Posted by ksvt on July 20, 2000, at 7:32:59
In reply to Use Both Drugs and Therapy, Advises Study on Depre, posted by dj on July 18, 2000, at 20:25:19
> May 18, 2000
>
> Use Both Drugs and Therapy, Advises Study on Depression
>
> By ERICA GOODE, NY Times
>
> When it comes to treating depression, those who espouse drugs as the most effective therapy and those who champion psychotherapy have often been at war. But a new study indicates that at least for patients with chronic depression, a combination of antidepressants and psychotherapy works significantly better than either treatment alone.
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> The study, appearing in today's issue of The New England Journal of Medicine, is the largest to compare drugs and psychotherapy for chronic depression.
>
> After 12 weeks of treatment, the response among the patients given only an antidepressant and the patients who received 16 to 20 sessions of psychotherapy was about the same: 55 percent in the drug group and 52 percent in the psychotherapy group showed improvement.
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> But the response rates jumped sharply for the subjects given both the drug and psychotherapy, with 85 percent showing significant improvement in their symptoms. A total of 519 patients, at 12 academic medical centers across the country, completed the course of treatment for the study.
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> As in other studies, patients taking the antidepressant improved more quickly during the first few weeks of treatment than those receiving psychotherapy. But by the 12th and final week, the researchers found, patients in the psychotherapy group had caught up.
>
> The study's lead investigator, Dr. Martin B. Keller, chairman of psychiatry at Brown University Medical School, said about 5 percent of Americans suffered from chronic depression, a condition that can persist for years. On average, patients in the study reported having suffered from some form of depression for more than two decades.
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> The study was financed by Bristol-Myers Squibb, which makes Serzone, the antidepressant used in the research. All but one of the 12 principal authors of the study have consulted for, received honorariums from or had other financial dealings with the company, and with other companies that make antidepressants.
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> Serzone was used, Dr. Keller said, because it appears less likely than some other drugs to produce sexual dysfunction as a side effect, and because it aids sleep, an advantage for depressed patients who often have trouble sleeping. Cognitive behavioral analysis, the form of psychotherapy used in the study, was developed by Dr. James P. McCullough, a psychologist at Virginia Commonwealth University who was a co-author in this research.
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> The method, the journal's report said, "teaches patients to focus on the consequences of their behavior" and uses a "social problem-solving" approach to interpersonal relationships.
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> Dr. Robert J. DeRubeis, an associate professor of psychology at the University of Pennsylvania, said the new study was significant, both because it showed the two treatments to be equivalent in effectiveness and because it demonstrated the additional benefits of combining them.
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> But Dr. DeRubeis added that many people were likely to receive one form of treatment or the other, not both, for various reasons, including cost considerations, restrictions on insurance coverage, drug side effects and personal preference.
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> Still, other researchers said the fact that patients receiving both drugs and psychotherapy were also more likely to have a complete remission of their symptoms should encourage managed care companies to foot the bill for combined treatment. Studies indicate that the more thoroughly a patient recovers from depression, the less likely a relapse.dj - I tried to post something on this the other day but it never showed up. The one thing this article doesn't address if the length of psychotherapy, which is a real issue for insurance companies and HMOs. If you suffer from chronic recurrent depression, you're probably on the drugs for life plan, as it has been explained to me, to lessen the frequency and duration of subsequent episodes. I clearly do better with both drugs and therapy, maybe in part because I've never felt that I was fully responsive to drug therapies, but while I've sort of resigned myself to drugs as a pretty permanent part of my landscape, I also worry that I can't really visualize an end to therapy. I'm sure some insurance company would love to use me as an example of why they don't like footing the bill for therapy. I think it helps me function better but I'm not convinced it's bringing me closer to a lasting remission.
poster:ksvt
thread:40900
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