Dysthymic disorder IPTD

IPT was modified for dysthymic disorder, a disorder whose chronicity does not fit the standard IPT model. This adaptation also may provide a better fit for dysthymic patients without acute life events who previously would have been put in the interpersonal deficits category of acute IPT. IPT-D encourages patients to reconceptualize what they have considered lifelong character flaws as ego-dystonic, chronic mood-dependent symptoms: as chronic but treatable "state" rather than immutable "trait". Therapy itself was defined as an "iatrogenic role transition" from believing oneself flawed in personality to recognizing and treating the mood disorder. Markowitz (1994, 1998) openly treated 17 pilot subjects with 16 sessions of IPT-D, of whom none worsened and 11 remitted. Medication benefits many dysthymic patients (Kocsis et al., 1988; Thase et al., 1996), but nonresponders may need psychotherapy, and even medication responders may benefit from combined treatment (Markowitz, 1994). Based on these pilot results, a comparative study of 16 weeks of IPT-D alone, SP, and sertraline plus clinical management, as well as a combined IPT/sertraline cell, has been completed at Weill Medical College of Cornell University.

Browne, Steiner, and others at McMaster University in Hamilton, Canada, treated more than 700 dysthymic patients in the community with either 12 sessions of standard IPT over

4 months, sertraline for 2 years, or their combination. Patients were followed for 2 years (Browne et al., 2002). Based on an improvement criterion of at least a 40% reduction in score of the Montgomery-Asberg Depression Rating Scale (MADRS) at 1-year follow-up, 51% of IPT-alone subjects improved, fewer than the 63% taking sertraline and 62% in combined treatment. On follow-up, however, IPT was associated with significant economic savings in use of health care and social services. Combined treatment was thus most cost-effective, and was as efficacious as, but less expensive than, sertraline alone.

In a comparison of medication to combined treatment, Feijo de Mello and colleagues (2001) randomly assigned 35 dysthymic outpatients to moclobemide with or without 16 weekly sessions of IPT. Both groups improved, but with a nonsignificant trend for greater improvement on the Ham-D and MADRS in the combined treatment group.

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