The treatment of chronic depression, part 2: A double-blind, randomized trial of sertraline and imipramine

Background: Chronic depression appears to be a common, frequently disabling illness that is often inadequately treated. Unlike episodic depressions wi th shorter illness duration, neither acute nor long-term treatment approach es for chronic depression have been well studied. Method: 635 outpatients at 12 sites who met DSM-III-R criteria for chronic major depression or double depression were randomly assigned to 12 weeks of double-blind treatment with either sertraline (in daily doses of 50-200 mg ) or imipramine (in daily doses of 50-300 mg). Efficacy and safety were ass essed either weekly or every 2 weeks during the 12 weeks of acute treatment . Results: Despite high rates of chronicity (mean duration of major depressio n = 8.9 +/- 9.1 years: mean duration of dysthymia = 23 +/- 13 years) and hi gh rates of comorbidity, 52% of patients achieved a satisfactory therapeuti c response to sertraline or imipramine (by a conservative, intent-to-treat analysis). Approximately 21% of the patients who had achieved a therapeutic response at week 12 had not done so at week 8, confirming the longer time to response in depressions with high chronicity. Patients treated with sert raline reported significantly fewer adverse events and were significantly l ess likely to discontinue treatment due to side effects than imipramine-tre ated patients (6.3% vs. 12.0%). Conclusion: These results indicate that patients suffering from depression with high chronicity can achieve a good therapeutic response to acute treat ment with either sertraline or imipramine, although sertraline is better to lerated.