Efficacy of Combined Therapy and Pharmacotherapy for Depressed Patients with or without Personality Disorders

Kool, Simone; Dekker, Jack; Duijsens, Inge J.; Jonghe, Frans de; Puite, Barteld

doi:10.1080/10673220303950

Cited by 89 publications

(44 citation statements)

References 20 publications

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“…Many authors have found that concomitant personality disorders have negative effects on the treatment outcome of patients with major depression, both on depressive symptoms and on social functioning (51)(52)(53)(54). A study by Kool and others compared combined treatment and pharmacotherapy of depression, examining the effect of personality disorders on differences in clinical response (26). In patients with concomitant personality disorders, combined therapy was superior to pharmacotherapy in measures of global psychopathology, depressive symptoms, and quality of life.…”

Section: Discussionmentioning

confidence: 99%

Combined Treatment of Major Depression in Patients with Borderline Personality Disorder: A Comparison with Pharmacotherapy

et al. 2006

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Objective: Combined treatment with psychotherapy and antidepressants is more effective than monotherapies. Recent data show that combined therapy has better results in patients with depression and Axis II codiagnosis. The aim of this study was to compare combined treatment using interpersonal psychotherapy (IPT) with pharmacotherapy alone in patients with depression and borderline personality disorder (BPD).Methods: There were 39 consecutive outpatients diagnosed with BPD who presented with a major depressive episode enrolled in this study. They were randomly assigned to 1 of 2 treatment groups: fluoxetine 20 mg to 40 mg daily or fluoxetine 20 mg to 40 mg daily plus IPT 1 session weekly. Owing to noncompliance, 7 patients dropped out. We assessed the 32 patients who completed the 24 weeks of treatment at baseline, Week 12, and Week 24, using a semistructured interview for clinical characteristics, the Clinical Global Impression Scale (CGI), the Hamilton Depression Rating Scale (HDRS), and the Hamilton Anxiety Rating Scale (HARS), and 2 self-report questionnaires, that is, the Satisfaction Profile (SAT-P) for quality of life and the 64-item Inventory for Interpersonal Problems (IIP-64). We performed statistical analysis, using univariate general linear models with 2 factors: duration and type of treatment.Results: Changes in remission rates, CGI, and HARS score did not differ between treatments. According to changes in the HDRS scores; changes in psychological functioning and social functioning scores on the SAT-P; and changes in vindictive or self-centred, cold or distant, intrusive or needy, and socially inhibited scores on the IIP-64, combined therapy was superior to fluoxetine alone. Conclusions:Combined therapy with IPT is more effective than antidepressant therapy alone, both in treating symptoms of major depression and in improving dimensions of quality of life and interpersonal functioning. Clinical implications· Combining fluoxetine and IPT is a more effective treatment of major depression symptoms in patients with BPD than fluoxetine alone. · Combined treatment produces more significant improvements in quality of life and interpersonal functioning in patients with BPD suffering from depression. · Combined therapy with fluoxetine and IPT can be considered a treatment of choice for major depression with BPD. Limitations· The sample size was relatively small; thus, conclusive statements cannot be made. · We did not compare combined therapy and IPT alone. · Follow-up data on recurrences of major depressive episodes have not yet been analyzed.

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Section: Discussionmentioning

confidence: 99%

Combined Treatment of Major Depression in Patients with Borderline Personality Disorder: A Comparison with Pharmacotherapy

et al. 2006

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“…The psychotherapy consisted of sixteen sessions of short-term, supportive PDT. A range of trials and studies have demonstrated its effectiveness in the treatment of depression [7,9,38,42,43,44,45,46,47,48,49,50,51,52]. The first eight sessions took place weekly, the last eight fortnightly.…”

Section: Methodsmentioning

confidence: 99%

What Is the Best Sequential Treatment Strategy in the Treatment of Depression? Adding Pharmacotherapy to Psychotherapy or Vice Versa?

Dekker

Van

Hendriksen

et al. 2012

Psychother Psychosom

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Background: Insufficient response to monotreatment for depression is a common phenomenon in clinical practice. Even so, evidence indicating how to proceed in such cases is sparse. Methods: This study looks at the second phase of a sequential treatment algorithm, in which 103 outpatients with moderately severe depression were initially randomized to either short-term supportive psychodynamic therapy (PDT) or antidepressants. Patients who reported less than 30% symptom improvement after 8 weeks were offered combined treatment. Outcome measures were the Hamilton Depression Rating Scale (HAM-D), the Clinical Global Impression of Severity and Improvement, the SCL-90 depression subscale and the EuroQOL questionnaire. Results: Despite being nonresponsive, about 40% of patients preferred to continue with monotherapy. At treatment termination, patients initially randomized to PDT had improved more than those initially receiving antidepressants, as indicated by the HAM-D and the EuroQOL, independently of whether the addition was accepted or not. Conclusions: Starting with psychotherapy may be preferable in mildly and moderately depressed outpatients. For patients who receive either PDT or antidepressants, combined therapy after early nonresponse seems to be helpful. Nevertheless, this sequential strategy is not always preferred by patients.

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“…There is some controversy on the response of depressed patients with personality disorders to individual treatment. Some found that their response to the combination of psychotherapy and treatment with antidepressants is superior compared with antidepressant treat-ment alone [31] , while others found that patients with long-term psychodynamic psychotherapy alone improved more on the HAM-D score than psychodynamic psychotherapy combined with medication [32] . Therefore, the assessment of personality disorders and defensive functioning could be useful in choosing between various treatments for depression.…”

Section: Discussionmentioning

confidence: 99%

Trait Anxiety and Defensive Functioning in Relation to Antidepressant Treatment Outcome

Sukul¹,

Birkenhäger²,

Broek³

et al. 2009

Psychopathology

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Background: Depression can occur in patients with or without trait anxiety. Although it is assumed that assessment of defenses can be useful in planning biological treatment, no studies have confirmed this hypothesis. In this study we focus on the relation between trait anxiety and defensive functioning, and on the combined influence of these personality characteristics on response to antidepressants among inpatients with a major depressive episode. Methods: Major depressive episode was diagnosed using the Schedule for Affective Disorders and Schizophrenia (SADS) and the severity of the depression was measured with the Hamilton Rating Scale for Depression (HAM-D). The level of trait anxiety was assessed using a questionnaire with 34 questions pertaining to trait anxiety. The Defense Style Questionnaire (DSQ 88) was used to assess defensive functioning followed by a weighted overall defensive functioning score (ODF). Partial correlations and multiple regression analyses were used to analyze the data. Results: The final sample included 85 patients. A significant negative effect of trait anxiety by ODF (p: 0.000) was found on the outcome score, i.e. the combination of a high score on trait anxiety and a low score on the ODF resulted in a significantly higher final score on the HAM-D. Conclusions: The most important finding in this study is that the combination of a high level of trait anxiety and immature defensive functioning evidently had a negative effect on antidepressant treatment outcome.

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Efficacy of Combined Therapy and Pharmacotherapy for Depressed Patients with or without Personality Disorders

Cited by 89 publications

References 20 publications

Combined Treatment of Major Depression in Patients with Borderline Personality Disorder: A Comparison with Pharmacotherapy

Combined Treatment of Major Depression in Patients with Borderline Personality Disorder: A Comparison with Pharmacotherapy

What Is the Best Sequential Treatment Strategy in the Treatment of Depression? Adding Pharmacotherapy to Psychotherapy or Vice Versa?

Trait Anxiety and Defensive Functioning in Relation to Antidepressant Treatment Outcome

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