Am J Psychiatry 1992; 149:1324-1334
Copyright © 1992 by American Psychiatric Association
Melancholic/endogenous depression and response to somatic treatment and placebo
ED Peselow, MP Sanfilipo, C Difiglia and RR Fieve
New York University School of Medicine, Brooklyn.
OBJECTIVE: The authors' goals were to examine the effects of somatic
treatment and placebo in patients with and without endogenous/melancholic
depression. METHOD: Before entry into one of four trials of antidepressant
drugs versus placebo, 231 patients were assessed as to whether they met
Research Diagnostic Criteria for definite endogenous depression and/or
DSM-III criteria for major depressive episode with melancholia. These
patients were prospectively assessed for subsequent response to
antidepressant treatment or placebo. Previous studies of the effect of
endogenous/melancholic depression on treatment response were also reviewed.
RESULTS: Of the 76 patients with DSM-III melancholia given active
medication, 41 (54%) had a complete or partial response, but only 10 (23%)
of the 44 patients with melancholia given placebo had a complete or partial
response. Of the 76 depressed patients without melancholia given active
medication, 46 (61%) had a complete or partial response, and 15 (43%) of
the 35 depressed patients without melancholia given placebo had a complete
or partial response. Moderately depressed patients with DSM-III melancholia
had a significantly better response to active medication than did severely
depressed patients with melancholia and showed the greatest difference
between response to active medication and response to placebo. The results
of the review of previous studies of the effect of endogenous/melancholic
depression on treatment response were mixed. CONCLUSIONS: Depressed
patients with melancholia were not particularly different from depressed
patients without melancholia in their responses to antidepressant
medication but did differ from patients without melancholia in their
responses to active medication versus placebo, particularly if their
depression was moderate and not severe. This suggests that patients with
DSM-III melancholia may be unresponsive to nonsomatic treatments.
