title: Which symptoms predict recurrence of depression in women treated with maintenance interpersonal psychotherapy?
abstract: BACKGROUND
  Even low levels of residual symptoms are known to increase the risk of relapse and early recurrence of major depression. It is not known if ongoing psychotherapy lessens this risk. We therefore examined the impact of persistent symptoms, including mood, insomnia, and anxiety symptoms, on time to recurrence in women receiving maintenance interpersonal psychotherapy (IPT-M) for recurrent depression.
  
  
  METHODS
  We analyzed data on 131 women aged 20-60 from a 2-year randomized trial of weekly versus twice-monthly versus monthly IPT-M. Participants achieved remission with IPT alone (n=99) or IPT plus sequential antidepressant medication (n=32). Medications were tapered before starting maintenance treatment. Residual symptoms were assessed with the Hamilton Rating Scale for Depression (HRSD; total score and subscales); insomnia was also assessed in 76 women with the Pittsburgh Sleep Quality Index (PSQI). Data analyses used Cox proportional hazards regression models.
  
  
  RESULTS
  Neither overall burden of residual symptoms (HRSD total score), nor HRSD mood and anxiety subscale scores predicted recurrence during ongoing IPT-M. In contrast, persistent insomnia measured both by the HRSD-17 insomnia subscale and the PSQI predicted recurrence. Women with persistent insomnia who required sequential pharamacotherapy had the highest recurrence rate (65%) compared to women requiring sequential treatment without insomnia (13%), or women who had recovered with IPT alone but had persistent insomnia (21%) or no insomnia (18%).
  
  
  CONCLUSIONS
  Persistent insomnia following the recovery from an episode of recurrent major depression is associated with increased risk of recurrence despite maintenance psychotherapy, particularly for those withdrawn from antidepressant medication.
authors.affiliation: Western Psychiatric Institute and Clinic, Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.
authors.forename: Alexandre Y
authors.initials: AY
authors.lastname: Dombrovski
authors.forename: Jill M
authors.initials: JM
authors.lastname: Cyranowski
authors.forename: Benoit H
authors.initials: BH
authors.lastname: Mulsant
authors.forename: Patricia R
authors.initials: PR
authors.lastname: Houck
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Buysse
authors.forename: Carmen
authors.initials: C
authors.lastname: Andreescu
authors.forename: Michael E
authors.initials: ME
authors.lastname: Thase
authors.forename: Alan G
authors.initials: AG
authors.lastname: Mallinger
authors.forename: Ellen
authors.initials: E
authors.lastname: Frank
mesh_terms: D000328:Adult; D000339:Affect; D001008:Anxiety Disorders / Q000175:diagnosis / Q000523:psychology / Q000628:therapy; D003131:Combined Modality Therapy; D015897:Comorbidity; D003865:Major Depressive Disorder / Q000175:diagnosis / Q000523:psychology / Q000628:therapy*; D005260:Female; D006801:Humans; D008875:Middle Aged; D010552:Personality Assessment / Q000706:statistics & numerical data; D011594:Psychometrics; D011613:Psychotherapy / Q000379:methods*; D011725:Pyridines / Q000627:therapeutic use; D012008:Recurrence; D018570:Risk Assessment; D017367:Selective Serotonin Reuptake Inhibitors / Q000627:therapeutic use; D007319:Sleep Initiation and Maintenance Disorders / Q000523:psychology / Q000628:therapy; D014196:Trazodone / Q000627:therapeutic use; D055815:Young Adult; D000077334:Zolpidem
chemical_list: D011725:Pyridines; D017367:Selective Serotonin Reuptake Inhibitors; D014196:Trazodone; D000077334:Zolpidem
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