The purpose of this controlled randomized 10 week trial is to compare the differential effectiveness of phenelzine (monoamine oxidase inhibitor (MAOI)). Cognitive therapy (CT), and pill placebo in reducing symptoms of outpatients with unipolar nonpsychotic major depressive disorder who meet Liebowitz et al.'s (1984, 1988) criteria for atypical depression. This study is important because atypical depression is a common, chronic, disabling illness that is responsive to treatment. Published findings suggest that atypical depression may be especially responsive to phenelzine (approximately 71%). Our pilot data suggest that approximately 85% of atYpical depressions respond to CT. If the response rate of atypical depressions treated with CT equals that of phenelzine, CT would represent an alternative treatment without the significant risks and side effects of an MAOI. This study is the first controlled trial evaluating the effectiveness of a psychotherapy for atypical depression although in practice many of these patients receive psychotherapy. This study is also the first comparison of CT and a MAOI.
Minor aims of the study include gathering preliminary data on: the effect of a diagnosed personality disorder on treatment, the characteristic profile of treatment responders, and the durability of treatment effects. One hundred twenty five male and female outpatients. Aged 20-65, with unipolar nonpsychotic atypical depression will be diagnosed and randomized to one treatment condition following a 14-day drug wash-out and exposure to a baseline run-in of a nonspecific treatment. Only patients whose symptoms fail to remit are randomized and treated. Manipulation checks on the adequacy of treatment include platelet inhibition levels and Cognitive Therapy Scale (CTS) scores. Dependent measures cover the following four areas: psychiatric diagnosis, symptom severity cognitions, and interpersonal functioning. The efficacy of treatment is assessed at randomization, weeks 2,4,8 and 10 or at end-point by a clinical evaluator blind to treatment assignment Multivariate, univariate and post hoc analyses are planned.

Agency
National Institute of Health (NIH)
Institute
National Institute of Mental Health (NIMH)
Type
Research Project (R01)
Project #
5R01MH045043-05
Application #
2246331
Study Section
Treatment Development and Assessment Research Review Committee (TDA)
Project Start
1989-05-01
Project End
1995-04-30
Budget Start
1993-05-01
Budget End
1995-04-30
Support Year
5
Fiscal Year
1993
Total Cost
Indirect Cost
Name
University of Texas Sw Medical Center Dallas
Department
Psychiatry
Type
Schools of Medicine
DUNS #
City
Dallas
State
TX
Country
United States
Zip Code
75390
Vittengl, Jeffrey R; Clark, Lee Anna; Jarrett, Robin B (2005) Validity of sudden gains in acute phase treatment of depression. J Consult Clin Psychol 73:173-82
Jarrett, R B; Kraft, D; Schaffer, M et al. (2000) Reducing relapse in depressed outpatients with atypical features: a pilot study. Psychother Psychosom 69:232-9
Jarrett, R B; Schaffer, M; McIntire, D et al. (1999) Treatment of atypical depression with cognitive therapy or phenelzine: a double-blind, placebo-controlled trial. Arch Gen Psychiatry 56:431-7
Jarrett, R B; Basco, M R; Risser, R et al. (1998) Is there a role for continuation phase cognitive therapy for depressed outpatients? J Consult Clin Psychol 66:1036-40
Jarrett, R B; Giles, D E; Gullion, C M et al. (1991) Does learned resourcefulness predict response to cognitive therapy in depressed outpatients? J Affect Disord 23:223-9
Jarrett, R B; Eaves, G G; Grannemann, B D et al. (1991) Clinical, cognitive, and demographic predictors of response to cognitive therapy for depression: a preliminary report. Psychiatry Res 37:245-60
Jarrett, R B (1990) Psychosocial aspects of depression and the role of psychotherapy. J Clin Psychiatry 51 Suppl:26-35;discussion 35-8