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Sertraline and/or interpersonal psychotherapy for patients with dysthymic disorder in primary care: 6-month comparison with longitudinal 2-year follow-up of effectiveness and costs
Abstract
Background There is little information on the long-term effects and costs of a combination of Sertraline and interpersonal psychotherapy (IPT) for the treatment of dysthymia in primary care.Methods In a single-blind, randomized clinical trial, 707 adults (18-74 years of age inclusive) with DSM-IV dysthymic disorder, with or without past and/or current major depression, as an acute or chronic episode, in a community-based primary care practice in Ontario, Canada, were randomized to treatment with either Sertraline alone (50-200 mg), or IPT alone (10 sessions), or Sertraline plus IPT combined. In the acute treatment phase (first 6 months) all groups received full active treatment. This was followed by an additional 18-month naturalistic follow-up phase. Subjects were assessed for effectiveness of treatment in reducing depressive symptoms using the Montgomery Asberg Depression Rating Scale (MADRS) at 6 months and twice again during the 18-month follow-up by blind independent observers. Treatment costs and subjects' use of other health and social services were also investigated.Results At 6 months, 586 subjects completed the MADRS questionnaire. There was a significant difference (P=0.025) in mean MADRS scores: 14.3 (Group I); 14.9 (Group II); 16.8 (Group III), using analysis of covariance. Response (40% improvement) rates were 60.2% for Sertraline alone, 46.6% for IPT alone, and 57.5% for Sertraline augmented by IPT (P=0.02). At 2 years, 525 subjects were retained for follow-up. There was no statistically significant difference between Sertraline alone and Sertraline plus IPT in symptom reduction. However, both were more effective than IPT alone in reducing depressive symptoms (P=0.03). There was a statistically significant difference between groups in costs for use of health and social services. The IPT treatment groups had the lower costs for use of health and social services.Conclusions Sertraline or Sertraline plus IPT was more effective than IPT alone after 6 months. Over the long term (2 years), all three treatments provide reasonably effective treatment for reducing symptoms of dysthymia, but Sertraline or combining Sertraline with IPT is more effective than IPT alone. Of these two more effective treatments, subjects in the Sertraline plus IPT group had less health and social service costs by $480 per person over 2 years. These findings underscore the effects of combining pharmacotherapy and psychotherapy and the economic value of this more comprehensive treatment of dysthymia in primary care.
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“Two empirically supported psychotherapies are designed for the treatment of chronic depression and dysthymia, i.e. interpersonal psychotherapy (IPT) and cognitive behavioural analysis system of psychotherapy (CBASP) [43,44].”
From Helpful and hindering factors for remission in dysthymia and panic disorder at 9-year follow-up: A mixed methods study (2008) · cites this paper as [43]
In the citing paper
“Both psychotherapies emphasize the importance of learning to resolve interpersonal problems as crucial for overcoming chronic depression.”
From Helpful and hindering factors for remission in dysthymia and panic disorder at 9-year follow-up: A mixed methods study (2008) · cites this paper as [43]
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“In terms of the long-term effects of the combination therapy, in treatment for DSM-IV dysthymic disorder in adults, combined sertraline (SSRI) and IPT therapy as well as sertraline alone were more effective than IPT alone at a 2-year naturalistic follow-up, and of these two effective treatment options the combination…”
BackgroundA comparative trial of psychotherapy and pharmacotherapy for “pure” dysthymic patients
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“Design = OT ▪ 3 months: weekly supervision in small groups Browne et al. (2002) 7 07 PC patients Individual 6 months (mean # sessions = 10) ▪ Response rates: 60.2% SE, 46.6% IPT, and 57.5% SE+IPT.”
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BackgroundResultEfficacy of Interpersonal Psychotherapy plus pharmacotherapy in chronically depressed inpatients
Schramm, E., Schneider, D., Zobel, I., van Calker, D., Dykierek, P., Kech, S., Härter, M., & Berger, M. (2008) · Journal of Affective Disorders · doi:10.1016/j.jad.2007.10.013 · Cited by 88
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“These 62 full-text articles were excluded for the following reasons: being reviews or meta-analyses [21-23,2530,32,34,53-60], being a protocol for a study [61], being a study based on earlier/other studies [43,45,62-76], there was no comparison in the study [77], MDD was not the primary diagnosis [78-82], the study ha…”
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Counselling for mental health and psychosocial problems in primary care
Bower, P., Knowles, S. E., Coventry, P. A., & Rowland, N. (2011) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd001025.pub3 · Cited by 83
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“01) after removal of the study by Browne and colleagues [26] and the greatest decrease (BR= 1.”
BackgroundMethodResultInfluentialDifferential effects of treatments for chronic depression: A latent growth model reanalysis.
Stulz, N., Thase, M. E., Klein, D. N., Manber, R., & Crits-Christoph, P. F. (2010) · Journal of Consulting and Clinical Psychology · doi:10.1037/a0019267 · Cited by 58
“, a less symptomatically severe form of chronic depression), which suggested pharmacotherapy (sertraline) to be superior to psychotherapy (IPT) alone, with only equivocal evidence of an additive effect (Browne et al., 2002; Markowitz et al., 2005).”
BackgroundEvidence-Based Applications of Combination Psychotherapy and Pharmacotherapy for Depression
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Baghai, T. C., Blier, P., Baldwin, D. S., Bauer, M., Goodwin, G. M., Fountoulakis, K. Ν., Kasper, S. F., Leonard, B. E., Malt, U. F., Stein, D. J., et al. (2011) · European Archives of Psychiatry and Clinical Neuroscience · doi:10.1007/s00406-011-0259-6 · Cited by 51
“, interpersonal psychotherapy, may be of use especially when combined with antidepressants [80], but specifically in dysthymic patients, the added value of psychotherapy may also be diminished in comparison to patients suffering from MDD without dysthymia [109].”
ResultInterpersonal psychotherapy for chronic depression
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“However, in a study of dysthymic patients ( Browne et al., 2002 ) involving a 6-month acute treatment phase comparing sertraline alone, IPT alone and combination treatment, responses were equivalent in the two groups taking medication, both of which were superior to IPT alone.”
BackgroundResultInfluentialEffectiveness and cost effectiveness of counselling in primary care
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Interpersonal psychotherapy for depressed older adults
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“Dropout rates also seem to vary according to treatment modality, with lower rates typically reported for combination treatments [12,13,18] and higher rates typically reported for group interventions [17,19,20].”
BackgroundResultSpezifische Therapie für chronische Depression
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Depression in the elderly: new concepts and therapeutic approaches
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An evidence-based review of the clinical use of sertraline in mood and anxiety disorders
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“An augmentation of response to sertraline by interpersonal psychotherapy was also reported in a 2-year, naturalistic study of primary-care patients (Browne et al., 2002), but not in a study of adolescents (12–18 years).”
BackgroundBreaking the Myths: New Treatment Approaches for Chronic Depression
Michalak, E. E., & Lam, R. W. M. (2002) · The Canadian Journal of Psychiatry · doi:10.1177/070674370204700705 · Cited by 36
“The second notable study in this area is Steiner and others’ recent Canadian trial of primary care patients with dysthymia (n = 707) ( 64 ).”
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“…Zhou et al, 2015) and adults (Schramm et al, 2008; Zobel et al., 2011; Toth et al., 2013; Lemmens et al, 2015), perinatal depression (Brandon et al., 2012; Reay et al., 2012), dysthymia (Browne et al., 2002), and eating disorders (Wilfley et al., 2002; Carter et al., 2011; Hilbert et al., 2012).”
BackgroundInterpersonal psychotherapy for depression and other disorders
Blanco, C., Markowitz, J. C., & Weissman, M. M. (2012) · doi:10.1093/med/9780199696758.003.0169 · Cited by 35
Cristea, I. A., Gentili, C., Pietrini, P., & Cuijpers, P. J. (2016) · The British Journal of Psychiatry · doi:10.1192/bjp.bp.115.179275 · Cited by 35
“…No No No No Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Overall Bedi et al (2000)24 Blackburn & Moore (1997)25 Blom et al (2007)26 Browne et al (2002)27 David et al (2008)28 Dekker (2008)29 DeRubeis et al (2005)30 Dunner et al (1996)33 Elkin et al (1989)34 Faramarzi et al…”
BackgroundLöwe, B., Karapanagiotou‐Schenkel, I., Bair, M. J., & Göbel, C. (2005) · Journal of Affective Disorders · doi:10.1016/j.jad.2005.05.005 · Cited by 31
de León, B. G., del Pino‐Sedeño, T., Serrano-Pérez, P., Álvarez, C. R., Bejarano‐Quisoboni, D., & Trujillo‐Martín, M. M. (2022) · BMC Psychiatry · doi:10.1186/s12888-022-04120-w · Cited by 36
“Table 2 Risk of bias of included RCTs Cluster-RCTs Study Domains Randomization process Identification and recruitment of participants Effect of assignment to intervention Missing outcome data Measurement of the outcome Selection of the reported result Akerblad 2003 [26] High Low Low Low Some concerns Low Chang 2014 [7…”
Aburizik, A., Dindo, L. N., Kaboli, P. J., Charlton, M. E., Klein, D. M., & Turvey, C. (2013) · Journal of Affective Disorders · doi:10.1016/j.jad.2013.06.028 · Cited by 25
Murray, G., Michalak, E. E., Axler, A., Yaxley, D., Hayashi, B., Westrin, Å., Ogrodniczuk, J. S., Tam, E. M., Yatham, L. N., & Lam, R. W. M. (2009) · Journal of Affective Disorders · doi:10.1016/j.jad.2009.10.015 · Cited by 25
“…of psychotherapy to medication has also been limited by potentially insufficient dose/duration of psychotherapy (Arnow and Constantino, 2003; Browne et al., 2002) and insufficient power given the likely shared placebo component of pharmacotherapy and psychotherapy (see Jindal and Thase,…”
Tröger, A., Miguel, C., Čihařová, M., de Ponti, N., Durman, G., Cuijpers, P. J., & Karyotaki, E. (2023) · Journal of Affective Disorders · doi:10.1016/j.jad.2023.10.047 · Cited by 24
Psychotherapie der chronischen Depression
Padberg, F., Sabaß, L., Dewald-Kaufmann, J., & Jobst, A. (2015) · Nervenheilkunde · doi:10.1055/s-0038-1627647 · Cited by 11
“Browne und Mitarbeiter (27) untersuchten 707 Patienten mit Dysthymie, die entweder Sertralin-Monotherapie, IPT alleine oder eine Kombination erhielten.”
BackgroundKriston, L., von Wolff, A., & Hölzel, L. P. (2010) · BMC Psychiatry · doi:10.1186/1471-244x-10-95 · Cited by 23
Improving work outcomes of dysthymia (persistent depressive disorder) in an employed population
Adler, D. A., Lerner, D., Visco, Z. L., Greenhill, A., Chang, H., Cymerman, E., Azocar, F., & Rogers, W. H. (2015) · General Hospital Psychiatry · doi:10.1016/j.genhosppsych.2015.04.001 · Cited by 23
van Schaik, A., van Marwijk, H., Beekman, A. T. F., de Haan, M., & van Dyck, R. (2007) · BMC Family Practice · doi:10.1186/1471-2296-8-52 · Cited by 20
Depressed Mothers, Depressed Children
Markowitz, J. C. (2008) · American Journal of Psychiatry · doi:10.1176/appi.ajp.2008.08060861 · Cited by 20
Depression in adults: psychological treatments and care pathways.
Price, J., Butler, R., Hatcher, S., & Korff, M. V. (2007) · PubMed Central · Cited by 19
Evidence-based psychotherapies for depression
Markowitz, J. C. (2008) · Journal of Occupational & Environmental Medicine · doi:10.1097/jom.0b013e318168f76e · Cited by 19
“Time-limited psychotherapies such as CBT and IPT have repeatedly demonstrated efficacy in a brief format, and may well repay their costs over time.(34,35) They may smooth difficulties and provide skills that forestall future depressive episodes, whereas pharmacotherapy works only as long as the patient continues to ta…”
BackgroundConstantino, M. J., Adams, M. L., Pazzaglia, A. M., Bernecker, S. L., Ravitz, P., & McBride, C. (2013) · Psychotherapy Research · doi:10.1080/10503307.2013.765997 · Cited by 17
“Other clinical characteristics related to worse outcome include chronicity and endogenous depression (Browne et al., 2002; Carter et al., 2011).”
BackgroundCuijpers, P. J., de Wit, L. M., Weitz, E. S., Andersson, G., & Huibers, M. J. H. (2015) · Research Publications (Maastricht University) · Cited by 17
Treatment of premenstrual dysphoric disorder with luteal phase dosing of sertraline
Halbreich, U. M., & Kahn, L. S. (2003) · Expert Opinion on Pharmacotherapy · doi:10.1517/14656566.4.11.2065 · Cited by 16
“It has also been reported to be efficacious as a treatment for dysthymic disorder [108-110], generalised anxiety disorder (GAD) and several other dysphoric disorders and situations.”
BackgroundSvanborg, C., Bäärnhielm, S., Åberg Wistedt, A., & Lützen, K. (2008) · BMC Psychiatry · doi:10.1186/1471-244x-8-52 · Cited by 14
“Two empirically supported psychotherapies are designed for the treatment of chronic depression and dysthymia, i.e. interpersonal psychotherapy (IPT) and cognitive behavioural analysis system of psychotherapy (CBASP) [43,44].”
BackgroundOtto, M. W., Smits, J. A. J., & Reese, H. E. (2006) · FOCUS The Journal of Lifelong Learning in Psychiatry · doi:10.1176/foc.4.2.204 · Cited by 15
Vega, B. R., Barnier, P. O., Bayón, C., Palao, Á., Torres, G. M., Benito, G., Diéguez, M. R., & Liria, A. F. (2011) · Psycho-Oncology · doi:10.1002/pon.2036 · Cited by 15
Clinical trials studying pharmacotherapy and psychological treatments alone and together
Haythornthwaite, J. A. (2005) · Neurology · doi:10.1212/wnl.65.12_suppl_4.s20 · Cited by 15
Byrne, C., BROWNE, G. B., Roberts, J. G., Mills, M., Bell, B. J., Gafni, A., Jamieson, E., & Webb, M. (2006) · Journal of the American Academy of Child & Adolescent Psychiatry · doi:10.1097/01.chi.0000190351.13818.d7 · Cited by 15
Self-citationvon Wolff, A., Jansen, M., Hölzel, L. P., Westphal, A., Härter, M. C., & Kriston, L. (2014) · Psychiatric Services · doi:10.1176/appi.ps.201300309 · Cited by 13
What Else Materially Influences What Is Represented and Published as Evidence?
Luborsky, L. B., Barrett, M. S., Antonuccio, D. O., Shoenberger, D., & Stricker, G. (2006) · American Psychological Association eBooks · doi:10.1037/11265-006 · Cited by 13
Berger, T., Brakemeier, E., Klesse, C., & Schramm, E. (2009) · Der Nervenarzt · doi:10.1007/s00115-008-2624-x · Cited by 12
McPherson, S., & Hengartner, M. (2019) · BJPsych Open · doi:10.1192/bjo.2019.65 · Cited by 10
Cohen, Z. D., Breunese, J., Markowitz, J. C., Weitz, E. S., Hollon, S. D., Browne, D. T., Rucci, P., Corda, C., Menchetti, M., Weissman, M. M., et al. (2024) · Psychological Medicine · doi:10.1017/s0033291724001788 · Cited by 12
“We consider the current finding preliminary as it was based only on three studies, in one of which antidepressants continued to be offered throughout the entire 2-year follow-up period whereas no additional IPT was provided (Browne et al., 2002).”
Bozzatello, P., & Bellino, S. (2020) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2020.578910 · Cited by 7
Interpersonal psychotherapy for depression
Law, R. (2011) · Advances in Psychiatric Treatment · doi:10.1192/apt.bp.109.007641 · Cited by 10
Moulding, R., Blashki, G. A., Gunn, J. M., Mihalopolous, C., Pirkis, J., Naccarella, L., & Joubert, L. (2007) · Deakin Research Online (Deakin University) · Cited by 10
Cognitive behavioral analysis system of psychotherapy for chronic depression
Arnow, B. A. (2005) · Cognitive and Behavioral Practice · doi:10.1016/s1077-7229(05)80035-5 · Cited by 10
Brief psychotherapies for depression: current status
Scott, J., & Watkins, E. (2004) · Current Opinion in Psychiatry · doi:10.1097/00001504-200401000-00002 · Cited by 13
Productivity Costs in Economic Evaluations
Krol, M. (2012) · RePub (Erasmus University Rotterdam) · Cited by 10
Metadata
- Authors
- Browne, G., Steiner, M., Roberts, J., Gafni, A., Byrne, C., Dunn, E., Bell, B., Mills, M., Chalklin, L., Wallik, D., & Kraemer, J.
- Affiliations
- McMaster University (CA)
- St. Joseph’s Healthcare Hamilton (CA)
- University of Toronto (CA)
- Corresponding author
- Browne, Gina
- Venue
- Journal of Affective Disorders
- Publisher
- Elsevier BV
- Published
- 2002-04
- Volume
- 68
- Issue
- 2-3
- Pages
- 317-330
- ISSN
- 0165-0327 (ISSN-L)
- OpenAlex
- W2038701603
- Cited by
- 199
- References
- 65
- Citations by year
- 2026: 2 · 2025: 1 · 2024: 7 · 2023: 3 · 2022: 2 · 2021: 3 · 2020: 7 · 2019: 5 · 2018: 1 · 2017: 4 · 2016: 6 · 2015: 9 · 2014: 10 · 2013: 14 · 2012: 9
- FWCI
- 7.32
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of Affective Disorders (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Pfizer
- Medical Research Council
- Topics
- Health Sciences › Medicine › Pharmacology (medical) › Treatment of Major Depression
- Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
- Health Sciences › Medicine › Psychiatry and Mental health › Mental Health Treatment and Access
- Keywords
- sertraline, interpersonal psychotherapy, dysthymia, major depressive disorder, combination pharmacotherapy, antidepressant augmentation, long-term treatment effectiveness, treatment costs, primary care, naturalistic follow-up, depressive symptoms, treatment response rate, relapse prevention, Ontario, Canada
- MeSH terms
- Adolescent, Adult, Aged, Canada, Combined Modality Therapy, Cost-Benefit Analysis, Depressive Disorder, Major, Major Depressive Disorder, Female, Follow-Up Studies, Humans, Male, Middle Aged, Patient Care Team, Primary Health Care, Psychotherapy, Single-Blind Method, Treatment Outcome, Dysthymic Disorder, Sertraline
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