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December 1979

Differential Symptom Reduction by Drugs and Psychotherapy in Acute Depression

Author Affiliations

From the Department of Psychiatry (Psychopharmacology), Tufts University School of Medicine, Medford, Mass (Drs DiMascio and Neu); the Department of Psychiatry, Harvard Medical School and Massachusetts General Hospital, Boston (Drs DiMascio and Klerman); the Department of Mental Health, Commonwealth of Massachusetts, Boston (Dr DiMascio); the Departments of Psychiatry (Drs Weissman and Prusoff) and Epidemiology (Dr Weissman), Yale University School of Medicine, New Haven, Conn; the Depression Research Unit, Connecticut Mental Health Center, New Haven (Dr Weissman); and the Institute of Research and Rehabilitation, Boston State Hospital (Ms Zwilling). Dr Klerman is now with the Alcohol, Drug Abuse and Mental Health Administration, Bethesda, Md.

Arch Gen Psychiatry. 1979;36(13):1450-1456. doi:10.1001/archpsyc.1979.01780130068008

• A randomized, controlled trial compared the combination of amitriptyline hydrochloride and short-term interpersonal psychotherapy, either treatment alone, and a nonscheduled treatment control group in ambulatory acute, nonbipolar, nonpsychotic depressives. Results show the efficacy of both psychotherapy and amitriptyline in overall symptom reduction. Amitriptyline and psychotherapy were about equal, and the effects of both treatments in combination were additive. The additive effect of combined treatment was largely due to the differential effects of the two treatments. Amitriptyline had its effect mainly on the vegetative symptoms of depression such as sleep and appetite disturbance, these occurred early in treatment, often within the first week. Psychotherapy had its effect mainly on mood, suicidal ideation, work, and interests; these effects occurred slightly later, at four to eight weeks.