Treatment of atypical depression: post-hoc analysis of a randomized controlled study testing the efficacy of sertraline and cognitive behavioural therapy in mildly depressed outpatients.
OBJECTIVE
Atypical features are common among depressed primary care patients, but clinical trials testing the efficacy of psychopharmacological and/or psychotherapeutic treatment are lacking. This paper examines the efficacy of sertraline and cognitive behavioural therapy (CBT) among depressed patients with atypical features.


METHODS
Analyses involve a double-blind comparison of sertraline versus placebo (N=47) and a single-blind comparison between CBT versus a guided self-help group (GSG) (N=48), with primary efficacy endpoints being the Inventory of Depressive Symptomatology (IDS(C)) and Hamilton Depression Scale (HAMD-17).


RESULTS
In intent-to-treat (ITT) analyses, the decrease on the IDS(C) scale (and HAMD-17) was greater after CBT compared to GSG: p=0.01 (HAMD-17: p=0.01). The difference between selective serotonin reuptake inhibitors (SSRI) versus placebo was not significant: p=0.22 (HAMD-17: p=0.36).


CONCLUSIONS
The number of cases in each treatment group was small, thereby limiting statistical power. Patients medicated with sertraline were 10 to 15 years younger than those included in the other groups of treatment.


CONCLUSIONS
CBT may be an effective alternative to GSG for mildly depressed patients with atypical features. Although SSRI were not superior to placebo, it would be premature to rule out SSRI as efficacious in atypical depression.
Department of Psychiatry, Ludwig-Maximilians-University Munich, Nussbaumstrasse 7, Munich, Germany.
V
V
Henkel
R
R
Mergl
A-K
AK
Allgaier
M
M
Hautzinger
R
R
Kohnen
J C
JC
Coyne
H-J
HJ
Möller
U
U
Hegerl
D000328:Adult; D000928:Antidepressive Agents / Q000627:therapeutic use; D015928:Cognitive Behavioral Therapy; D003866:Depressive Disorder / Q000523:psychology / Q000628:therapy*; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D057194:Intention to Treat Analysis; D008297:Male; D008875:Middle Aged; D010045:Outpatients / Q000523:psychology; D018579:Patient Selection; D011569:Psychiatric Status Rating Scales; D012657:Self-Help Groups; D020280:Sertraline / Q000627:therapeutic use*; D012720:Severity of Illness Index; D016037:Single-Blind Method; D016896:Treatment Outcome
D000928:Antidepressive Agents; D020280:Sertraline