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Chapter 24. Depression-Focused Psychotherapies

Edward S. Friedman, M.D.; Michael E. Thase, M.D.
DOI: 10.1176/appi.books.9781585622986.256315

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Excerpt

The term depression-focused psychotherapy is used herein to describe the time-limited psychosocial treatments that have been tested and found to be effective treatments of major depressive disorder. In this chapter we will review the most influential of these forms of therapy: interpersonal psychotherapy (IPT) (Klerman et al. 1984) and the cognitive-behavioral models of therapy, including cognitive therapy (CT) (Beck et al. 1979) and cognitive-behavioral analysis system of psychotherapy (CBASP) (McCullough 2000). Each of these models of psychotherapy emphasizes the use of model-specific formulations, psychoeducation, and procedurally guided interventions to help patients learn to cope with and, it is hoped, recover from depression. Another feature in common is that each of these psychotherapies has been subjected to empirical study using randomized clinical trials. In this chapter we describe the conceptual and pragmatic underpinnings for the major forms of depression-focused psychotherapy and summarize evidence concerning their efficacy in the treatment of major depressive disorder in the adult population, building on the comprehensive review published by the Agency for Health Care Policy and Research (Depression Guideline Panel 1993) and the "Practice Guideline for the Treatment of Patients With Major Depressive Disorder" published by the American Psychiatric Association (2000). The interested reader might also wish to consult the earlier version of this chapter for a more detailed review of the older literature (Thase 2001).

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Figure 24–1. Course of depressive severity from baseline (M0) to month 8 (M8) among intent-to-treat primary care cohorts randomized to interpersonal psychotherapy (IPT), nortriptyline hydrochloride (NT), or usual care (UC).HAM-D = 17-item Hamilton Rating Scale for Depression (Hamilton 1960).Source. Reprinted from Schulberg HC, Block MR, Madonia M, et al.: "Treating Major Depression in Primary Care Practice: Eight-Month Clinical Outcomes." Archives of General Psychiatry 53:913–919, 1996. Copyright 1996. Used with permission.

Figure 24–2. Relationship of treatment specificity and delta ratio to time to recurrence.Note. High delta ratio/high focus, n = 13; low delta ratio/high focus, n = 8; high delta ratio/low focus, n = 13; and low delta ratio/low focus, n = 7.Source. Reprinted from Spanier C, Frank E, McEachran AB, et al.: "The Prophylaxis of Depressive Episodes in Recurrent Depression Following Discontinuation of Drug Therapy: Integrating Psychological and Biological Factors." Psychological Medicine 26:461–475, 1996. Copyright 1996. Used with permission.

Figure 24–3. Survival function of four treatment groups stratified by age at current major depressive episode.Note. Kaplan-Meier tests of survival function were significant for subjects ages 60–69 years (log rank = 25.9; df = 3; P = 0.001) and subjects 70 years or older (log rank = 9.05; df = 3; P = 0.03). Pairwise contrasts within each age stratum were not performed due to small sample sizes. IPT = interpersonal psychotherapy.Source. Reprinted from Reynolds CF III, Frank E, Perel JM, et al.: "Nortriptyline and Interpersonal Psychotherapy as Maintenance Therapies for Recurrent Major Depression: A Randomized Controlled Trial in Patients Older Than 59 Years." JAMA 281:39–45, 1999a. Copyright 1999. Used with permission.

Figure 24–4. Symptomatic responses to cognitive therapy and phenelzine sulfate pharmacotherapy were not significantly different, and both treatments were superior to administration of placebo.HAM-D = Hamilton Rating Scale for Depression (Hamilton 1960).Source. Reprinted from Jarrett RB, Schaffer M, McIntire D, et al.: "Treatment of Atypical Depression With Cognitive Therapy or Phenelzine: A Double-Blind, Placebo-Controlled Trial." Archives of General Psychiatry 56:431–437, 1999. Copyright 1999. Used with permission.

Figure 24–5. Recurrence rates after antidepressant discontinuation among patients who received either cognitive-behavioral therapy (CBT) or clinical management.Note.The difference between groups was highly significant (log rank 2 = 11.98, P < 0.001).Source. Reprinted from Fava GA, Rafanelli C, Grandi S, et al.: "Prevention of Recurrent Depression With Cognitive Behavioral Therapy: Preliminary Findings." Archives of General Psychiatry 53:816–820, 1998. Copyright 1998. Used with permission.
Table Reference Number
Table 24–1. Shared elements of depression-focused psychotherapies developed for treatment of major depression
Table Reference Number
Table 24–2. Randomized clinical trials comparing depression-focused psychotherapies and nonpharmacological control conditions as acute-phase treatments of major depressive disorder 
Table Reference Number
Table 24–3. Randomized controlled clinical trials comparing depression-focused psychotherapies and pharmacotherapy as acute-phase treatments of major depressive disorder

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