The finding that nonspecific supportive clinical management was superior to more specialized psychotherapies was opposite to the primary hypothesis and challenges assumptions about the effective ingredients of successful treatments for anorexia nervosa.

Objective: The first objective of this paper was to describe the pattern of remission, response and recovery in patients with major depression who were randomised for treatment with fluoxetine or nortriptyline. The second objective was to report on the demographic and diagnostic predictors of the response and recovery in these depressed patients. Method: One hundred and ninety-five patients with major depression were recruited for this outpatient study. After a detailed clinical and neurobiological evaluation patients were randomized to receive either fluoxetine or nortiptyline as an initial antidepressant treatment. Results: Of the 195 depressed patients randomised to treatment, 154 completed an adequate 6-week trial of either fluoxetine or nortriptyline as their initial antidepressant. Of the 41 patients who did not complete an adequate trial the dropout rate was higher on those randomized to nortriptyline (p = 0.02). There was also an important interaction of drug and gender in determining dropouts in that women did not complete an adequate trial with nortriptyline and men did not complete an adequate trial with fluoxetine (p = 0.002). Of the 154 patients who completed an adequate 6-week antidepressant trial there were no significant differences in 6-week measures of depression severity or of percentage improvement. However, if we use an intention to treat analysis and dichotomise outcomes into response, remission or recovery; then recovery rates were significantly higher with fluoxetine than nortriptyline (p = 0.005). Using an intention to treat analysis fluoxetine was superior to nortriptyline in women, in those less than 25-years old, and in those with atypical depression. Independent of drug, those with chronic depressions had a poorer outcome. Conclusion: In this sample of depressed patients randomized to nortriptyline or fluoxetine the change in depressive symptoms over 6 weeks were comparable between fluoxetine and nortriptyline. However, when we look at the more clinically important variable of recovery then fluoxetine was superior to nortriptyline. Predictors of a poorer response to nortriptyline were gender, young age and atypical depression. The results challenge traditional beliefs that selective serotonin re-uptake inhibitors (SSRIs) and tricyclic antidepressant have comparable efficacy.

Possible effective components of SSCM are discussed.

The majority of patients with bipolar disorder have onset prior to twenty years with early onset associated with increased impairment. Despite this, little attention has been given to the psychosocial developmental impact of this disorder. This qualitative study explored the impact of having bipolar disorder on the development of a sense of self and identity. Key findings from this qualitative study identified that for these participants, bipolar disorder had a significant impact in the area of self and identity development. Bipolar disorder created experiences of confusion, contradiction, and self doubt which made it difficult for these participants to establish continuity in their sense of self. Their lives were characterized by disruption and discontinuity and by external definitions of self based on their illness. Developing a more integrated self and identity was deemed possible through self-acceptance and incorporating different aspects of themselves. These findings would suggest that it is critical to view bipolar disorder within a psychosocial developmental framework and consider the impact on the development of self and identity. A focus on the specific areas of impact and targeting interventions that facilitate acceptance and integration thus promoting self and identity development would be recommended.

Objective: To evaluate the long-term efficacy of three psychotherapies for anorexia nervosa.Method: Participants were women with broadly defined anorexia nervosa who had participated in a RCT comparing specialized psychotherapies (cognitive behavior therapy, CBT, and interpersonal psychotherapy, IPT) with a control condition (specialist supportive clinical management, SSCM), and attended long-term follow-up assessment (mean 6.7 years 6 1.2).Results: Forty three of the original sample of 56 women participated in longterm follow-up assessment (77%). No significant differences were found on any pre-selected primary, secondary or tertiary outcome measures among the three psychotherapies at long-term follow-up assessment. Significantly different patterns of recovery were identified for the psychotherapies across time on the primary global outcome measure. Although SSCM was associated with a more rapid response than IPT, by follow-up all three treatments were indistinguishable.Discussion: Potential implications for the timing of interventions to improve treatment response in anorexia nervosa are critically examined. V V C 2010 by Wiley Periodicals, Inc.

IPSRT and SSC used as an adjunct to pharmacotherapy appear to be effective in reducing depressive and manic symptoms and improving social functioning in adolescents and young adults with bipolar disorder and high rates of comorbidity. Identifying effective treatments that particularly address depressive symptoms is important in reducing the burden of bipolar disorder.

Background: Interpersonal psychotherapy and cognitive-behavioural therapy (CBT) are established as effective treatments for major depression. Controversy remains regarding their effectiveness for severe and melancholic depression. Aims:To compare the efficacy of interpersonal psychotherapy and CBT in people receiving out-patient treatment for depression and to explore response in severe depression (Montgomery-Åsberg Depression Rating Scale (MADRS) score above 30), and in melancholic depression. Method: Randomised clinical trial of 177 patients with a principal Axis I diagnosis of major depressive disorder receiving 16 weeks of therapy comprising 8 -19 sessions. Primary outcome was improvement in MADRS score from baseline to end of treatment. Results: There was no difference between the two psychotherapies in the sample as a whole, but CBT was more effective than interpersonal psychotherapy in severe depression, and the response was comparable with that for mild and moderate depression. Melancholia did not predict poor response to either psychotherapy. Conclusions: Both therapies are equally effective for depression but CBT may be preferred in severe depression. Declaration of interest: None.

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