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James H. Kocsis, MD; Allen J. Frances, MD; Carlyle Voss, MD; J. John Mann, MD; Barbara J. Mason, PhD; John Sweeney, PhD

Arch Gen Psychiatry. 1988;45(3):253-257.

Abstract
• Antidepressant drugs in the treatment of chronic depressions have received little systematic study. We used a two-week, single-blind placebo washout followed by a six-week, double-blind comparison of imipramine hydrochloride and placebo in a sample of 76 outpatients with DSM-III dysthymic disorder entered into a trial at two centers. Subjects were preponderantly female, had insidious onset at an early age, and had depressions of moderate severity; 96% also met the DSM-III criteria for major depressive disorder at the time of presentation. Sixty percent had a history of persistent depressive symptoms sufficient to meet criteria for major depression for longer than two years. Markedly favorable responses occurred in 45% of imipramine-treated (n = 29) and 12% of placebo-treated (n = 25) patients and, respectively, 59% and 13% of those who completed the study. Imipramine produced significant advantage in measures of depressive symptoms, global severity of illness, and self-rated social and vocational function. Recovered patients experienced remission from both long-standing symptoms and deficits as well as more recently exacerbated aspects of their syndrome. Patients with pure dysthymic disorder of a mild, subsyndromal type were uncommon in these clinical settings. However, anti-depressant medication was effective for many moderately severe chronic depressions, which had previously been untreated or undertreated, presumably related to misdiagnosis.

Author Affiliations
From the Departments of Psychiatry, New York Hospital—Cornell Medical Center (Drs Kocsis, Frances, Mann, Mason, and Sweeney), and Maine Medical Center, Portland (Dr Voss).

Footnotes
Accepted for publication Oct 16, 1987.

Reprint requests to New York Hospital—Cornell Medical Center, 525 E 68th St, New York, NY 10021 (Dr Kocsis).

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