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Martin B. Keller, MD; Philip W. Lavori, PhD; Gerald L. Klerman, MD; Nancy C. Andreasen, MD, PhD; Jean Endicott, PhD; William Coryell, MD; Jan Fawcett, MD; John P. Rice, PhD; Robert M. A. Hirschfeld, MD

Arch Gen Psychiatry. 1986;43(5):458-466.

Abstract
• We examined the treatment of 338 patients with nonbipolar major depressive disorders during the first eight weeks after entry into the National Institute of Mental Health—Clinical Research Branch Collaborative Program on the Psychobiology of Depression: Clinical Study. Of the 250 entered as inpatients, 31% received either no antidepressant somatotherapy or very low or unsustained levels, and only 49% received at least 200 mg of imipramine hydrochloride (or its equivalent) for four consecutive weeks. Of these patients, 19% received less than 30 minutes of psychotherapy per week. Among the 88 who entered as outpatients, 29% received no antidepressant somatotherapy; another 24% received very low or unsustained levels; only 19% received at least 200 mg of imipramine hydrochloride or its equivalent for four consecutive weeks. Of these patients, 52% received less than 30 minutes of psychotherapy per week. Only a few clinical factors were found to be predictive of treatment intensity. Very large differences in the amount and type of treatment across the five collaborating university centers do not appear to be related to differences in patient characteristics.

Author Affiliations
From the National Institute of Mental Health—Clinical Research Branch Collaborative Program on the Psychobiology of Depression: Clinical Studies, Rockville, Md (Drs Keller, Lavori, Klerman, Andreasen, Endicott, Coryell, Fawcett, Rice, and Hirschfeld); the Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston (Drs Keller, Lavori, and Klerman); the Department of Psychiatry, University of Iowa, Iowa City (Drs Andreasen and Coryell); the Department of Psychiatry, New York State Psychiatric Institute, College of Physicians and Surgeons, New York (Dr Endicott); the Department of Psychiatry, Rush-Presbyterian Medical Center, Chicago (Dr Fawcett); the Department of Psychiatry, Washington University School of Medicine, St Louis (Dr Rice); and the Center for Studies of Affective Disorders, Clinical Research Branch, Division of Extramural Programs, National Institute of Mental Health (Dr Hirschfeld).

Footnotes
Accepted for publication Sept 10, 1984.

Reprint requests to Department of Psychiatry, Massachusetts General Hospital, Boston, MA 02114 (Dr Keller).

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