WHICH DEPRESSED-PATIENTS WILL RESPOND TO INTERPERSONAL PSYCHOTHERAPY - THE ROLE OF ABNORMAL EEG SLEEP PROFILES

Objective: The authors tested the hypothesis that patients whose episo des of major depression evidenced more neurobiological disturbance wou ld be less responsive to psychotherapy. Method: The study subjects wer e outpatients who were given a diagnosis of recurrent major depressive disorder (unipolar or bipolar II), according to the Research Diagnost ic Criteria, following an interview with the Schedule for Affective Di sorders and Schizophrenia. They were classified into a group with norm al sleep profiles (N=50) and a group with abnormal sleep profiles (N=4 1) on the basis of a validated index score derived from three EEG slee p variables monitored for 2 nights: sleep efficiency, REM latency, and REM density. The groups' responses to short-term interpersonal psycho therapy were compared by means of chi-square tests and life table and random effects model analyses. Responses to the addition of pharmacoth erapy for subjects who did not respond to interpersonal psychotherapy were also compared. Results: The patients with abnormal sleep profiles had significantly poorer clinical outcomes with respect to symptom ra tings, attrition rates, and remission rates than the patients with mor e normal sleep profiles. Seventy-Jive percent of the patients who did not respond to interpersonal psychotherapy had remissions during subse quent pharmacotherapy. Conclusions: These findings help to define furt her a neurobiological ''boundary'' that may limit response to psychoth erapy in depression. An abnormal sleep profile may reflect a more mark ed disturbance of CNS arousal that warrants pharmacotherapy.