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Antidepressant medications v. cognitive therapy in people with depression with or without personality disorder

Published online by Cambridge University Press:  02 January 2018

Jay C. Fournier ,
Robert J. DeRubeis ,
Richard C. Shelton ,
Robert Gallop ,
Jay D. Amsterdam  and
Steven D. Hollon
Jay C. Fournier
Affiliation:
Department of Psychology, University of Pennsylvania, Philadelphia, Pennsylvania
Robert J. DeRubeis*
Affiliation:
Department of Psychology, University of Pennsylvania, Philadelphia, Pennsylvania
Richard C. Shelton
Affiliation:
Department of Psychiatry, Vanderbilt University, Nashville, Tennessee
Robert Gallop
Affiliation:
Department of Mathematics and Applied Statistics, West Chester University, West Chester, Pennsylvania
Jay D. Amsterdam
Affiliation:
Department of Psychiatry, University of Pennsylvania, Philadelphia, Pennsylvania
Steven D. Hollon
Affiliation:
Department of Psychology, Vanderbilt University, Nashville, Tennessee, USA
*
Robert J. DeRubeis, Department of Psychology, University of Pennsylvania, Philadelphia, PA 19104-6196, USA. Email: [email protected]
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Abstract

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Background

There is conflicting evidence about comorbid personality pathology in depression treatments.

Aims

To test the effects of antidepressant drugs and cognitive therapy in people with depression distinguished by the presence or absence of personality disorder.

Method

Random assignment of 180 out-patients with depression to 16 weeks of antidepressant medication or cognitive therapy. Random assignment of medication responders to continued medication or placebo, and comparison with cognitive therapy responders over a 12-month period.

Results

Personality disorder status led to differential response at 16 weeks; 66% v. 44% (antidepressants v. cognitive therapy respectively) for people with personality disorder, and 49% v. 70% (antidepressants v. cognitive therapy respectively) for people without personality disorder. For people with personality disorder, sustained response rates over the 12-month follow-up were nearly identical (38%) in the prior cognitive therapy and continuation-medication treatment arms. People with personality disorder withdrawn from medication evidenced the lowest sustained response rate (6%). Despite the poor response of people with personality disorder to cognitive therapy, nearly all those who did respond sustained their response.

Conclusions

Comorbid personality disorder was associated with differential initial response rates and sustained response rates for two well-validated treatments for depression.

Type
Papers
Information
The British Journal of Psychiatry , Volume 192 , Issue 2 , February 2008 , pp. 124 - 129
Copyright
Copyright © Royal College of Psychiatrists, 2008 

References

1 American Psychiatric Association. Practice guideline for the treatment of patients with major depressive disorder (revision). Am J Psychiatry 2000; 157: 49.Google Scholar
2 Elkin, I, Shea, MT, Watkins, JT, Imber, SD, Sotsky, SM, Collins, JF, Glass, DR, Pilkonis, PA, Leber, WR, Docherty, JP. National Institute of Mental Health Treatment of Depression Collaborative Research Program: General effectiveness of treatments. Arch Gen Psychiatry 1989; 46: 971–82.CrossRefGoogle ScholarPubMed
3 Hollon, SD, Jarrett, RB, Nierenberg, AA, Thase, ME, Trivedi, M, Rush, AJ. Psychotherapy and medication in the treatment of adult and geriatric depression: which monotherapy or combined treatment? J Clin Psychiatry 2005; 66: 455–68.CrossRefGoogle ScholarPubMed
4 Hardy, GE, Barkham, M, Shapiro, DA, Stiles, WB, Rees, A, Reynolds, S. Impact of Cluster C personality disorders on outcomes of contrasting brief psychotherapies for depression. J Consult Clin Psychol 1995; 63: 997–1004.CrossRefGoogle ScholarPubMed
5 Kool, S, Schoevers, R, de Maat, S, Van, R, Molenaar, P, Vink, A, Dekker, J. Efficacy of pharmacotherapy in depressed patients with and without personality disorders: A systematic review and meta-analysis. J Affect Disord 2005; 88: 269–78.CrossRefGoogle ScholarPubMed
6 Newton-Howes, G, Tyrer, P, Johnson, T. Personality disorder and the outcome of depression: meta-analysis of published studies. Br J Psychiatry 2006; 188: 13–20.CrossRefGoogle ScholarPubMed
7 DeRubeis, RJ, Hollon, SD, Amsterdam, JD, Shelton, RC, Young, PR, Salomon, RM, O'Reardon, JP, Lovett, ML, Gladis, MM, Brown, LL, Gallop, R. Cognitive therapy vs medications in the treatment of moderate to severe depression. Arch Gen Psychiatry 2005; 62: 409–16.CrossRefGoogle ScholarPubMed
8 Hollon, SD, DeRubeis, RJ, Shelton, RC, Amsterdam, JD, Salomon, RM, O'Reardon, JP, Lovett, ML, Young, PR, Haman, KL, Freeman, BB, Gallop, R. Prevention of relapse following cognitive therapy vs medications in moderate to severe depression. Arch Gen Psychiatry 2005; 62: 417–22.CrossRefGoogle ScholarPubMed
9 First, M, Spitzer, R, Gibbon, M, Williams, J. Structured Clinical Interview for DSM–IV–TR – Axis I Disorders, Research Version, Patient Edition with Psychotic Screen (SCID–I/P W/PSY SCREEN). Biometrics Research, New York State Psychiatric Institute, 2001.Google Scholar
10 Hamilton, M. A rating scale for depression. J Neurol Neurosurg Psychiatry 1960; 23: 56–62.CrossRefGoogle ScholarPubMed
11 Spitzer, R, Williams, J, Gibbon, M, First, M. Structured Clinical Interview for DSM–II–R Personality Disorders (SCID–II, Version 1.0). American Psychiatric Press, 1990.Google Scholar
12 Doyle, TJ, Tsuang, MT, Lyons, MJ. Comorbidity of depressive illnesses and personality disorders. In Comorbidity in Affective Disorders (ed Tohen, M): 105–156. Marcel Dekker Inc., 1999.Google Scholar
13 Keller, MB, Lavori, PW, Friedman, B, Nielsen, E, Endicott, J, McDonald-Scott, P, Andreasen, NC. The Longitudinal Interval Follow-up Evaluation. A comprehensive method for assessing outcome in prospective longitudinal studies. Arch Gen Psychiatry 1987; 44: 540–8.CrossRefGoogle ScholarPubMed
14 Kuritz, S, Landis, J, Koch, G. A General overview of Mantel-Haenszel methods: applications and recent developments. Ann Rev Public Health 1988; 9: 123–60.CrossRefGoogle ScholarPubMed
15 Hosmer, D, Lemeshow, S. Applied Logistic Regression. Wiley, 1989.Google Scholar
16 Bryk, A, Raudenbush, S. Hierarchical Linear Modeling: Applications and Data Analysis Methods. Sage, 1996.Google Scholar
17 Goldstein, H. Models in Educational and Social Research. Oxford University Press, 1987.Google Scholar
18 Willett, JB. Measuring change: What individual growth modeling buys you. In Change and Development: Issues of Theory, Method, and Application. The Jean Piaget Symposium Series (eds Amsel, E, Renninger, KA): 213 243. Lawrence Erlbaum Associates, 1997.Google Scholar
19 Cox, D, Oakes, D. Analysis of Survival Data. Chapman & Hall, 1984.Google Scholar
20 Klein, DF. Preventing hung juries about therapy studies. J Consult Clin Psychol 1996; 64: 81–7.CrossRefGoogle ScholarPubMed
21 Tyrer, P, Seivewright, N, Ferguson, B, Murphy, S, Johnson, AL. The Nottingham study of neurotic disorder. Effect of personality status on response to drug treatment, cognitive therapy and self-help over two years. Br J Psychiatry 1993; 162: 219–26.CrossRefGoogle ScholarPubMed
22 Diggle, P, Kenward, MG. Informative drop-out in longitudinal data analysis. Appl Stat 1994; 43: 49–93.CrossRefGoogle Scholar
23 Gibbons, RD, Hedeker, D, Elkin, I, Waternaux, C, Kraemer, HC, Greenhouse, JB, Shea, MT, Imber, SD, Sotsky, SM, Watkins, JT. Some conceptual and statistical issues in analysis of longitudinal psychiatric data: Application to the NIMH Treatment of Depression Collaborative Research Program dataset. Arch Gen Psychiatry 1993; 50: 739–50.CrossRefGoogle Scholar
24 Rouillon, F. Depression comorbid with anxiety or medical illness: The role of paroxetine. Int J Psychiatry Clin Pract 2001; 5: 3–10.CrossRefGoogle ScholarPubMed
25 Johnson, PA, Hurley, RA, Benkelfat, C, Herpertz, SC, Taber, KH. Understanding emotion regulation in borderline personality disorder: contributions of neuroimaging. J Neuropsychiatry Clin Neurosci 2003; 15: 397–402.CrossRefGoogle ScholarPubMed
26 New, AS, Buchsbaum, MS, Hazlett, EA, Goodman, M, Koenigsberg, HW, Lo, J, Iskander, L, Newmark, R, Brand, J, O'Flynn, K, Siever, LI. Fluoxetine increases relative metabolic rate in prefrontal cortex in impulsive aggression. Psychopharmacology 2004; 176: 451–8.CrossRefGoogle ScholarPubMed
27 Salzman, C, Wolfson, AN, Schatzberg, A, Looper, J, Henke, R, Albanese, M, Schwartz, J, Miyawaki, E. Effect of fluoxetine on anger in symptomatic volunteers with borderline personality disorder. J Clin Psychopharmacol 1995; 15: 23–9.CrossRefGoogle ScholarPubMed
28 Wolff, MC, Leander, D. Selective serotonin reuptake inhibitors decrease impulsive behavior as measured by an adjusting delay procedure in the pigeon. Neuropsychopharmacology 2002; 27: 421–9.CrossRefGoogle ScholarPubMed
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