Although several forms of treatment have shown promise in ameliorating the course of recurrent depression, a better understanding of the preventative capacity of psychotherapy seems especially critical for women. In light of the potentially adverse implications of antidepressant treatment throughout the childbearing years and the many psychosocial vulnerability factors for depression observed in women, a clearly efficacious maintenance psychotherapy would represent an important addition to the clinical armamentarium. Furthermore, there is increasing evidence that for men and women alike the risk of a new episode of depressive illness in the six months following discontinuation of antidepressant medication is unacceptably high, whether medication had been continued for 12, 18, 36 months or longer following remission. Our earlier study of Maintenance Therapies in Recurrent Depression (MH29618-05-13) pointed to the potential utility of interpersonal psychotherapy as a maintenance treatment (Frank et al., 1990b; 1991), particularly in women.
The specific aim of this competing continuation proposal is to complete an investigation that should considerably expand our knowledge regarding the prophylactic capacity of maintenance interpersonal psycotherapy (IPT-M) in women suffering from recurrent depression. In order to determine whether higher """"""""doses"""""""" of IPT-M than were employed in our earlier maintenance trial can further extend survival time, depressed women in at least their second episode of unipolar depression are randomly assigned to one of three levels of IPT-M (high dose = weekly; medium dose = biweekly; low dose = monthly) after weekly acute and continuation interpersonal psychotherapy (IPT - Klerman et al., 1984). We hypothesize that increased frequency of IPT-M will be associated with longer time to recurrence and fewer instances of symptomatic exacerbation not meeting criteria for a new episode. We further hypothesize that three variables are likely to moderate this effect: 1) women in patient/therapist dyads rated as low on specificity of IPT during maintenance treatment; 2) women who experience more severely stressful life events during the maintenance phase; and 3) women with reduced delta sleep at pretreatment baseline will all show shorter time to recurrence. By limiting our investigation to those women with recurrent depression who respond to acute IPT, we focus our investigation on the population most likely to benefit from nonpharmacologic maintenance strategies. To our knowledge, no group has yet reported data on maintenance psychotherapy outcome in depression following acute treatment with psychotherapy alone, nor is any other group currently carrying out or planning such an investigation. Thus, when completed, this study will provide unique information regarding the efficacy of psychotherapy alone as a treatment strategy in women with recurrent depression.
Showing the most recent 10 out of 11 publications
