Maintenance Treatment

Interpersonal therapy was first developed and tested in an eight-month, six-cell study (Klerman et al., 1974; Paykel et al., 1975). In today's parlance this study would be considered a 'continuation' treatment, as the concept of maintenance antidepressant treatment has lengthened. One-hundred-and-fifty acutely depressed women outpatients who responded (with >50 % symptom reduction) to between four and six weeks of AMI were randomly assigned to receive eight months of weekly IPT alone, AMI alone, placebo alone, combined IPT-AMI, IPT-placebo, or no pill. Maintenance pharmacotherapy prevented relapse and symptom exacerbation, whereas IPT improved social functioning (Weissman et al., 1974). Effects of IPT on social functioning were not apparent for six to eight months, and combined psychotherapy-pharmacotherapy had the best outcome.

Two studies in Pittsburgh, Pennsylvania have assessed longer antidepressant maintenance trials of IPT. Frank et al. (1990, 1991a), studied 128 outpatients with severe recurrent depression. Patients were initially treated with combined high dose imipramine (>200 mg/day) and weekly IPT. Responders remained on high dosage medication while IPT was tapered to a monthly frequency during a four-month continuation phase. Patients remaining remitted were then randomly assigned to three years of either:

• ongoing high dose imipramine plus clinical management;

• high dose imipramine plus monthly IPT;

• monthly IPT plus placebo; or

• placebo plus clinical management.

High-dose imipramine, with or without maintenance IPT, was the most efficacious treatment, protecting more than 80 % of patients over three years. In contrast, most patients on placebo relapsed within the first few months. Once-monthly IPT, although less efficacious than medication, was statistically and clinically superior to placebo in this high-risk patient population. Reynolds and colleagues (1999) essentially replicated these maintenance findings in a study of geriatric patients with major depression comparing IPT and nortriptyline.

The modal depressed patient is a woman of childbearing age, and many depressed pregnant or nursing women prefer to avoid pharmacotherapy. Frank and colleagues' finding of an 82-week survival time without recurrence with monthly maintenance IPT alone would suffice to protect many women with recurrent depression through pregnancy and nursing without medication. Further research is needed to determine the relative efficacy of IPT to newer medications such as selective serotonin reuptake inhibitors, as well as the efficacy of more-frequent-than-monthly doses of maintenance IPT. A study is under way in Pittsburgh comparing differing doses of maintenance IPT for depressed patients.

Anxiety and Depression 101

Anxiety and Depression 101

Everything you ever wanted to know about. We have been discussing depression and anxiety and how different information that is out on the market only seems to target one particular cure for these two common conditions that seem to walk hand in hand.

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