The efficacy of long-term psychodynamic psychotherapy, fluoxetine and their combination in the outpatient treatment of depression

Abstract

Objective: There are few randomized controlled trials examining the efficacy of long-term psychodynamic psychotherapy (LTPP) in depression treatment. LTPP was compared with fluoxetine treatment and their combination; Methods: 272 depressed patients (aged 26–34, 72% with a first episode of depression) were randomized to receive LTPP (one session/week), fluoxetine treatment (20–60 mg/day) or their combination for 24 months. Beck Depression Inventory (BDI) was the outcome measure. The psychotherapy was not manualized and the treatment took place under real-life conditions in an outpatient psychiatric clinic. Results: Intention-to-treat analyses indicated that all the treatments were associated with significant reductions in the BDI scores (mean reduction of 18.88 BDI points). Furthermore, LTPP and combination therapy were more effective in reducing BDI scores than fluoxetine alone (22.08 and 22.04 vs. 12.53 BDI points). Conclusions: LTPP, pharmacological treatment with fluoxetine and their combination are effective in reducing symptoms of patients with moderate depression. LTPP and combined treatment were more effective compared to fluoxetine alone. These findings have implications for patients with depression who may benefit from long-term psychotherapy or combined treatment, or for depressed patients who do not wish to take medications such as fluoxetine.

Abstract

Objective: There are few randomized controlled trials examining the efficacy of long-term psychodynamic psychotherapy (LTPP) in depression treatment. LTPP was compared with fluoxetine treatment and their combination; Methods: 272 depressed patients (aged 26–34, 72% with a first episode of depression) were randomized to receive LTPP (one session/ week), fluoxetine treatment (20–60 mg/day) or their combination for 24 months. Beck Depression Inventory (BDI) was the outcome measure. The psychotherapy was not manualized and the treatment took place under real-life conditions in an outpatient psychiatric clinic. Results: Intention-to-treat analyses indicated that all the treatments were associated with significant reductions in the BDI scores (mean reduction of 18.88 BDI points). Furthermore, LTPP and combination therapy were more effective in reducing BDI scores than fluoxetine alone (22.08 and 22.04 vs. 12.53 BDI points). Conclusions: LTPP, pharmacological treatment with fluoxetine and their combination are effective in reducing symptoms of patients with moderate depression. LTPP and combined treatment were more effective compared to fluoxetine alone. These findings have implications for patients with depression who may benefit from long-term psychotherapy or combined treatment, or for depressed patients who do not wish to take medications such as fluoxetine.

Zusammenfassung:

Ziele: Es gibt nur wenige randomisierte kontrollierte Studien, welche die Effizienz von psychodynamischer Langzeit-Psychotherapie (LTPP) in der Behandlung von Depressionen untersuchen. LTPP wurde mit einer Fluoxetin-Behandlung und einer Kombination aus beiden verglichen. Methode: 272 depressive Patienten (Alter zwischen 26 und 34, 72% davon mit einer ersten Episode von Depression) erhielten randomisiert zugeordnet entweder die LTPP (eine Session pro Woche), die Fluoxetin-Behandlung (20-60mg pro Tag) oder eine Kombination aus beiden über einen Zeitraum von 24 Monaten. Das Outcome wurde mit Beck’s Depressionsinventar (BDI) erfasst. Die Psychotherapie war nicht manualisiert und die Behandlung fand unter realen Lebensbedingungen in einer ambulanten psychiatrischen Klinik statt. Ergebnisse: Intention-to-treat Analysen indizierten, dass alle Behandlungsformen mit einer signifikanten Reduktion des BDI-Scores assoziiert waren (mittlere Reduktion um 18.88 BDI-Punkte). Weiterhin reduzierten die LTPP und die kombinierte Behandlung effektiver den BDI-Score als die alleinige Fluoxetin-Behandlung (22.08 und 22.04 vs. 12.53 BDI-Punkte). Zusammenfassung: LTPP, pharmakologische Intervention und ihre Kombination reduzieren effektiv die Symptome von Patienten mit moderater Depression. Die LTPP und die kombinierte Behandlung waren effektiver im Vergleich zur alleinigen Fluoxetin-Behandlung. Diese Ergebnisse haben Implikationen für depressive Patienten, die eventuell von einer Langzeit-Therapie oder einer kombinierten Behandlung profitieren könnten, oder auch für depressive Patienten, welche keine Medikamente wie Fluoxetin einnehmen möchten.

Objetivo: Poucos estudos randomizados controlados examinaram a eficácia da psicoterapia psicodinâmica de longa duração (PPLD) no tratamento da depressão. A PPLD foi comparada com o tratamento com fluoxetina e com a combinação de ambas. Método: 272 pacientes deprimidos (com idades entre 26-34, 72% dos quais com um primeiro episódio de depressão) foram randomizados para receber um tratamento PPLD (uma sessão por semana), um tratamento com fluoxetina (20-60 mg/dia), ou a sua combinação, durante 24 meses. Foi usado o Beck Depression Inventory (BDI) como medida de resultado. A psicoterapia não foi manualizada e o tratamento ocorreu em condições de vida reais numa clínica psiquiátrica em ambulatório. Resultados: Análises por intenção de tratamento indicaram que todos os tratamentos foram associados a reduções significativas nas pontuações do BDI (redução média de 18.88 pontos). Além disto, a PPLD e a terapia combinada foram mais eficazes na redução da pontuação do BDI do que apenas a fluoxetina (22,08 e 22,04 vs. 12,53). Conclusões: A PPLD, o tratamento farmacológico com fluoxetina, e a sua combinação, são eficazes na redução dos sintomas de pacientes com depressão moderada. A PPLD e o tratamento combinado foram mais eficazes em comparação com o uso exclusivo de fluoxetina. Estas conclusões têm implicações para os pacientes com depressão que poderão beneficiar da psicoterapia de longa duração ou do tratamento combinado, ou para os pacientes deprimidos que não desejem tomar medicação como a fluoxetina.

目標：到目前為止鮮有以隨機控制組的方式檢視長期心理動力心理治療療效（LTPP）之研究。本研究比較LTPP和氟西汀（商品名為百憂解）處遇，以及結合兩者的治療效果。方法：272位憂鬱症病人（在26-34歲之間，72%為第一期憂鬱）被隨機分派至長期心理動力治療組（每週一次）、百憂解處遇組（20-60毫克/天）、或者結合兩者的治療，為期24個月。以貝克憂鬱量表為測量工具。心理治療並未依照標準化的手冊實施，而是在一般的精神科門診進行。結果：意向處理分析顯示，所有處遇在貝克憂鬱量表的分數皆有顯著性下降（憂鬱指數平均減少18.88）。更進一步，長期心理動力治療與結合兩者的治療，比起單獨使用百憂解，更能有效降低貝克憂鬱量表的分數（憂鬱指數減少22.08、22.04比12.53）。結論：長期心理動力治療、單獨使用百憂解藥物，以及結合兩者的治療皆能有效降低中度憂鬱患者的症狀，而長期心理動力治療和結合兩者的治療，比起單獨使用百憂解，更加有效。研究發現對於希望接受長期心理動力治療或結合長期心理治療與藥物的憂鬱症病人，或一些不願意使用藥物，例如百憂解的憂鬱症病人而言有所啟示。

Keywords:

• long-term psychodynamic psychotherapy
• fluoxetine
• depression