Atypical features and treatment response in the National Institute of Mental Health Treatment of Depression Collaborative Research Program

Citation
Jw. Stewart et al., Atypical features and treatment response in the National Institute of Mental Health Treatment of Depression Collaborative Research Program, J CL PSYCH, 18(6), 1998, pp. 429-434
Citations number
20
Categorie Soggetti
Pharmacology,"Neurosciences & Behavoir
Journal title
JOURNAL OF CLINICAL PSYCHOPHARMACOLOGY
ISSN journal
02710749 → ACNP
Volume
18
Issue
6
Year of publication
1998
Pages
429 - 434
Database
ISI
SICI code
0271-0749(199812)18:6<429:AFATRI>2.0.ZU;2-H
Abstract
Because depression with atypical features is poorly responsive to imipramin e, treatment trials including a tricyclic antidepressant arm should assess depressive subtype. Sotsky and Simmens had previously reanalyzed data from the National Institute of Mental Health Treatment of Depression Collaborati ve Research Program (TDCRP) providing independent confirmation that imipram ine is ineffective for patients with atypical features. The TDCRP was a 16- week study in which 239 outpatients with major depression were randomly ass igned to cognitive behavior therapy (CBT), interpersonal psychotherapy (IPT ), imipramine-case management (IMI-CM), or pill placebo-case management (Pb o-Chl). We used Sotsky and Simmens' algorithm to investigate the effect of diagnostic subtype on all four treatments. Hierarchical multiple regression analyses demonstrated IMI-CM benefit relative to Pbo-CM in patients withou t but not in those with atypical features. These analyses did not demonstra te differential psychotherapy efficacy between depressive subtypes. In conc lusion, subsequent analyses of the TDCRP study demonstrated the need to ide ntify the subgroup of depressed patients who have atypical features. Failur e to identify this subtype underestimates imipramine's benefit in the appro priately treated subgroup. Comparisons of other treatments with imipramine may be misleading if they do not account for diagnostic subtype.