Depression collaborative

Meyer, Bjorn, Paul A. Pilkonis, Janice L. Krupnick, Matthew K Egan, SamuelJ. Simmens, and Stuart M. Sotsky, Patient Alliance Treatment Expectancies, and Outcome Further Analyses, From the National Institute of Mental Health Treatment, of Depression Collaborative Research Program , Journal of Consulting and Clinical Psychology 70, no. 4 (2002), 1051-55... 

Sotsky, Stuart M., D. R. Glass, M. Tracie Shea, Paul A. Pilkonis, J. F. Collins, Irene Elkin, John T. Watkins, S. D. Imber, W. R. Leber and J. Moyer, Patient Predictors of Response to Psychotherapy and Pharmacotherapy Findings in the NIMH Treatment of Depression Collaborative Research Program , American Journal of Psychiatry 148 (1991) 997-1008... 

Comorbid personality disorders have long been associated with TRD and a poor response to antidepressant treatment. For example, Pfohl et al. (1984) observed only a 16% response rate in inpatients with comorbid depression and personality disorder compared with a 50% response rate in patients with pure depression. Similar results were reported from a study by D. W. Black et al. (1987), in which, with the use of ECT in addition to a TCA, the response rate among those with a comorbid Axis II disorder was lower, 42% compared with a 60% recovery in those without Axis II pathology. The best approach for these patients may be a combination of psychotherapy and medication. This approach was recently borne out by the Treatment of Depression Collaborative Research Project (Shea et al. 1990), which found that cognitive-behavioral therapy yielded a better response than either imipra-... 

EUdn I, Shea T, Watkins JT, et al National Institute of Mental Health Treatment of Depression Collaborative Research Program general effectiveness of treatments. Arch Gen Psychiatry 46 971-982, 1989... 

Shea MT, Pilkonis PA, Beckham E, et al Personality disorders and treatment outcome in the NIMH treatment of depression collaborative research program. Am J Psychiatry 147 711-718, 1990... 

Elkin I.. Shea, T., Watkins, J. f., et ah Initial severity and different treatment outcome in the National Institute of Mental Health treatment of depression collaborative research program. J. Consult. Clin. Psychol. 63, 841-847, 1995. 

The study by Elkin et al. (391) from the National Institute of Mental Health Treatment of Depression Collaborative Research Program suggested that antidepressants had superior efficacy in the treatment of moderate to more severe episodes of major depression (i.e., 17-item HDRS score of 20 or more). In response to that claim, DeRubeis et al. (396) performed a metaanalysis of four studies and found that CBT was as effective as several different antidepressants in such cases. More recently, Keller et al. (397) found that a variant of CBT called cognitive-behavioral analyses (CBAS) therapy was as effective as nefazodone (mean dose = 460 mg per day) in producing both response and remission in outpatients with moderate to more severe chronic depression. 

Furukawa, T. A., Kitamura, T. Takahashi, K. (2000). Treatment received by depressed patients in Japan and its determinants naturalistic observation from multi-center collaborative follow-up study. /. Affect. Disord., 60(3), 173-9. 

Versiani, M., Amrein, R., and Stahl, M. (1997) Moclobemide and imiptamine in chtonic depression (dysthymia) an international double-blind, placebo-controlled trial. International Collaborative Study Gtoup. Int Clin Psychopharmacol 12 183-193. 

Although studies reviewed thus far support the efficacy of lithium treatment for acute mania, the presence of concurrent depression or depressive symptoms during mania, the so-called mixed state, has been associated with poor lithium response. In 1976, Himmelhoch et al. observed that patients with mixed states were significantly less likely to demonstrate a good treatment response than were manic patients [42% vs. 81%] in a retrospective chart review of 84 consecutively referred patients with bipolar disorder. Secunda et al. [1985] reported on 18 patients with mania studied as part of the Collaborative Study of the Psychobiology of Depression and found that patients with concomitant depression and mania [n = 8] had a significantly lower rate of... 

Mendlewicz J, Kerkhofs M Sleep electroencephalography in depressive illness a collaborative study by the World Health Organization. Br J Psychiatry 159 505-509, 1991... 

Results of a National Institute of Mental Health collaborative study indicated that antidepressant therapy should not be discontinued before 4-5 symptom-free months have passed (Prien and Kupfer 1986). Most clinicians treat single episodes of depression for a minimum of 6 months. In most cases, antidepressant medication should be continued at the same dose that resulted in remission—hence the saying, what gets you well keeps you well. ... 

A collaborative VA study (364) found that the addition of imipramine or a monoamine oxidase inhibitor to CPZ did not benefit chronic psychotic patients any more than CPZ alone. Further, the addition of an amphetamine was slightly harmful. This finding has since been replicated in several studies on apathetic schizophrenic patients (365). A study of chronic ambulatory schizophrenics compared amitriptyline plus perphenazine with perphenazine alone ( 366). While they found the combination slightly better in ameliorating depressive symptoms, it was at the cost of a slight increase in patients thought disorder. 

Another approach is to develop selective and reversible MAOIs. The goal again is to produce agents with a minimal risk of tyramine reactions and thus markedly diminish the need for the dietary restrictions that have plagued the use of nonselective and irreversible A, B inhibitors. Collaborative clinical trials of the reversible inhibitors of monoamine oxidase A (RIMAs) in Europe have included more than 2,000 patients, many hospitalized for more severe, endogenous depressive episodes (183). In comparison trials with the TCAs, the onset of effect with RIMAs was also more rapid in some cases. 

Rickels K, Gordon PE, Weiss CC, et al. Amitriptyline and trimipramine in neurotic depressed patients a collaborative study. Am J Psychiatry 1970 127 208-218. 

Zarate and his collaborators (301) conducted a systematic follow-up study, evaluating the number of hospitalizations in the 5 years before clozapine compared with the rehospitalization rate while on this agent. These authors found that monotherapy with clozapine reduced both the number of episodes and rehospitalizations in 17 previously severely ill affective patients. The yearly rate before clozapine was 0.8 1.2 and after clozapine 0.4 1.2, a difference that was statistically significant. Rehospitalization rates were lowest in the schizophrenic, schizoaffective bipolar, and schizoaffective depressed patients, whereas unipolar and bipolar depressed patients had the highest relapse rate. 

Using subjects from the European Collaborative Project on Affective Disorders, Lerer et al. (109) reported a significant excess of the Ser23 allele in 513 patients with recurrent major depression (p = 0.006) and 649 patients with bipolar disorder (p = 0.02) vs 901 normal controls. There was also considerable variability in the frequency of this allele across ethic groups. 

Dietary Supplements are collaborating on a study to evaluate the efficacy and safety of standardized extract of Hypericum in major depression. 

Prien, R. F., Caffey, E. M., Jr., Klett, C. J. 1973, Prophylactic efficacy of lithium carbonate in manic-depressive illness. Report of the Veterans Administration and National Institute of Mental Health collaborative study group, Arch.Gen.Psychiatry, vol. 28, no. 3, pp. 337-341. 

The viewpoint of the editorial is so warped that it does not even mention that the FDA also found that the vast majority of clinical trials showed that antidepressants are ineffective in treating depression in children. As already noted, only 3 of 15 placebo-controlled clinical trials showed any efficacy. (Two of the three positive studies were sponsored by Eli Lilly, with Graham Emlsie, a close Lilly collaborator, as the first author see subsequent discussion.) Also remember FDA committee member and epidemiologist Thomas Newman s (2004) observations that the adverse effects of the antidepressants were much better established than their efficacy, which could largely be accounted for by the placebo effect. 

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