Efficacy and safety of two treatment algorithms in bipolar depression consisting of a combination of lithium, lamotrigine or placebo and paroxetine.

OBJECTIVE: In a previous paper, we reported about the efficacy of the addition of lamotrigine to lithium in patients with bipolar depression. In the second phase of this study paroxetine was added to ongoing treatment in non-responders. METHOD: Bipolar depressed patients (n = 124) treated with lithium were randomized to addition of lamotrigine or placebo. In non-responders after 8 weeks, paroxetine 20 mg was added for another 8 weeks to ongoing treatment. RESULTS: After 8 weeks the improvement in patients treated with lamotrigine vs. patients treated with placebo was significant. After addition of paroxetine this difference disappeared as a result of greater further improvement in the non-responders to placebo. CONCLUSION: Addition of lamotrigine to lithium was found effective in bipolar depressed patients. Further addition of paroxetine in non-responders to lithium plus lamotrigine did not appear to provide additional benefit, while it appeared to do so in non-responders to lithium plus placebo.

[Treatment for chronic depression: cognitive behavioral analysis system of psychotherapy (CBASP)]. / Behandeling voor chronische depressie: 'cognitive behavioral analysis system of psychotherapy' (CBASP).

BACKGROUND: Chronic depression is a common disorder in secondary care. Treatment results for this group of depressed patients are often disappointing and the existing treatment protocols are insufficiently tailored to chronic MDD. For this reason, an effective psychotherapeutic treatment will constitute a welcome addition to the range of treatments currently available for chronically depressed patients. AIM: To describe 'cognitive behavioral analysis system of psychotherapy' (CBASP), the first form of psychotherapy specifically designed for the treatment of chronic depression. METHOD: This article describes the evidence, rational and the most important techniques of CBASP. RESULTS: In the United States CBASP has proven to be effective in one trial. As a result of these findings, CBASP is recommended in the Dutch treatment guidelines as an evidence-based treatment option for chronic depression. However, the findings have not yet been replicated and little is known about possible ways of implementing CBASP in the Netherlands. For this reason a randomised controlled trial on the effectiveness of CBASP has started in three psychiatric hospitals in the Netherlands. CONCLUSION: CBASP is recommended as a treatment option for chronic depression in the Dutch treatment guidelines, but evidence should be further supported by additional research.

[The Multidisciplinary Guideline for Depression: a commentary]. / De Multidisciplinaire richtlijn Depressie. Een commentaar.

The multidisciplinary guideline for the treatment of depression has come to be regarded as an important summary of the currently available information about the treatment of depression. We are critical of several of the views expressed in this guideline--first of all, the guideline opts for the selective uptake inhibitors fluvoxamine, paroxetine and sertraline rather than for citalopram, and secondly, the guideline rates antidepressants more highly than psychotherapy or a combination of antidepressants and psychotherapy. There is a lack of cohesion between the various aspects of treatment and little attention is given to the problems of treating depression in everyday practice. In our view this restricts the applicability of the guideline.

The influence of depressive state features on trait measurement.

BACKGROUND: Certain personality characteristics may change during depression, reflecting temporary states, while others remain stable. This study investigates the stability of personality during depression. Identification of depression-sensitive personality traits may help to elucidate the mechanisms that influence course and outcome of depression. METHODS: For 42 ambulatory and 38 day care patients with a depressive disorder, depression severity and personality characteristics were measured repeatedly during a 12 week-period. The total HDRS score was indicative of depression severity, while the NEO-FFI was used for measurement of basic personality traits and the IPS for depression-specific traits. RESULTS: In 12 weeks, depression severity significantly decreased for both patient groups. The Big Five traits Neuroticism and Extraversion and all but one aspect of Interpersonal sensitivity showed depression-related changes towards the normal range. Openness, Altruism and Conscientiousness remained stable. LIMITATIONS: The number of patients excluded from the study due to missing data is substantial. Furthermore, it was not possible to control for treatment influence due to a double-blind design. CONCLUSIONS: Neuroticism, Extraversion and Interpersonal sensitivity scores are likely to reflect state components during a depression, while the stability of Openness, Conscientiousness and Altruism scores indicates pure personality traits.