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Treatment of atypical depression: Post-hoc analysis of a randomized controlled study testing the efficacy of sertraline and cognitive behavioural therapy in mildly depressed outpatients

Published online by Cambridge University Press:  16 April 2020

V. Henkel ,
R. Mergl ,
A.-K. Allgaier ,
M. Hautzinger ,
R. Kohnen ,
J.C. Coyne ,
H.-J. Möller  and
U. Hegerl
V. Henkel
Affiliation:
Department of Psychiatry, Ludwig-Maximilians-University Munich, Nußbaumstr. 7, 80336Munich, Germany
R. Mergl*
Affiliation:
Department of Psychiatry, University of Leipzig, Semmelweisstr. 10, 04103Leipzig, Germany
A.-K. Allgaier
Affiliation:
Department of Child and Adolescent Psychiatry, Ludwig-Maximilians-University Munich, Pettenkoferstr. 8a, 80336Munich, Germany
M. Hautzinger
Affiliation:
Department of Psychology, Eberhard-Karls-University Tuebingen, Christophstr. 2, 72072Tuebingen, Germany
R. Kohnen
Affiliation:
RPS Research Germany GmbH, Scheurlstr. 21, 90478Nuremberg, Germany
J.C. Coyne
Affiliation:
Department of Psychiatry, University of Pennsylvania Health System, 11 Gates, 3400 Spruce Street, PA-19104Philadelphia, USA
H.-J. Möller
Affiliation:
Department of Psychiatry, Ludwig-Maximilians-University Munich, Nußbaumstr. 7, 80336Munich, Germany
U. Hegerl
Affiliation:
Department of Psychiatry, University of Leipzig, Semmelweisstr. 10, 04103Leipzig, Germany
*
*Corresponding author. Tel.: +49 341 9724556; fax: +49 341 9724539. E-mail address: Roland.Mergl@medizin.uni-leipzig.de (R. Mergl).
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Abstract

Objective

Atypical features are common among depressed primary care patients, but clinical trials testing the efficacy of psychopharmacological and/or psychotherapeutic treatment are lacking. This paper examines the efficacy of sertraline and cognitive behavioural therapy (CBT) among depressed patients with atypical features.

Subjects and methods

Analyses involve a double-blind comparison of sertraline versus placebo (N = 47) and a single-blind comparison between CBT versus a guided self-help group (GSG) (N = 48), with primary efficacy endpoints being the Inventory of Depressive Symptomatology (IDSC) and Hamilton Depression Scale (HAMD-17).

Results

In intent-to-treat (ITT) analyses, the decrease on the IDSC scale (and HAMD-17) was greater after CBT compared to GSG: p = 0.01 (HAMD-17: p = 0.01). The difference between selective serotonin reuptake inhibitors (SSRI) versus placebo was not significant: p = 0.22 (HAMD-17: p = 0.36).

Limitations

The number of cases in each treatment group was small, thereby limiting statistical power. Patients medicated with sertraline were 10 to 15 years younger than those included in the other groups of treatment.

Conclusions

CBT may be an effective alternative to GSG for mildly depressed patients with atypical features. Although SSRI were not superior to placebo, it would be premature to rule out SSRI as efficacious in atypical depression.

Keywords

Atypical depressionPrimary health careSertralineCognitive behavioural therapyPost-hoc analysis
Type
Depression
Information
European Psychiatry , Volume 25 , Issue 8 , December 2010 , pp. 491 - 498
Copyright
Copyright © Elsevier Masson SAS 2010

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References

Akiskal, HS, Weise, REThe clinical spectrum of so-called “minor” depressions. Am J Psychother 1992; 46: 9–22.CrossRefGoogle ScholarPubMed
American Psychiatric Association. Diagnostic and statistical manual of mental disorders (DSM-IV). 4th ed. Washington, DC: APA; 1994.Google Scholar
Barrett, JE, Williams, JW Jr., Oxman, TE, Frank, E, Katon, W, Sullivan, Met al.Treatment of dysthymia and minor depression in primary care: a randomized trial in patients aged 18 to 59 years. J Fam Pract 2001; 50: 405–412.Google ScholarPubMed
Barrett, JE, Williams, JW Jr., Oxman, TE, Katon, W, Frank, E, Hegel, MTet al.The treatment effectiveness project. A comparison of the effectiveness of paroxetine, problem-solving therapy, and placebo in the treatment of minor depression and dysthymia in primary care patients: background and research plan. Gen Hosp Psychiatry 1999; 21: 260–273.CrossRefGoogle ScholarPubMed
Brewin, CR, Bradley, CPatient preferences and randomised clinical trials. BMJ 1989; 299: 313–315.CrossRefGoogle ScholarPubMed
DeRubeis, RJ, Gelfand, LA, Tang, TZ, Simons, ADMedications versus cognitive behavior therapy for severely depressed outpatients: mega-analysis of four randomized comparisons. Am J Psychiatry 1999; 156: 1007–1013.Google ScholarPubMed
Gueorguieva, R, Krystal, JHMove over ANOVA: progress in analyzing repeated-measures data and its reflection in papers published in the Archives of General Psychiatry. Arch Gen Psychiatry 2004; 61: 310–317.CrossRefGoogle ScholarPubMed
Hamilton, MA rating scale for depression. J Neurol Neurosurg Psychiatry 1960; 23: 56–62.CrossRefGoogle ScholarPubMed
Hautzinger, MCognitive behaviour therapy of depression. Weinheim: Beltz/PVU; 2003.Google Scholar
Hegerl, U, Hautzinger, M, Mergl, R, Kohnen, R, Schütze, M, Scheunemann, Wet al.Effects of pharmacotherapy and psychotherapy in depressed primary-care patients: a randomized, controlled trial including a patients’ choice arm. Int J Neuropsychopharmacol 2010; 13: 31–44.CrossRefGoogle ScholarPubMed
Henkel, V, Mergl, R, Coyne, JC, Kohnen, R, Allgaier, AK, Rühl, Eet al.Depression with atypical features in a sample of primary care outpatients: prevalence, specific characteristics and consequences. J Affect Disord 2004; 83: 237–242.CrossRefGoogle Scholar
Jarrett, RB, Kraft, D, Schaffer, M, Witt-Browder, A, Risser, R, Atkins, DHet al.Reducing relapse in depressed outpatients with atypical features: a pilot study. Psychother Psychosom 2000; 69: 232–239.CrossRefGoogle ScholarPubMed
Jarrett, RB, Schaffer, M, McIntire, D, Witt-Browder, A, Kraft, D, Risser, RCTreatment of atypical depression with cognitive therapy or phenelzine: a double-blind, placebo-controlled trial. Arch Gen Psychiatry 1999; 56: 431–437.CrossRefGoogle ScholarPubMed
Katon, W, Von Korff, M, Lin, E, Walker, E, Simon, GE, Bush, Tet al.Collaborative management to achieve treatment guidelines. Impact on depression in primary care. JAMA 1995; 273: 1026–1031.CrossRefGoogle ScholarPubMed
Lepine, JP, Gastpar, M, Mendlewicz, J, Tylee, ADepression in the community: the first pan-European study DEPRES (Depression Research in European Society). Int Clin Psychopharmacol 1997; 12: 19–29.CrossRefGoogle Scholar
Liebowitz, MR, Quitkin, FM, Stewart, JW, McGrath, PJ, Harrison, WM, Markowitz, JSet al.Antidepressant specificity in atypical depression. Arch Gen Psychiatry 1988; 45: 129–137.CrossRefGoogle ScholarPubMed
Lonnqvist, J, Sihvo, S, Syvalahti, E, Kiviruusu, OMoclobemide and fluoxetine in atypical depression: a double-blind trial. J Affect Disord 1994; 32: 169–177.CrossRefGoogle ScholarPubMed
Matza, LS, Revicki, DA, Davidson, JR, Stewart, JWDepression with atypical features in the National Comorbidity Survey: classification, description, and consequences. Arch Gen Psychiatry 2003; 60: 817–826.CrossRefGoogle ScholarPubMed
Mercier, MA, Stewart, JW, Quitkin, FMA pilot sequential study of cognitive therapy and pharmacotherapy of atypical depression. J Clin Psychiatry 1992; 53: 166–170.Google ScholarPubMed
Oxman, TE, Sengupta, ATreatment of minor depression. Am J Geriatr Psychiatry 2002; 10: 256–264.CrossRefGoogle ScholarPubMed
Pande, AC, Birkett, M, Fechner-Bates, S, Haskett, RF, Greden, JFFluoxetine versus phenelzine in atypical depression. Biol Psychiatry 1996; 40: 1017–1020.CrossRefGoogle ScholarPubMed
Paykel, ES, Freeling, P, Hollyman, JAAre tricyclic antidepressants useful for mild depression? A placebo controlled trial. Pharmacopsychiatry 1988; 21: 15–18.CrossRefGoogle ScholarPubMed
Quitkin, FM, McGrath, PJ, Stewart, JW, Harrison, W, Tricamo, E, Wager, SGet al.Atypical depression, panic attacks, and response to imipramine and phenelzine. A replication. Arch Gen Psychiatry 1990; 47: 935–941.CrossRefGoogle ScholarPubMed
Quitkin, FM, Stewart, JW, McGrath, PJ, Liebowitz, MR, Harrison, WM, Tricamo, Eet al.Phenelzine versus imipramine in the treatment of probable atypical depression: defining syndrome boundaries of selective MAOI responders. Am J Psychiatry 1988; 145: 306–311.Google ScholarPubMed
Rost, K, Zhang, M, Fortney, J, Smith, J, Coyne, J, Smith, GR Jr.er al.Persistently poor outcomes of undetected major depression in primary care. Gen Hosp Psychiatry 1998; 20: 12–20.CrossRefGoogle ScholarPubMed
Rush, AJ, Giles, DE, Schlesser, MA, Fulton, CL, Weissenburger, J, Burns, CThe inventory for depressive symptomatology (IDS): preliminary findings. Psychiatry Res 1986; 18: 65–87.CrossRefGoogle ScholarPubMed
Scott, J, Sensky, TMethodological aspects of randomized controlled trials of psychotherapy in primary care. Psychol Med 2003; 33: 191–196.CrossRefGoogle ScholarPubMed
Spitzer, RL, Kroenke, K, Linzer, M, Hahn, SR, Williams, JB, deGruy, FVet al.Health-related quality of life in primary care patients with mental disorders. Results from the PRIME-MD 1000 Study. JAMA 3rd 1995; 274: 1511–1517.CrossRefGoogle ScholarPubMed
Stewart, JW, Deliyannides, DA, McGrath, PJIs duloxetine effective treatment for depression with atypical features?. Int Clin Psychopharmacol 2008; 23: 333–336.CrossRefGoogle ScholarPubMed
Stewart, JW, Garfinkel, R, Nunes, EV, Donovan, S, Klein, DFAtypical features and treatment response in the National Institute of Mental Health Treatment of Depression Collaborative Research Program. J Clin Psychopharmacol 1998; 18: 429–434.CrossRefGoogle ScholarPubMed
Stewart, JW, McGrath, PJ, Fava, M, Wisniewski, SR, Zisook, S, Cook, Iet al.Do atypical features affect outcome in depressed outpatients treated with citalopram?. Int J Neuropsychopharmacol 2009. 10.1017/S1461145709000182Google ScholarPubMed
Trivedi, MH, Thase, ME, Fava, M, Nelson, CJ, Yang, H, Qi, Yet al.Adjunctive aripiprazole in major depressive disorder: analysis of efficacy and safety in patients with anxious and atypical features. J Clin Psychiatry 2008; 69: 928–936.CrossRefGoogle ScholarPubMed
Twisk, JWThe problem of evaluating the magnitude of tracking coefficients. Eur J Epidemiol 2003; 18: 1025–1026.CrossRefGoogle ScholarPubMed
Wittchen, HUReliability and validity studies of the WHO – composite international diagnostic interview (CIDI): a critical review. J Psychiatr Res 1994; 28: 57–84.CrossRefGoogle ScholarPubMed
World Health Organization. ICD-10: The ICD-10 classification of mental and behavioural disorders: clinical descriptions and diagnostic guidelines. London: Gaskell (Royal College of Psychiatrists); 1992.Google Scholar
World Health Organization. WHO info package: mastering depression in primary care. Frederiksborg: World Health Organization; 1998.Google Scholar
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