Short-Term Dynamic Psychotherapy Versus Pharmacotherapy for Major Depressive Disorder: A Randomized, Placebo-Controlled Trial

Center for Psychotherapy Research, Department of Psychiatry, University of Pennsylvania School of Medicine, Philadelphia, USA.
The Journal of Clinical Psychiatry (Impact Factor: 5.5). 11/2011; 73(1):66-73. DOI: 10.4088/JCP.11m06831
Source: PubMed


To determine whether supportive-expressive psychotherapy (SET), a form of dynamic psychotherapy, and pharmacotherapy + clinical management (MED) for major depressive disorder (MDD) are more effective than pill-placebo + clinical management (PBO).
This National Institute of Mental Health (NIMH)-sponsored randomized controlled trial was conducted (from November 2001 through June 2007) at the University of Pennsylvania Medical School. The sample included 156 patients diagnosed with MDD (DSM-IV) and having a 17-item Hamilton Rating Scale for Depression (HRSD(17)) score ≥ 14 for at least 2 consecutive weeks. This was an underserved sample in which 41% were male, 52% were self-designated minorities, and 76% had an annual income under $30,000. Treatment lasted 16 weeks. Medication patients not responsive by week 8 (maximum dose 200 mg/d of sertraline) were switched to venlafaxine (maximum dose 375 mg/d). Nonresponsive placebo patients at week 8 were switched to a different placebo.
Patients' depression improved over the 16 weeks (P < .0001), with no between-group differences (P = .95), even among severely (HRSD(17) score ≥ 20) depressed patients (P = .45). Response rates did not differ between groups (P = .73). Gender and minority status moderated outcome (P = .014), with psychotherapy more efficacious for minority men than MED (P = .027, Cohen d = 1.02) and PBO (P = .019, d = 1.09). PBO was more efficacious for white men than MED (P = .03, d = 0.62) and SET (P = .003, d = 1.07). For white women, MED (P = .005, d = 0.77) and SET (P = .033, d = 0.71) were more efficacious than placebo. No differences among treatments were found for minority women.
This trial of urban MDD patients failed to confirm that either active treatment was better than placebo. Minority status and gender had significant and differential effects on outcome that warrant replication in future studies. Identifier: NCT00043550.

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    • "Depression is associated with a substantial decrease in QOL, and is a major contributor to decrement in general health (Rapaport et al., 2005, Moussavi et al., 2007). Medication, psychodynamic psychotherapy, and even placebo have been shown to effectively reduce observer-rated depressive symptoms of patients with MDD when compared in a recent RCT (Barber et al., 2012). However, whether these treatments lead to improvement in other areas of functioning in patients with MDD throughout and between treatments has not been previously evaluated. "
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    ABSTRACT: Major depressive disorder (MDD) is associated with a decrease in quality of life (QOL) and well-being. Therefore, researchers are increasingly complementing traditional symptom measurements with QOL and well-being assessments in order to broaden the evaluation of treatment outcomes. The current prospective study investigated the effectiveness of supportive-expressive therapy (SET), antidepressant medication (MED) and placebo (PBO) in improving QOL and well-being in patients with MDD. Data from a randomized controlled trial (trial registration: NCT00043550) comparing SET, MED and PBO for the treatment of depression (N=156) were analyzed. Outcome measures addressed patients' QOL and physical and mental well-being. Changes in outcomes were assessed across and between treatments using linear mixed models. Across treatments, patients showed significant improvement in QOL and mental and physical health measures, as well as a reduction in interpersonal distress and depressive and anxiety symptoms (p≤.002 for all measures). Those changes were not only the products of a decrease in depressive symptoms, but also predicted subsequent reduction in symptoms. No significant differences were found between the three treatment conditions. The limitation is the study's moderate sample size. Current treatments for depression significantly improve patients' QOL and well-being. No significant differences were found between the three conditions examined in this study. The current study highlights the role of well-being in predicting subsequent symptomatic change.
    Journal of Affective Disorders 10/2013; 152-154(1). DOI:10.1016/j.jad.2013.10.015 · 3.38 Impact Factor
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    • "Details about inclusion criteria and study procedures are reported by Barber et al. (2012). The current sample consisted of 151 patients, mean age was 37.5 years (SD ¼12.12), 60.9% were female. "
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    ABSTRACT: Previous studies reported inconsistent findings regarding the association of interpersonal problems with therapy outcome. The current study investigates if interpersonal problems predict process and outcome of three different treatments for depression. The data originate from a randomized clinical trial comparing supportive-expressive psychotherapy, antidepressant medication and pill-placebo for treatment of depression. Interpersonal problems were used as predictors of alliance, symptomatic improvement and premature termination of treatment. Interpersonal problems related to communion predicted better alliances, but slower symptomatic improvement. Low agency predicted slower symptomatic improvement in supportive-expressive psychotherapy, but not in the medication or placebo condition. Lower interpersonal distress was associated with an increased likelihood to terminate treatment prematurely. The sample size did not allow the detection of small effects within the treatment groups. Interpersonal problems are influential for the treatment of depression, but parts of their effects depend on the type of treatment.
    Journal of Affective Disorders 08/2013; 151(2). DOI:10.1016/j.jad.2013.07.003 · 3.38 Impact Factor
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    • "Few studies of adult patients [30-35] have explored gender as a moderator [36] of individual psychotherapy, which means testing whether female and male patients responded differently to different psychotherapy treatments. Ogrodniczuk et al. [31], Ulberg et al. [32,33], Frank et al. [34] and Barber et al. [35] found that gender moderates the effect of psychotherapy. The findings from research on the effect of gender in children and young people seem contradictory [37]. "
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    ABSTRACT: BACKGROUND: Depression in adolescents seems to be a growing problem that causes mental suffering and prevents young people from joining the workforce. There is also a high risk of relapse during adult life. There is emerging evidence for the effect of psychodynamic psychotherapy in adolescents. In-session relational intervention (that is, transference intervention) is a key component of psychodynamic psychotherapy. However, whether depressed adolescents profit most from psychodynamic psychotherapy with or without transference interventions has not been stated. Object The effect of transference interventions in depressed adolescents and the moderator moderating effect of quality of object relations, personality disorder and gender will be explored. Methods and study design The First Experimental Study of Transference Work--In Teenagers (FEST--IT) will be a randomized clinical trial with a dismantling design. The study is aimed to explore the effects of transference work in psychodynamic psychotherapy for adolescents with depression. One hundred patients ages 16 to 18 years old will be randomized to one of two treatment groups, in both of which general psychodynamic techniques will be used. The patients will be treated over 28 weeks with either a moderate level of transference intervention or no transference intervention. Follow-up will be at 1 year after treatment termination. The outcome measures will be the Psychodynamic Functioning Scales (PFS), Inventory of Interpersonal Problems--Circumplex Version (IIP-C), Global Assessment of Functioning (GAF), and the total mean score of Symptom Checklist--90 (Global Severity Index; GSI), Beck Depression Inventory (BDI), and Montgomery Asberg Rating Scale (MADRS). The quality of adolescents' relationships will be a central focus of the study, and the Adolescent Relationship Scales (ARS) and Differentiation--Relatedness Scale (DRS) will also be used. Change will be assessed using linear-mixed models. Gender personality disorder (PD) and quality of object relations (QOR) will be the preselected putative moderators. DISCUSSION: The object of this clinical trial is to explore the effect of transference interventions in psychodynamic psychotherapy in adolescents with a major depressive disorder. Using a randomized and dismantling design, we hope that the study will add more specific knowledge to the evidence base. Trial registration Identifier: NCT01531101 First Experimental Study of Transference work Work--In Teenagers (FEST-IT).
    Trials 09/2012; 13(1):159. DOI:10.1186/1745-6215-13-159 · 1.73 Impact Factor
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