ABSTRACT
BACKGROUND: Interpersonal psychotherapy and cognitive-behavioural therapy (CBT) are established as effective treatments for major depression. Controversy remains regarding their effectiveness for severe and melancholic depression. AIMS: To compare the efficacy of interpersonal psychotherapy and CBT in people receiving out-patient treatment for depression and to explore response in severe depression (Montgomery-Asberg Depression Rating Scale (MADRS) score above 30), and in melancholic depression. METHOD: Randomised clinical trial of 177 patients with a principal Axis I diagnosis of major depressive disorder receiving 16 weeks of therapy comprising 8-19 sessions. Primary outcome was improvement in MADRS score from baseline to end of treatment. RESULTS: There was no difference between the two psychotherapies in the sample as a whole, but CBT was more effective than interpersonal psychotherapy in severe depression, and the response was comparable with that for mild and moder-ate depression. Melancholia did not predict poor response to either psychotherapy. CONCLUSIONS: Both therapies are equally effective for depression but CBT may be preferred in severe depression.
Subject(s)
Depressive Disorder, Major/therapy , Psychotherapy/methods , Adolescent , Adult , Aged , Cognitive Behavioral Therapy/methods , Female , Humans , Male , Middle Aged , Psychiatric Status Rating Scales , Treatment OutcomeABSTRACT
BACKGROUND: Interpersonal psychotherapy and cognitive-behavioural therapy are widely accepted as effective treatments for major depression. There is little evidence on how personality disorder or personality traits affect treatment response. AIMS: To determine whether personality disorder or traits have an adverse impact on treatment response to interpersonal psychotherapy or cognitive-behavioural therapy in people receiving out-patient treatment for depression. METHOD: The study was a randomised trial in a university-based clinical research unit for out-patients with depression. RESULTS: Personality disorder did not adversely affect treatment response for patients with depression randomised to cognitive-behavioural therapy. Conversely, personality disorder did adversely affect treatment response for patients randomised to interpersonal psychotherapy. CONCLUSIONS: Despite the two therapies having comparable efficacy in patients with depression, response to interpersonal psychotherapy (but not cognitive-behavioural therapy) is affected by personality traits. This could suggest the two therapies are indicated for different patients or that they work by different mechanisms.
Subject(s)
Depressive Disorder, Major/therapy , Personality Disorders/therapy , Psychotherapy/methods , Adolescent , Adult , Aged , Cognitive Behavioral Therapy/methods , Depressive Disorder, Major/psychology , Female , Humans , Male , Middle Aged , Personality Disorders/psychology , Temperament , Treatment OutcomeABSTRACT
We examined 180 patients with a principal diagnosis of Major Depression, with or without a lifetime diagnosis of alcohol dependence. In the ever-dependent group, the GAF was lower; cannabis dependence higher; and Borderline, Schizotypal and Paranoid personality disorders more common. They reported more paranoia and interpersonal sensitivity on the Hopkins Symptom Checklist and more friction and interpersonal behaviour on the Social Adjustment Scale. On the Temperament and Character Inventory, novelty seeking was higher and persistence and cooperativeness lower. PBI scores and family histories did not differ significantly. Treatment outcome did not vary, except that subjects with lifetime alcohol dependence and current heavy drinking did less well.
