ABSTRACT
The authors compared the outcomes of 35 outpatients with dysthymic disorder randomized to receive either treatment with moclobemide and interpersonal therapy (IPT) or moclobemide and routine clinical management. Diagnosis was based on the ICD-10 symptom checklist. Patients were evaluated by trained raters using the 17-item Hamilton Rating Scale for Depression (Ham-D), Montgomery-Asberg Depression Rating Scale (MADRS), Global Assessment of Functioning, and Quality of Life and Satisfaction Questionnaire at baseline, 12, 24, and 48 weeks. Patients in both treatment groups showed statistically significant improvement in all measures across time. There was a nonsignificant trend toward lower scores on Ham-D and MADRS for patients in the moclobemide plus IPT group. Longer, better-powered trials should be carried out to study the efficacy of IPT plus antidepressant medication in the treatment of dysthymic disorder.
Subject(s)
Antidepressive Agents/therapeutic use , Dysthymic Disorder/psychology , Dysthymic Disorder/therapy , Moclobemide/therapeutic use , Psychotherapy , Adult , Dysthymic Disorder/drug therapy , Female , Humans , Male , Middle Aged , Patient Satisfaction , Psychiatric Status Rating Scales , Quality of LifeABSTRACT
The author describes a patient with recurrent depression, according to DSM-IV diagnostic criteria. The features were of a delusional depressive episode lasting 5 years, associated with severe impairment of psychosocial functioning. The patient also had chronic hepatitis, of unknown aetiology, and portal hypertension with some high gastrointestinal bleeding episodes. The depressive episode had been treated unsuccessfully with therapeutic doses of imipramine and lithium augmentation associated with haloperidol and, afterwards, with risperidone. Mirtazapine was introduced, coadministered with haloperidol and after 8 weeks there was an improvement in delusional depressive and other negative symptoms. The patient remained well for 9 months. This case indicates that mirtazapine is an option for patients with psychotic depression who are refractive to tricyclic antidepressants. Mirtazapine is also a safe drug, well tolerated in this severe clinical condition.
