Maintenance treatment

IPT was first developed and tested in an 8-month, six-cell study (Klerman et al., 1974; Paykel et al., 1975). In today's parlance, this study would be considered a "continuation"

treatment, as the concept of maintenance antidepressant treatment has lengthened. One hundred and fifty acutely depressed women outpatients who responded (with at least 50% symptom reduction as rated by a clinical interviewer) to 4-6 weeks of AMI were randomly assigned to receive 8 months of weekly IPT alone, AMI alone, placebo alone, combined IPT-AMI, IPT-placebo, or no pill. Randomization to IPT or a low-contact psychotherapy condition at entry into the continuation phase, followed by randomization to medication, placebo, or no pill at the end of the second month of continuation. Maintenance pharmacotherapy prevented relapse and symptom exacerbation, whereas IPT improved social functioning (Weissman et al., 1974). The effects of IPT on social functioning were not apparent for 6-8 months, and combined psychotherapy-pharmacotherapy had the best outcome.

Two studies in Pittsburgh, Pennsylvania, have assessed longer antidepressant maintenance trials of IPT. Frank et al. (1990, 1991; Frank 1991a), studied 128 outpatients with multiply, rapidly recurrent depression. Patients, who had had, on average, seven episodes of major depression, were initially treated with combined high-dose imipramine (>200 mg/day) and weekly IPT. Responders remained on high-dosage medication while IPT was tapered to a monthly frequency during a 4-month continuation phase. Patients remaining remitted were then randomly assigned to 3 years of one of the following:

(1) ongoing high-dose imipramine plus clinical management

(2) high-dose imipramine plus monthly IPT

(3) monthly IPT alone

(4) monthly IPT plus placebo

(5) placebo plus clinical management.

High-dose imipramine, with or without maintenance IPT, was the most efficacious treatment, protecting more than 80% of patients over 3 years. In contrast, most patients on placebo relapsed within the first few months. Once-monthly IPT, while less efficacious than medication, was statistically and clinically superior to placebo in this high-risk patient population. Reynolds and colleagues (1999) essentially replicated these maintenance findings in a study of geriatric patients with major depression that compared IPT and nortriptyline. It is notable that both of these studies used unusually high doses (that is, maintenance of acute levels, rather than a dosage taper) of antidepressant medications, while employing the lowest ever (albeit only ever) monthly maintenance dosage of a psychotherapy.

The modal depressed patient is a woman of childbearing age, but many depressed pregnant or nursing women prefer to avoid pharmacotherapy. Frank and colleagues' finding of an 82-week survival time without recurrence with monthly maintenance IPT alone would suffice to protect many women with recurrent depression through pregnancy and nursing without medication. Further research is needed to determine the relative efficacy of IPT to newer medications, such as selective serotonin reuptake inhibitors, as well as the efficacy of more-frequent-than-monthly doses of maintenance IPT. A study underway in Pittsburgh compares differing doses of maintenance IPT for depressed patients.

Anxiety and Depression 101

Anxiety and Depression 101

Everything you ever wanted to know about. We have been discussing depression and anxiety and how different information that is out on the market only seems to target one particular cure for these two common conditions that seem to walk hand in hand.

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