Interpersonal Psychotherapy and Antidepressant Medication: Evaluation of a Sequential Treatment Strategy in Women With Recurrent Major Depression

Background: Few data are available to guide
treatment selection in major depression. With increasing pressure
to maximize the efficiency and minimize the costs of treatment,
it is important to have information that could guide treatment
selection or point to treatment strategies that have a high
probability of success.

Method: We used a successive cohort approach to
compare 2 highly similar groups of women with recurrent unipolar
disorder (DSM-III-R or DSM-IV): one in which the combination of
interpersonal psychotherapy (IPT) and pharmacotherapy was
initiated at the outset of treatment and a second in which IPT
alone was provided first and only those who did not remit with
IPT alone were offered the combination treatment.

Results: In the group in which the combination
was initiated at the outset of treatment (N = 180), the remission
rate was 66%, comparable to the remission rate observed in most
outpatient treatment studies of major depression. In contrast,
among the women in the second cohort who were first treated with
IPT alone and only those who did not remit were given combination
therapy (N = 159), the remission rate was 79%, significantly
greater than that observed in the group that received combination
treatment from the outset (chi² = 6.55, p = .02).

Conclusion: These results suggest that the
strategy of offering IPT to women with recurrent unipolar
disorder and, in the absence of remission, adding antidepressant
pharmacotherapy can be a highly effective treatment, one that may
be particularly attractive to women in the childbearing years.
Although slower in its onset of action, this sequential strategy
is likely to enable the clear majority of such women to achieve a
full remission of depressive symptoms.