title: Reducing relapse in depressed outpatients with atypical features: a pilot study.
abstract: BACKGROUND
  Patients with major depressive disorder (MDD) and atypical features have reactive mood plus at least two symptoms: hypersomnia, hyperphagia, leaden paralysis or a lifetime sensitivity to rejection. These patients respond to cognitive therapy (CT) or phenelzine (PHZ) significantly more than 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 features 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 participate in 16 months or treatment-free follow-up.
  
  
  RESULTS
  A log-rank test showed that the relapse and recurrence-free survival over the 24 months after the acute phase was significantly greater for the responders who continued treatment than for those who discontinued treatment. Kaplan-Meier estimates of relapse and recurrence were significantly higher for patients whose treatment was discontinued than for those whose treatment continued (83 vs 49% based on unblinded ratings of the Research Diagnostic Criteria for MDD or 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 treatment 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.
authors.affiliation: Department of Psychiatry, the University of Texas Southwestern Medical Center at Dallas, USA. robin.jarrett@email.swmed.edu
authors.forename: R B
authors.initials: RB
authors.lastname: Jarrett
authors.forename: D
authors.initials: D
authors.lastname: Kraft
authors.forename: M
authors.initials: M
authors.lastname: Schaffer
authors.forename: A
authors.initials: A
authors.lastname: Witt-Browder
authors.forename: R
authors.initials: R
authors.lastname: Risser
authors.forename: D H
authors.initials: DH
authors.lastname: Atkins
authors.forename: J
authors.initials: J
authors.lastname: Doyle
mesh_terms: D000208:Acute Disease; D000328:Adult; D000553:Ambulatory Care; D000928:Antidepressive Agents / Q000627:therapeutic use*; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D003131:Combined Modality Therapy; D003865:Major Depressive Disorder / Q000175:diagnosis / Q000523:psychology* / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D010624:Phenelzine / Q000627:therapeutic use*; D010865:Pilot Projects; D011569:Psychiatric Status Rating Scales; D055502:Secondary Prevention; D012720:Severity of Illness Index; D016896:Treatment Outcome
chemical_list: D000928:Antidepressive Agents; D010624:Phenelzine