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1.
Psychother Psychosom ; 69(5): 232-9, 2000.
Artigo em Inglês | MEDLINE | ID: mdl-10965287

RESUMO

BACKGROUND: Patients with major depressive disorder (MDD) and atypical features have reactive mood plus at least two symptoms: hypersomnia, hyperphagia, leaden paralysis or a lifetime sensitivity to rejection. These patients respond to cognitive therapy (CT) or phenelzine (PHZ) significantly more than pill placebo (PBO). The purpose of this report is to motivate research on tolerable continuation phase treatment designed to reduce the significant risk of relapse and recurrence which depressed patients with atypical features face. METHODS: Outpatients with DSM-III-R MDD and atypical features who responded to acute-phase CT, clinical management plus PHZ or PBO (n = 31) were randomized to continue or discontinue treatment for 8 months and participate in 16 months or treatment-free follow-up. RESULTS: A log-rank test showed that the relapse and recurrence-free survival over the 24 months after the acute phase was significantly greater for the responders who continued treatment than for those who discontinued treatment. Kaplan-Meier estimates of relapse and recurrence were significantly higher for patients whose treatment was discontinued than for those whose treatment continued (83 vs 49% based on unblinded ratings of the Research Diagnostic Criteria for MDD or of self/other referral for treatment of depressive symptoms). CONCLUSIONS: We note several important limitations of the design and analysis of these pilot data. We hypothesize that not only pharmacotherapy, but also CT used as a continuation phase treatment may reduce relapse in this population. This hypothesis warrants rigorous evaluation in samples of outpatients with MDD and atypical features that are large enough to allow comparative tests.


Assuntos
Antidepressivos/uso terapêutico , Terapia Cognitivo-Comportamental/métodos , Transtorno Depressivo Maior/psicologia , Transtorno Depressivo Maior/terapia , Fenelzina/uso terapêutico , Doença Aguda , Adulto , Assistência Ambulatorial , Terapia Combinada , Transtorno Depressivo Maior/diagnóstico , Feminino , Seguimentos , Humanos , Masculino , Projetos Piloto , Escalas de Graduação Psiquiátrica , Prevenção Secundária , Índice de Gravidade de Doença , Resultado do Tratamento
2.
Arch Gen Psychiatry ; 56(5): 431-7, 1999 May.
Artigo em Inglês | MEDLINE | ID: mdl-10232298

RESUMO

BACKGROUND: Patients with atypical depression are more likely to respond to monoamine oxidase inhibitors than to tricyclic antidepressants. They are frequently offered psychotherapy in the absence of controlled tests. There are no prospective, randomized, controlled trials, to our knowledge, of psychotherapy for atypical depression or of cognitive therapy compared with a monoamine oxidase inhibitor. Since there is only 1 placebo-controlled trial of cognitive therapy, this trial fills a gap in the literature on psychotherapy for depression. METHODS: Outpatients with DSM-III-R major depressive disorder and atypical features (N = 108) were treated in a 10-week, double-blind, randomized, controlled trial comparing acute-phase cognitive therapy or clinical management plus either phenelzine sulfate or placebo. Atypical features were defined as reactive mood plus at least 2 additional symptoms: hypersomnia, hyperphagia, leaden paralysis, or lifetime sensitivity to rejection. RESULTS: With the use of an intention-to-treat strategy, the response rates (21-item Hamilton Rating Scale for Depression score, < or =9) were significantly greater after cognitive therapy (58%) and phenelzine (58%) than after pill placebo (28%). Phenelzine and cognitive therapy also reduced symptoms significantly more than placebo according to contrasts after a repeated-measures analysis of covariance and random regression with the use of the blind evaluator's final Hamilton Rating Scale for Depression score. The scores between cognitive therapy and phenelzine did not differ significantly. Supplemental analyses of other symptom severity measures confirm the finding. CONCLUSIONS: Cognitive therapy may offer an effective alternative to standard acute-phase treatment with a monoamine oxidase inhibitor for outpatients with major depressive disorder and atypical features.


Assuntos
Terapia Cognitivo-Comportamental , Transtorno Depressivo/terapia , Inibidores da Monoaminoxidase/uso terapêutico , Fenelzina/uso terapêutico , Adulto , Assistência Ambulatorial , Análise de Variância , Terapia Combinada , Transtorno Depressivo/tratamento farmacológico , Transtorno Depressivo/psicologia , Método Duplo-Cego , Esquema de Medicação , Feminino , Humanos , Masculino , Placebos , Escalas de Graduação Psiquiátrica/estatística & dados numéricos , Análise de Regressão , Índice de Gravidade de Doença , Resultado do Tratamento
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