Double-blind comparison of sertraline, imipramine, and placebo in the treatment of dysthymia: Effects on personality

Objective: Although previous studies have shown that dysthymia, or chronic depression, commonly responds to antidepressant medications (with improveme nts in depressive symptoms and psychosocial functioning), there have been n o systematic studies of the impact of antidepressant treatment on personali ty variables in patients with this disorder. Method: In a multicenter study, 410 patients with early-onset primary dysth ymia were treated in a randomized prospective fashion with sertraline, imip ramine, or placebo. The data were analyzed in terms of the subjects' scores on the Tridimensional Personality Questionnaire, a 100-item self-report in strument that measures four temperamental dimensions: harm avoidance, rewar d dependence, novelty seeking, and persistence. Results: At baseline, the harm avoidance scores of the dysthymic subjects w ere approximately 1.5 standard deviations higher than those of a previously reported community sample. After treatment, there was a significant decrea se in harm avoidance scores, with no significant between-group differences. Remission of dysthymia was associated with significantly greater improveme nt in harm avoidance, with the greatest numerical change found in the patie nts treated with sertraline. Subjects' Tridimensional Personality Questionn aire scores were correlated at a 0.50 level with the Social Adjustment Scal e both pre- and posttreatment, suggesting that a high degree of harm avoida nce may be associated with poor social functioning. Conclusions: Before treatment, chronically depressed patients demonstrate a n abnormality in temperament, as measured by elevated degrees of harm avoid ance. Remission of dysthymia is associated with improvement in this aspect of temperament.