In a follow-up report, Blackburn et al57 reported that TCA was le

In a follow-up report, Blackburn et al57 reported that TCA was less effective than CT or CT+TCA for sustaining remission in both the hospital outpatient and general practice groups. They note that TCA alone may have been less effective than the two other

conditions because of poor medication adherence; plasma levels were not monitored Inhibitors,research,lifescience,medical during the trial. Two years of naturalistic follow-up revealed that no patients receiving CT+TCA relapsed during the first 6 months of follow-up, compared with 30% in the TCA group and 6% in the CT group. Despite a small sample size, Blackburn et al’s results suggested to many that combination treatment may bring about the greatest change and improvement among depressed individuals.58 Our group has examined the efficacy of maintenance medication and IPT in preventing Inhibitors,research,lifescience,medical recurrences.29 The Pittsburgh Study of Maintenance Therapies in Recurrent Depression contrasted IPT-M with maintenance pharmacotherapy (imipramine [IMP]), combination pharmacotherapy-psychotherapy, and a control condition (placebo and no therapy) Inhibitors,research,lifescience,medical over a period of 3 years in depressed patients who had clear histories of recurrent depression (at least three episodes; sample mean was seven episodes) and had been treated acutely with a combination of IPT and IMP. Active medication provided the best prophylaxis, with or without IPT-M. No advantage was observed for the

combination; however, survival time without a new episode of major depression following discontinuation of medication was significantly and positively related to monthly IPT-M alone or with a placebo tablet. We conducted a similar placebo-controlled study of maintenance pharmacotherapy and psychotherapy (IPT) in 180 geriatric patients with nonpsychotic Inhibitors,research,lifescience,medical unipolar major depression.59 Patients were treated acutely with nortriptyline (NTP) and IPT. After

16 weeks of stabilized depression scores, patients were randomly assigned to one of four maintenance therapy conditions: (i) medication clinic plus NTP; (ii) medication clinic plus placebo; (iii) IPT-M plus NTP; or (iv) IPT-M plus placebo. Survival Inhibitors,research,lifescience,medical analyses suggest that maintenance NTP and IPT, together and singly, is superior to medication clinic visits and no pharmacotherapy over in preventing or delaying a depressive recurrence. Patients assigned to the combined treatment condition had the best outcome, with 80% remaining depression-free during the 3-year maintenance period. A 1997 analysis involving patients from several studies conducted at Western Psychiatric Institute and Clinic60 revealed that, among 595 patients experiencing a unipolar major depressive episode, for the more severely depressed patients, remission rates (HRSD<7 for 4 weeks) were higher for those receiving concurrent IPT and antidepressant pharmacotherapy with IMP than were remission rates for CT or IPT alone (43% versus 25%, P=0.001).

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