Shea, M. T. et al. Course of depressive symptoms over follow-up: findings from the National Institute of Mental Health Treatment of Depression Collaborative Research Program. Arch. Gen. Psychiatry 49, 782-787

Department of Psychiatry and Human Behavior, Brown University, Providence, RI 02906.
Archives of General Psychiatry (Impact Factor: 14.48). 11/1992; 49(10):782-7.
Source: PubMed


We studied the course of depressive symptoms during an 18-month naturalistic follow-up period for outpatients with Major Depressive Disorder treated in the National Institute of Mental Health Treatment of Depression Collaborative Research Program. The treatment phase consisted of 16 weeks of randomly assigned treatment with the following: cognitive behavior therapy, interpersonal therapy, imipramine hydrochloride plus clinical management (CM), or placebo plus CM. Follow-up assessments were conducted at 6, 12, and 18 months after treatment. Of all patients entering treatment and having follow-up data, the percent who recovered (8 weeks of minimal or no symptoms following the end of treatment) and remained well during follow-up (no Major Depressive Disorder relapse) did not differ significantly among the four treatments: 30% (14/46) for those in the cognitive behavior therapy group, 26% (14/53) for those in the interpersonal therapy group, 19% (9/48) for those in the imipramine plus CM group, and 20% (10/51) for those in the placebo plus CM group. Among patients who had recovered, rates of Major Depressive Disorder relapse were 36% (8/22) for those in the cognitive behavior therapy group, 33% (7/21) for those in the interpersonal therapy group, 50% (9/18) for those in the imipramine plus CM group, and 33% (5/15) for those in the placebo plus CM group. The major finding of this study is that 16 weeks of these specific forms of treatment is insufficient for most patients to achieve full recovery and lasting remission. Future research should be directed at improving success rates of initial and maintenance treatments for depression.

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Available from: Paul A Pilkonis, Jul 24, 2014
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    • "However, there is a lack of evidence comparing the differential long-term effects of different psychological interventions (Cuijpers et al., 2008a). Although available research suggests that different psychological treatments have equivalent effects over time (Blay et al., 2002; e.g., Deffenbacher et al., 1995; Shea et al., 1992), some evidence suggests the superiority of certain treatments (Ellison et al., 2009). For instance, Shapiro et al. (1995) found equivalent post-treatment outcomes for depression through CBT and psychodynamic-interpersonal psychotherapy , but at the one year follow-up assessments, CBT showed significantly better outcomes. "
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    ABSTRACT: Background: In a previous clinical controlled trial (Lopes et al., 2014), narrative therapy (NT) showed promising results in ameliorating depressive symptoms with comparable outcomes to cognitive-behavioral therapy (CBT) when patients completed treatment. This paper aims to assess depressive symptoms and interpersonal problems in this clinical sample at follow-up. Methods: Using the Beck Depression Inventory-II and Outcome Questionnaire-45.2 Interpersonal Relations Scale, naturalistic prospective follow-up assessment was conducted at 21 and 31 months after the last treatment session. Results: At follow-up, patients kept improving in terms of depressive symptoms and interpersonal problems. The odds that a patient maintained recovery from depressive symptoms at follow-up were five times higher than the odds that a patient maintained recovery from interpersonal problems. In the same way, the odds of a patient never recovering from interpersonal problems were five times higher than the odds of never recovering from depressive symptoms. Limitations: The study did not control for the natural course of depression or treatment continuation. Conclusions: For depressed patients with greater interpersonal disabilities, longer treatment plans and alternative continuation treatments should be considered.
    Full-text · Article · May 2014 · Journal of Affective Disorders
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    • "Nonpharmacologic approaches toward the management of distress have demonstrated effectiveness in the general population and provide an alternative treatment approach for survivors. Specifically, cognitive-behaviour therapy (CBT) is a well-established treatment for anxiety and depression (Butler et al, 2006), with long-term benefits comparable to or exceeding those observed with pharmacotherapy treatment alone (Shea et al, 1992; DeRubeis et al, 1999; Hart et al, 2012). Of note, we did not have data related to the use of nonpharmacologic treatment approaches in our cohort of survivors. "
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    ABSTRACT: Background: This study investigated longitudinal patterns of psychological distress in adult survivors of childhood cancer. Methods: Participants included 4569 adult survivors in the Childhood Cancer Survivor Study Cohort (CCSS) who completed the Brief Symptom Inventory-18 on three occasions between 1994 and 2010. Longitudinal latent class analysis was used to identify discrete classes of psychological distress. Predictors of class membership were examined through logistic regression modelling with odds ratios (ORs) and 95% confidence intervals (CIs) reported. Results: Survivors were a median of 39 years of age and 30 years from diagnosis at the most recent follow-up. Most survivors reported few or no symptoms of distress over time, although subsets of survivors reported persistently elevated (depression: 8.9% anxiety: 4.8% somatisation: 7.2%) or significant increases in distress symptoms over the follow-up period (depression: 10.2% anxiety: 11.8% somatisation: 13.0%). Increasing distress symptoms were predicted by survivor perception of worsening physical health over time (depression: OR=3.3; 95% CI=2.4–4.5; anxiety: OR=3.0; 95% CI=2.2–4.0; somatisation: OR=5.3; 95% CI=3.9–7.4). Persistent distress symptoms were also predicted by survivor perception of worsening physical health over time, as well as by worsening pain and ending analgesic use. Conclusion: Subgroups of adult survivors are at-risk for chronic distress or significant increases in distress decades following their original cancer diagnosis. Routine screening of psychological distress in adult survivors of childhood cancer is warranted, especially for survivors who experience physical health morbidities.
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    • "Some argue that the best solution to this problem is to provide maintenance and continuation therapy. Others argue that short-term treatments are insufficient (Shea et al., 1992) and advocate for the provision of long-term treatments as a more efficient and potentially cost-effective way to help patients . One proposed solution is to provide maintenance and continuation therapy, with on-going clinical monitoring with flexible frequencies and patterns (e.g., Vittengl, Clark, & Jarrett, 2009). "
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    ABSTRACT: The aim of this study was to investigate the effectiveness of long-term psychoanalytic and psychodynamic psychotherapies. In a prospective, randomized outcome study, psychoanalytic (mean duration: 39 months, mean dose: 234 sessions) and psychodynamic (mean duration: 34 months, mean dose: 88 sessions) therapy were compared at post-treatment and at one-, two-, and three-year follow-up in the treatment of patients with a primary diagnosis of unipolar depression. All treatments were carried out by experienced psychotherapists. Primary outcome measures were the Beck Depression Inventory and the Scales of Psychological Capacities, and secondary outcome measures were the Global Severity Index of the Symptom Checklist 90-R, the Inventory of Interpersonal Problems, the Social Support Questionnaire, and the INTREX Introject Questionnaire. Interviewers at pre- and post-treatment and at one-year follow-up were blinded; at two- and threeyear follow-up, all self-report instruments were mailed to the patients. Analyses of covariance, effect sizes, and clinical significances were calculated to contrast the groups. We found significant outcome differences between treatments in terms of depressive and global psychiatric symptoms, personality functioning, and social relations at three-year follow-up, with psychoanalytic therapy being more effective. No outcome differences were found in terms of interpersonal problems. We concluded that psychoanalytic therapy associated with its higher treatment dose shows longer-lasting effects.
    No preview · Article · Jun 2013 · Psychiatry Interpersonal & Biological Processes
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