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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    • "It has long been known that dysfunction of ascending serotonergic pathways is crucially implicated in psychiatric disorders, such as panic, depression, and suicide. Several lines of evidence support this viewpoint, including that (1) low levels of serotonin (5- hydroxytriptophan; 5-HT) metabolites were found in depressed suicides [9], (2) depletion of 5-HT in volunteers triggers relapse of depressive episodes [10], (3) affective disorders appear to be linked to changes in the activity of serotonin transporter (SERT) [11], and (4) treatment with 5-HT reuptake inhibitors mitigates depressive symptoms, at least in a subpopulation of patients [12]. In addition, in depressed patients a number of structural defects were observed in the dorsal raphe nucleus (DRN), the brainstem region which provides the majority of cortical serotonergic fibers. "
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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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