Patients whose depression is complicated by a lifetime history of panic symptoms display a poorer treatment response to both psychotherapeutic and pharmacologic interventions. A newly adapted psychosocial treatment for depression with lifetime panic spectrum symptoms was evaluated in an open pilot study.
"IPT-PS retains both the structure and interpersonal problem areas of standard IPT, while incorporating modified cognitive, behavioral and emotion-focused strategies to identify and reduce panic and anxiety symptoms that interfere with interpersonal problem-solving tasks. For example, additional anxiety-focused goals of IPT-PS include helping patients to: accurately identify co-occurring anxiety symptoms and syndromes; reduce fears of physiologic arousal and patterns of somatic preoccupation; identify and distinguish between emotions; and reduce avoidance behaviors (Cyranowski et al., 2005). "
[Show abstract][Hide abstract] ABSTRACT: Objective:
We demonstrate the utility of the time-varying effect model (TVEM) for the analysis of psychotherapy data, with the aim of elucidating complex patterns of change over time and dynamic associations between constructs of interest. Specifically, we examine the association between depression and co-occurring anxiety in a sample of adults treated with interpersonal psychotherapy (IPT) for depression or a variant designed to address both depression and co-occurring anxiety (IPT-PS, IPT for depression with panic and anxiety symptoms).
Seventy-eight (82% female) adult outpatients with major depression and co-occurring anxiety were assessed at each of 16 outpatient treatment sessions using the Hamilton rating scales for depression and anxiety.
On average, depressive symptoms declined in a quadratic form over the course of treatment. While the association between anxiety and depression was modest early in treatment, it strengthened over the middle and latter treatment phases. Finally, exploratory analyses suggest that while IPT and IPT-PS were similarly effective in reducing depressive symptoms, IPT-PS may be more effective at uncoupling the association between core anxiety and depressive symptoms.
Findings point to the utility of the TVEM for psychotherapy research and the importance of assessing anxiety in the course of treating depression, especially following the initial phase of treatment (i.e., after Session 5).
Journal of Consulting and Clinical Psychology 09/2013; 82(5). DOI:10.1037/a0034430 · 4.85 Impact Factor
"Thus, co-occurring anxiety and avoidance behaviors may interfere with the active resolution of interpersonal problems as prescribed by interpersonal psychotherapy. Adaptations of psychotherapy that incorporate anxiety-specific psychoeducation and behavioral interventions, such as interpersonal psychotherapy for depression with panic spectrum symptoms (Cyranowski et al., 2005) hold promise. Cognitive behavioral therapy for older patients with anxiety syndromes (Wetherell et al., 2003; Wetherell et al., 2005) provides an alternative approach. "
[Show abstract][Hide abstract] ABSTRACT: Many older patients who recover from an episode of major depression continue to suffer from depressed mood, anxiety, and sleep problems. Our study assesses the impact of these residual symptoms on the risk of recurrence during maintenance treatment of late-life depression.
We analyzed data from a randomized clinical trial of maintenance treatment in patients with unipolar depression aged > or =70, 116 of whom remitted and remained stable during open pharmacotherapy and interpersonal psychotherapy (IPT) and were randomized to clinical management/pharmacotherapy; clinical management/placebo; monthly maintenance IPT/ pharmacotherapy; or monthly maintenance IPT/placebo. We assessed the impact of overall residual symptoms (based on the Hamilton Depression Rating Scale (HAM-D) total score) and of specific residual symptom clusters - mood symptoms (depressed mood, guilt, suicidality, energy/interests), sleep disturbance (early, middle, late insomnia), and anxiety (agitation, psychic and somatic anxiety, hypochondriasis) measured at randomization. Sleep disturbance was also assessed with the Pittsburgh Sleep Quality Index (PSQI). We used Cox proportional hazards regression models controlling for assignment to antidepressant medication versus placebo to identify predictors of recurrence.
Residual anxiety and residual sleep disturbance (as measured by the PSQI but not the HAM-D) independently predicted early recurrence.
Use of HAM-D clusters to define residual symptoms; analysis limited to completers of acute and continuation treatment.
In patients with late-life depression who have remitted with pharmacotherapy and psychotherapy, the deleterious effect of residual symptoms is due to persisting anxiety and, possibly, residual sleep disturbance.
[Show abstract][Hide abstract] ABSTRACT: This review focuses on information concerning antidepressants and psychotherapy in the treatment of both acute and chronic forms of unipolar depression in the English language literature. In it, we address the use of combination therapy, both from the outset of treatment and in a variety of sequences, ie, we examine the potential advantages of adding a targeted psychotherapy to an incompletely effective pharmacotherapy and the potential advantages of adding pharmacotherapy to an incompletely effective psychotherapy. The number of research reports available to address these questions is small relative to their importance for clinical practice. There is a clear need for more information about the relative efficacy of pharmacotherapy-psychotherapy combinations or sequences versus either pharmacotherapy or psychotherapy provided as monotherapies.
Dialogues in clinical neuroscience 02/2005; 7(3):263-72. DOI:10.1176/foc.4.4.581
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