The treatment of chronic depression, part 2: A double-blind, randomized trial of sertraline and imipramine

被引:137
作者
Keller, MB
Gelenberg, AJ
Hirschfeld, RMA
Rush, AJ
Thase, ME
Kocsis, JH
Markowitz, JC
Fawcett, JA
Koran, LM
Klein, DN
Russell, JM
Kornstein, SG
McCullough, JP
Davis, SM
Harrison, WM
机构
[1] Brown Univ, Butler Hosp, Dept Psychiat & Human Behav, Providence, RI 02912 USA
[2] Univ Arizona, Hlth Sci Ctr, Dept Psychiat, Tucson, AZ USA
[3] Univ Texas, Med Branch, Dept Psychiat & Behav Sci, Galveston, TX 77550 USA
[4] Univ Texas, SW Med Ctr, Dept Psychiat, Dallas, TX USA
[5] Univ Pittsburgh, Sch Med, Pittsburgh, PA USA
[6] Western Psychiat Inst & Clin, Pittsburgh, PA USA
[7] Cornell Univ, Sch Med, Dept Psychiat, New York, NY 10021 USA
[8] Rush Presbyterian St Lukes Med Ctr, Dept Psychiat, Chicago, IL 60612 USA
[9] Stanford Univ, Sch Med, Dept Psychiat, Stanford, CA 94305 USA
[10] SUNY Stony Brook, Dept Psychiat, Stony Brook, NY 11794 USA
[11] Virginia Commonwealth Univ, Med Coll Virginia, Dept Psychiat, Richmond, VA 23298 USA
[12] Quintiles Inc, Res Triangle Pk, NC USA
[13] Pfizer Inc, New York, NY USA
[14] Columbia Univ Coll Phys & Surg, Sch Med, New York, NY 10032 USA
关键词
D O I
10.4088/JCP.v59n1107
中图分类号
B849 [应用心理学];
学科分类号
040203 ;
摘要
Background: Chronic depression appears to be a common, frequently disabling illness that is often inadequately treated. Unlike episodic depressions with shorter illness duration, neither acute nor long-term treatment approaches for chronic depression have been well studied. Method: 635 outpatients at 12 sites who met DSM-III-R criteria for chronic major depression or double depression were randomly assigned to 12 weeks of double-blind treatment with either sertraline (in daily doses of 50-200 mg) or imipramine (in daily doses of 50-300 mg). Efficacy and safety were assessed either weekly or every 2 weeks during the 12 weeks of acute treatment. Results: Despite high rates of chronicity (mean duration of major depression = 8.9 +/- 9.1 years: mean duration of dysthymia = 23 +/- 13 years) and high rates of comorbidity, 52% of patients achieved a satisfactory therapeutic response to sertraline or imipramine (by a conservative, intent-to-treat analysis). Approximately 21% of the patients who had achieved a therapeutic response at week 12 had not done so at week 8, confirming the longer time to response in depressions with high chronicity. Patients treated with sertraline reported significantly fewer adverse events and were significantly less likely to discontinue treatment due to side effects than imipramine-treated patients (6.3% vs. 12.0%). Conclusion: These results indicate that patients suffering from depression with high chronicity can achieve a good therapeutic response to acute treatment with either sertraline or imipramine, although sertraline is better tolerated.
引用
收藏
页码:598 / 607
页数:12
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