Combination of medication
and pyschotherapy produce dramatic improvement in chronic
depression
A new combination of drug
therapy and a specific form of psychotherapy has produced
dramatic results in treating long-term depression,
according to a national study in which Stanford
participated.
"While the
psychotherapy alone or the use of the study medication
alone can produce successful results, the combination
treatment produced much more dramatic results," said
Charles DeBattista, MD, director of the Depression
Research Clinic and assistant professor of psychiatry and
behavioral sciences. "The added value of the
combination treatment produced a faster and more
successful improvement than any I've ever heard about
from a depression study."
A total of 681 patients
who had suffered from depression for two years or more
were selected by 12 academic medical centers nationwide
for the 80-week study. DeBattista said about 80 patients
were in the Stanford group.
Results from the acute
phase of treatment - the first 12 weeks - showed that the
combination of the study drug nefazodone and
psychotherapy produced significant benefit in 85 percent
of the patients, as measured by a common scale used to
evaluate depression. The drug alone produced a 55 percent
rate of success, about the same as the 52 percent rate
for psychotherapy.
The drug is marketed as
Serzone by Bristol-Myers Squibb Co., which sponsored and
paid for the national study.
DeBattista said the study
showed that use of the drug alone was comparable to
results found in previous studies for other
antidepressant drugs. The psychiatrist said further
studies are needed to determine if other common
antidepressants, including sertraline, imipramine and
desipramine, could produce the same results when combined
with the specialized form of psychotherapy, called the
Cognitive Behavioral Therapy for Chronic Depression. The
psychotherapy involves education to help the patient
understand emotional triggers affecting his or her life.
DeBattista said it was unknown whether other forms of
psychotherapy would produce similar results.
"We think this study
gives a strong indication that combination therapies
might be of value to the 14 million people who suffer
from chronic depression, even though the costs to
providers or to individuals are obviously higher than one
form of treatment alone," DeBattista said. Chronic
depression is defined as depression existing for more
than two years.
The lead investigator at
Stanford was Alan Schatzberg, MD, professor and chair of
psychiatry and behavioral sciences. Nationally, the lead
investigator was Martin B. Keller, MD, professor and
chair of the Department of Psychiatry and Human Behavior
at Brown University School of Medicine. Keller presented
the study's findings May 19 at the annual meeting of the
American Psychiatric Association in Washington, D.C. SR
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