontuações médias obtidas na reavaliação 12 meses após o início dos tratamentos. Os resultados sugerem que a psicoterapia psicodinâmica e a terapia com fluoxetina agem de forma diferente na cognição de pacientes deprimidos.
    Psicologia Teoria e Pesquisa 12/2013; 29(4):437-446. DOI:10.1590/S0102-37722013000400010
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    • "These recommendations start with 20 mg of fluoxetine per day during two to four weeks and, if necessary, gradual increase of dosage up to a maximum of 60 mg per day. Fluoxetine was chosen for its excellent cost-effectiveness comparing to the costs of depression treatment (Salminen et al., 2008). "
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    ABSTRACT: Randomized controlled trials (RCTs) examining the efficacy of different forms of therapy for depression are relatively common. However, there are not many RCTs comparing neurocognitive effects of these treatments. Neurocognitive changes across three types of treatment for depression were compared. Long-term psychodynamic psychotherapy (LTPP) was compared with fluoxetine treatment, and their combination, in the treatment of moderate depression. A 272 adult patients with beck depression inventory (BDI) scores 20-35 were randomized to receive LTPP, fluoxetine monotherapy or their combination for a 24 months period. The Wechsler adult intelligence scale version III (WAIS-III) was the primary neuropsychological measure. Multilevel mixed model analyses indicated that there were neurocognitive changes within and between treatments, with statistically significant differences over time (p>.01). LTPP and combined treatment seemed to be more efficacious in modifying specific areas of cognition than fluoxetine alone. Sample very homogenous, threatening external validity. LTPP and its combination with fluoxetine demonstrated to be effective for specific neurocognitive increasing in patients with moderate depression. This study suggests marked differences over time in the neurocognitive effects between the three treatment forms compared. Results found here may be of clinical relevance for building bridges between pharmacotherapy and psychodynamic psychotherapy.
    Journal of Affective Disorders 09/2013; 151(3). DOI:10.1016/j.jad.2013.08.036 · 3.38 Impact Factor
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    • "The NICE guideline indicated that it was not possible to demonstrate a consistent picture of any clinically important benefit for short-term psychodynamic psychotherapy (STPP) in depression. While cognitive-behavioral therapy and interpersonal therapy continue to have the most evidence for efficacy [15], however, some randomized trials and meta-analyses indicated that STPP could be effective in reducing symptoms and in improving functional ability of patients with mild or moderate depression [16–20]. "
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    ABSTRACT: Objectives and Methods. This was an observational study of the efficacy of short-term psychodynamic psychotherapy (STPP) in a sample of 35 (30 women and 5 men) patients with moderate-to-severe "male depression" (Gotland Scale for Male Depression (GSMD) ≥ 13) comorbid with unipolar mood disorder (dysthymia and major depression) or anxiety disorder. Outcome measures were GSMD and BHS (Beck Hopelessness Scale) score changes from baseline. Results. Patients had a strong response to STPP on the GSMD (estimated mean score change (± SE) = -9.08 ± 2.74; P < 0.01; partial eta squared = 0.50), but not on the BHS (estimated mean score change (± SE) = -0.92 ± 1.55; P = 0.57; partial eta squared = 0.03). BHS score changes were significantly associated with GSMD score changes (Pearson's r = 0.56; P < 0.001), even when controlling for the severity of hopelessness at the baseline (partial r = 0.62; P < 0.001). Conclusions. STPP proved to be effective in patients suffering from "male depression" although hopelessness was only marginally reduced by this treatment which points to the need to better understand how STPP can be involved in the reduction of suicide risk.
    Depression research and treatment 01/2013; 2013(11):408983. DOI:10.1155/2013/408983
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