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Differential Symptom Reduction by Drugs and Psychotherapy in Acute Depression

Alberto DiMascio, PhD; Myrna M. Weissman, PhD; Brigitte A. Prusoff, PhD; Carlos Neu, MD; Maggie Zwilling; Gerald L. Klerman, MD
[+] Author Affiliations

Accepted for publication June 29, 1979.

Deceased.

Reprint requests to Depression Research Unit, Connecticut Mental Health Center, Suite 2A, 904 Howard Ave, New Haven, CT 06519 (Dr Weissman).


Arch Gen Psychiatry. 1979;36(13):1450-1456. doi:10.1001/archpsyc.1979.01780130068008
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• A randomized, controlled trial compared the combination of amitriptyline hydrochloride and short-term interpersonal psychotherapy, either treatment alone, and a nonscheduled treatment control group in ambulatory acute, nonbipolar, nonpsychotic depressives. Results show the efficacy of both psychotherapy and amitriptyline in overall symptom reduction. Amitriptyline and psychotherapy were about equal, and the effects of both treatments in combination were additive. The additive effect of combined treatment was largely due to the differential effects of the two treatments. Amitriptyline had its effect mainly on the vegetative symptoms of depression such as sleep and appetite disturbance, these occurred early in treatment, often within the first week. Psychotherapy had its effect mainly on mood, suicidal ideation, work, and interests; these effects occurred slightly later, at four to eight weeks.

REFERENCES

Klerman GL:  Psychoneurosis: Integrating pharmacotherapy and psychotherapy , in Claghorn JL (ed): Successful Psychotherapy . New York, Brunner/Mazel Inc, 1976;, pp 69-91.
Klein D, Davis J: Diagnosis and Drug Treatment of Psychiatric Disorders . Baltimore, Williams & Wilkins Co, 1969;.
Weissman MM:  Psychotherapy and its relevance to the pharmacotherapy of affective disorders: From ideology to evidence , in Lipton M, DiMascio A, Killam K (eds): Psychopharmacology—A Generation of Progress . New York, Raven Press, 1978;, pp 1313-1321.
Luborsky L, Singer B, Luborsky L:  Comparative studies of psychotherapies . Arch Gen Psychiatry 32:995-1012, 1975;.
Lieberman M: Survey and Evaluation of the Literature on Verbal Psychotherapy od Depressive Disorders . Bethesda, Md, Clinical Research Branch, National Institute of Mental Health, March 1975;.
Cristol AH:  Studies of outcome of psychotherapy . Compr Psychiatry 13:189-200, 1972;.
Rehm LP: Studies in self-control treatment of depression. Read before the American Psychological Association, Washington, DC, Sept 5, 1976.
Lewinsohn P, Biglan A, Zeiss A:  Behavioral treatment of depression , in Davidson P (ed): Behavioral Management of Anxiety, Depression and Pain . New York, Brunner/Mazel Inc, 1976;, pp 91-146.
Kleber H, Weissman MM, Rounsaville BJ: Evaluation of Psychotherapy in Treating Heroin Dependent Individuals . Rockville, Md, National Institute of Drug Addiction, 1977;.
Rush AJ, Beck A, Kovacs M, et al:  Comparative efficacy of cognitive therapy and pharmacotherapy in the treatment of depressed outpatients . Cognitive Ther Res 1:17-37, 1977;.
Friedman AS:  Interaction of drug therapy with marital therapy in depressed patients . Arch Gen Psychiatry 32:619-637, 1975;.
Covi L, Lipman R, Derogatis L, et al:  Drugs and group psychotherapy in neurotic depression . Am J Psychiatry 131:191-198, 1972;.
Klerman GL, DiMascio A, Weissman MM, et al:  Treatment of depression by drugs and psychotherapy . Am J Psychiatry 131:186-191, 1974;.
Weissman MM, Klerman GL, Paykel ES, et al:  Treatment effects on the social adjustment of depressed patients . Arch Gen Psychiatry 30:771-778, 1974;.
Weissman MM, Prusoff BA, DiMascio A, et al:  The efficacy of drugs and psychotherapy in the treatment of acute depressive episodes . Am J Psychiatry 136:555-558, 1979;.
Herceg-Baron R, Prusoff BA, Weissman MM, et al:  Pharmacotherapy and psychotherapy in acutely depressed patients: A study of attrition patterns in a clinical trial . Compr Psychiatry 20:315-325, 1979;.
Endicott J, Spitzer RL:  A diagnostic interview: The Schedule for Affective Disorders and Schizophrenia . Arch Gen Psychiatry 35:837-848, 1978;.
Spitzer RL, Endicott J, Robins E:  Research Diagnostic Criteria: Rationale and Reliability . Arch Gen Psychiatry 35:773-785, 1978;.
Raskin A, Schulterbrandt J, Reatig N, et al:  Replication of factors of psychopathology in interview, ward behavior and self-report ratings of hospitalized depressives . J Nerv Ment Dis 148:87-98, 1969;.
Neu C, Prusoff BA, Klerman GL:  Measuring the interventions used in the short-term interpersonal psychotherapy of depression . Am J Orthopsychiatry 48:629-636, 1979;.
DiMascio A, Klerman GL, Weissman MM, et al:  An ethically justifiable and methodologically appropriate control group for psychotherapy research in acute depression . J Psychiatr Res , to be published.
Cicchetti DV, Chinyu L, Fontana AF, et al:  A computer program for assessing specific category rater agreement for qualitative data . Educ Psychol Measurement 38:805-813, 1978;.
Hamilton M:  A rating scale for depression . J Neurol Neurosurg Psychiatry 23:56-62, 1960;.
Weissman MM:  The psychological treatment of depression: Evidence for the efficacy of psychotherapy alone, in comparison with, and in combination with pharmacotherapy . Arch Gen Psychiatry 36:1261-1269, 1979;.
Shaw B:  A comparison of cognitive therapy and behavior therapy in the treatment of depression . J Consult Clin Psychol 45:543-551, 1977;.

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Klerman GL:  Psychoneurosis: Integrating pharmacotherapy and psychotherapy , in Claghorn JL (ed): Successful Psychotherapy . New York, Brunner/Mazel Inc, 1976;, pp 69-91.
Klein D, Davis J: Diagnosis and Drug Treatment of Psychiatric Disorders . Baltimore, Williams & Wilkins Co, 1969;.
Weissman MM:  Psychotherapy and its relevance to the pharmacotherapy of affective disorders: From ideology to evidence , in Lipton M, DiMascio A, Killam K (eds): Psychopharmacology—A Generation of Progress . New York, Raven Press, 1978;, pp 1313-1321.
Luborsky L, Singer B, Luborsky L:  Comparative studies of psychotherapies . Arch Gen Psychiatry 32:995-1012, 1975;.
Lieberman M: Survey and Evaluation of the Literature on Verbal Psychotherapy od Depressive Disorders . Bethesda, Md, Clinical Research Branch, National Institute of Mental Health, March 1975;.
Cristol AH:  Studies of outcome of psychotherapy . Compr Psychiatry 13:189-200, 1972;.
Rehm LP: Studies in self-control treatment of depression. Read before the American Psychological Association, Washington, DC, Sept 5, 1976.
Lewinsohn P, Biglan A, Zeiss A:  Behavioral treatment of depression , in Davidson P (ed): Behavioral Management of Anxiety, Depression and Pain . New York, Brunner/Mazel Inc, 1976;, pp 91-146.
Kleber H, Weissman MM, Rounsaville BJ: Evaluation of Psychotherapy in Treating Heroin Dependent Individuals . Rockville, Md, National Institute of Drug Addiction, 1977;.
Rush AJ, Beck A, Kovacs M, et al:  Comparative efficacy of cognitive therapy and pharmacotherapy in the treatment of depressed outpatients . Cognitive Ther Res 1:17-37, 1977;.
Friedman AS:  Interaction of drug therapy with marital therapy in depressed patients . Arch Gen Psychiatry 32:619-637, 1975;.
Covi L, Lipman R, Derogatis L, et al:  Drugs and group psychotherapy in neurotic depression . Am J Psychiatry 131:191-198, 1972;.
Klerman GL, DiMascio A, Weissman MM, et al:  Treatment of depression by drugs and psychotherapy . Am J Psychiatry 131:186-191, 1974;.
Weissman MM, Klerman GL, Paykel ES, et al:  Treatment effects on the social adjustment of depressed patients . Arch Gen Psychiatry 30:771-778, 1974;.
Weissman MM, Prusoff BA, DiMascio A, et al:  The efficacy of drugs and psychotherapy in the treatment of acute depressive episodes . Am J Psychiatry 136:555-558, 1979;.
Herceg-Baron R, Prusoff BA, Weissman MM, et al:  Pharmacotherapy and psychotherapy in acutely depressed patients: A study of attrition patterns in a clinical trial . Compr Psychiatry 20:315-325, 1979;.
Endicott J, Spitzer RL:  A diagnostic interview: The Schedule for Affective Disorders and Schizophrenia . Arch Gen Psychiatry 35:837-848, 1978;.
Spitzer RL, Endicott J, Robins E:  Research Diagnostic Criteria: Rationale and Reliability . Arch Gen Psychiatry 35:773-785, 1978;.
Raskin A, Schulterbrandt J, Reatig N, et al:  Replication of factors of psychopathology in interview, ward behavior and self-report ratings of hospitalized depressives . J Nerv Ment Dis 148:87-98, 1969;.
Neu C, Prusoff BA, Klerman GL:  Measuring the interventions used in the short-term interpersonal psychotherapy of depression . Am J Orthopsychiatry 48:629-636, 1979;.
DiMascio A, Klerman GL, Weissman MM, et al:  An ethically justifiable and methodologically appropriate control group for psychotherapy research in acute depression . J Psychiatr Res , to be published.
Cicchetti DV, Chinyu L, Fontana AF, et al:  A computer program for assessing specific category rater agreement for qualitative data . Educ Psychol Measurement 38:805-813, 1978;.
Hamilton M:  A rating scale for depression . J Neurol Neurosurg Psychiatry 23:56-62, 1960;.
Weissman MM:  The psychological treatment of depression: Evidence for the efficacy of psychotherapy alone, in comparison with, and in combination with pharmacotherapy . Arch Gen Psychiatry 36:1261-1269, 1979;.
Shaw B:  A comparison of cognitive therapy and behavior therapy in the treatment of depression . J Consult Clin Psychol 45:543-551, 1977;.

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