CHRONIC DEPRESSION - RESPONSE TO PLACEBO, IMIPRAMINE, AND PHENELZINE

We reanalyzed data from a larger, previously published study in order to directly address whether very chronically depressed patients could benefit from antidepressant medications. This study entered 598 depres sed patients into a study randomizing patients to 6 weeks of double-bl ind treatment with imipramine, phenelzine, or placebo. Patients were a ssessed for chronicity on a four-point scale from ''mostly well'' to ' 'virtually always depressed.'' The current analyses include only the 1 53 study completers who were rated as ''virtually always depressed.'' In these patients, imipramine was effective for significantly more pat ients than was placebo (22 [46%] of 48 responding to imipramine vs. 9 [17%] of 52 responding to placebo; chi2 = 9.50; p = 0.002), whereas ph enelzine was significantly more effective than imipramine (37 [70%] of 53 responding to phenelzine; chi2 = 5.96; p = .015). Patients with mi ld depression, early onset, or histories of panic attacks did not have substantially different outcomes than patients without these characte ristics. These findings suggest that some chronically depressed patien ts may be good candidates for treatment with antidepressant medication . Because the majority (80%) of the sample met Columbia criteria for d efinite or probable atypical depression, too few chronic depressives w ere available to evaluate separately antidepressant efficacy in chroni cally depressed outpatients who did not have atypical depression. Henc e, these results may be applicable only to patients with atypical depr ession.