title: Long-term effect of combined interpersonal psychotherapy and pharmacotherapy in a randomized trial of depressed patients.
abstract: OBJECTIVE
  Evaluation of the long-term benefits of combined pharmacological and psychotherapeutic depression treatment and the differential impact of early childhood trauma.
  
  
  METHODS
  A randomized trial was conducted in 124 in-patients with a diagnosis of major depressive disorder comparing 5 weeks of interpersonal psychotherapy plus pharmacotherapy (IPT) with medication plus clinical management (CM). The study included a prospective, naturalistic follow-up 3, 12 and 75 months after in-patient treatment. The Hamilton Rating Scale for Depression (HRSD) served as the primary outcome measure.
  
  
  RESULTS
  Patients in both treatments reduced their depressive symptoms between baseline and 5-year follow-up significantly with a faster decrease early in the follow-up phase. The time rate of change and acceleration on the HRSD was higher for patients in the combination therapy group. The contrast between the conditions at year 5 was non-significant. However, 28% of the IPT patients showed a sustained remission compared with 11% of the CM patients (P = 0.032). Early adversity was found to be a moderator of the relationship between treatment and outcome.
  
  
  CONCLUSIONS
  In the long-term, a combination of psycho- and pharmacotherapy was superior in terms of sustained remission rates to standard psychiatric treatment. Early trauma should be assessed routinely in depressed patients.
authors.affiliation: Department of Psychiatry, University Medical Center Freiburg, Germany. ingo.zobel@uniklinik-freiburg.de
authors.forename: I
authors.initials: I
authors.lastname: Zobel
authors.forename: S
authors.initials: S
authors.lastname: Kech
authors.forename: D
authors.initials: D
authors.lastname: van Calker
authors.forename: P
authors.initials: P
authors.lastname: Dykierek
authors.forename: M
authors.initials: M
authors.lastname: Berger
authors.forename: R
authors.initials: R
authors.lastname: Schneibel
authors.forename: E
authors.initials: E
authors.lastname: Schramm
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000928:Antidepressive Agents / Q000493:pharmacokinetics / Q000627:therapeutic use; D002649:Child Abuse / Q000523:psychology; D003131:Combined Modality Therapy; D019091:Critical Pathways; D003865:Major Depressive Disorder / Q000209:etiology / Q000523:psychology / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011569:Psychiatric Status Rating Scales; D011615:Psychotherapy, Group / Q000458:organization & administration*; D012720:Severity of Illness Index; D013810:Therapeutic Equivalency; D013995:Time; D016896:Treatment Outcome
chemical_list: D000928:Antidepressive Agents