In this competing continuation application we are proposing to further pursue a long-term maintenance treatment study of Dysthymia. Additional questions about long-term treatment have arisen in the course of the study, which constitute four new specific aims for the future work. During the past four years we entered 105 patients with DSM-III-R Dysthymia into a long-term study. Patients who remitted on open desipramine (DMI) treatment in the acute phase, were continued on DMI for four months (continuation phase), then randomly assigned to maintenance DMI or taper onto placebo for two years (maintenance phase). Preliminary analyses showed that maintenance DMI prevented relapse and increased survival time without relapse compared to placebo. Several important new and remaining questions will be addressed by the extension of this study: (1) Does long-term treatment response differ according to Dysthymia subtype, i.e., Pure Dysthymia versus Double- Depression? (2) Does the need for and effectiveness of maintenance treatment differ according to the type of remission induced, i.e., Full Remission versus Partial Remission? (3) What are the relative proportions of relapse following treatment discontinuation after various durations of remission, e.g. 6, 18 or 30 months? (4) Does retreatment with the same agent (DMI) reliably induce remission when a relapse occurs off medication? (5) What is the impact of longer-term treatment on measures of interpersonal and social vocational function? Certain modifications are to be made in the research design and the sample will be somewhat expanded in order to investigate these issues. The current study and research team is uniquely poised to meet specific aims that address crucial clinical questions about the treatment of Dysthymia which require longer-term follow-up.
| Kocsis, James H (2003) Pharmacotherapy for chronic depression. J Clin Psychol 59:885-92 |
| Miller, N L; Kocsis, J H; Leon, A C et al. (2001) Maintenance desipramine for dysthymia: a placebo-controlled study. J Affect Disord 64:231-7 |
| Markowitz, J C; Friedman, R A; Miller, N et al. (1996) Interpersonal improvement in chronically depressed patients treated with desipramine. J Affect Disord 41:59-62 |
| Kocsis, J H; Friedman, R A; Markowitz, J C et al. (1996) Maintenance therapy for chronic depression. A controlled clinical trial of desipramine. Arch Gen Psychiatry 53:769-74;discussion 775-6 |
| Friedman, R A; Mitchell, J; Kocsis, J H (1995) Retreatment for relapse following desipramine discontinuation in dysthymia. Am J Psychiatry 152:926-8 |
| Friedman, R A; Parides, M; Baff, R et al. (1995) Predictors of response to desipramine in dysthymia. J Clin Psychopharmacol 15:280-3 |
| Marin, D B; Kocsis, J H; Frances, A J et al. (1994) Desipramine for the treatment of ""pure"" dysthymia versus ""double"" depression. Am J Psychiatry 151:1079-80 |
| Markowitz, J C; Moran, M E; Kocsis, J H et al. (1992) Prevalence and comorbidity of dysthymic disorder among psychiatric outpatients. J Affect Disord 24:63-71 |
| Kocsis, J H; Sutton, B M; Frances, A J (1991) Long-term follow-up of chronic depression treated with imipramine. J Clin Psychiatry 52:56-9 |
| Kocsis, J H; Mason, B J; Frances, A J et al. (1989) Prediction of response of chronic depression to imipramine. J Affect Disord 17:255-60 |
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