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December 1990

Treatment of Recurrent Unipolar Major Depressive Disorder: Commentary on the Pittsburgh Study

Author Affiliations

From the Department of Psychiatry, Cornell University Medical College, New York, NY.

Arch Gen Psychiatry. 1990;47(12):1158-1162. doi:10.1001/archpsyc.1990.01810240078012

The publication in this issue of the Archives of the report from the Pittsburgh (Pa) studies1 on long-term treatment of recurrent unipolar major depression is important for a number of reasons.2-4

The major findings are as follows: (1) high rate of recurrence in 1 year for untreated control groups; (2) clinically meaningful and statistically significant prevention of relapse

See also p 1093. and recurrence using both imipramine hydrochloride and interpersonal psychotherapy (IPT); (3) trend toward value of combined treatment; and (4) the value of high-dose imipramine hydrochloride (over 200 mg/d) and blood level determinations to enhance pharmacotherapy (Fig1).

These findings have an immediate practical application to the clinical management and treatment of this important group of patients. While there may be controversy regarding the natural history of major depression, particularly the kraepelinian concept of high rates of remission of the acute episode and favorable outcome over

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