Reducing relapse in depressed outpatients with atypical features: A pilot study

Background: Patients with major depressive disorder (MDD) and atypical feat ures have reactive mood plus at least two sympoms: hypersomnia, hyperphagia , leaden paralysis or a lifetime sensitivity to rejection. These patients r espond to cognitive therapy (CT) or phenelzine (PHZ) significantly more tha n pill placebo (PBO). The purpose of this report is to motivate research on tolerable continuation phase treatment designed to reduce the significant risk of relapse and recurrence which depressed patients with atypical featu res face. Methods: Outpatients with DSM-III-R MDD and atypical features who responded to acute-phase CT, clinical management plus PHZ or PBO (n = 31) were randomized to continue or discontinue treatment for 8 months and parti cipate in 16 months or treatment-free follow-up. Results: A log-rank test s howed that the relapse and recurrence-free survival over the 24 months afte r the acute phase was significantly greater for the responders who continue d treatment than for those who discontinued treatment. Kaplan-Meier estimat es of relapse and recurrence were significantly higher for patients whose t reatment was discontinued than for those whose treatment continued (83 vs 4 9% based on unblinded ratings of the Research Diagnostic Criteria for MDD o r of self/other referral for treatment of depressive symptoms). Conclusions : We note several important limitations of the design and analysis of these pilot data. We hypothesize that not only pharmacotherapy, but also CT used as a continuation phase threatment may reduce relapse in this population. This hypothesis warrants rigorous evaluation in samples of outpatients with MDD and atypical features that are large enough to allow comparative tests . Copyright (C) 2000 S.Karger AG, Basel.