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


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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    • "Overall, dysthymic patients have shown to respond to anti-depressants and sometimes to psychotherapy. Of course, most of the patients who have been successfully treated by medication have residual symptoms and disturbed psychological function, which leads to interpersonal and social problems (16). Teasdale (1997), using the metaphor "mind-in-place" which he had borrowed from Robert Ornestein, states that we have got several minds each of which may be active for a moment. "
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    ABSTRACT: Dysthimia in adults is a chronic depression disorder which is characterized by a mild depression for at least 2 years. Remarkable psycho-social involvements, greater disturbances in psycho-social functions compared to other forms of depression and lack of definite findings about preferred treatment for this disorder led us to evaluate the effectiveness of Mindfulness based cognitive therapy (MBCT) method adjunct to pharmacotherapy compared with pharmachothrapy alone in treating dysthymia in this thesis. This study aimed to evaluate the effectiveness of mindfulness-based cognitive therapy on a chronic type of depression disorder called dysthymia. This study is a clinical trial of an interventional method which was carried out on dysthymic and double depressed patients who had referred to psychiatric clinics of Shiraz University of Medical Sciences, Shiraz, Iran. In doing so, 50 patients above the age of 18 were selected through convenience sampling and assigned into intervention and control groups. The control group only received medications while the intervention group in addition to receiving medication, participated in 8 sessions of a mindfulness based cognitive therapy course which was held once a week and each session lasted for 2 to 2.5 hours. All the participants filled out Beck Depression Inventory II and five facet mindfulness questionnaire. The data were analyzed using the SPSS statistical software (version 16) and univariate covariance and independent t test statistical methods. In this study, no statistically significant differences were found between the two groups regarding the demographic characteristics. The mean difference between the two groups was statistically significant for the variables in post-test considering the pre-test. The experimental group participants showed significant improvement in terms of the defined variables; a trend which was not observed in the control group participants. The results of this study show that adding MBCT to pharmacotherapy in treatment of dysthymic patients can cause significant improvement in depression symptoms and mindfulness skills in patients compared to pharmacotherapy alone.
    Full-text · Article · Mar 2013
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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.
    Full-text · Article · Sep 2009 · The Journal of Clinical Psychiatry
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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.
    Full-text · Article · Aug 2003 · Journal of Clinical Psychology
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