Maintenance Therapy for Chronic Depression: A Controlled Clinical Trial of Desipramine

doi:10.1001/archpsyc.1996.01830090013002

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Vol. 53 No. 9, September 1996

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Maintenance Therapy for Chronic Depression

A Controlled Clinical Trial of Desipramine

James H. Kocsis, MD; Richard A. Friedman, MD; John C. Markowitz, MD; Andrew C. Leon, PhD; Nina L. Miller, MA; Leah Gniwesch, MA; Michael Parides, MS

Arch Gen Psychiatry. 1996;53(9):769-774.

Abstract

Background
Previous studies have shown the efficacy of antidepressantsin the treatment of chronic depression. We report the resultsof a long-term study comparing desipramine hydrochloride andplacebo for maintenance therapy of remitted patients with chronicdepression.

Methods
Outpatients who met DSM-III-R diagnostic criteria for "pure"dysthymia (n=51), dysthymia with current major depression ("doubledepression") (n=64), or chronic major depression (n=14) weretreated on an open basis with desipramine. Full and partialremitters after 10 weeks entered a continuation phase of opentreatment with desipramine for 16 weeks. Remitted patients thenwere randomized to continue desipramine treatment or taperedto placebo treatment for a maintenance phase of up to 2 years.Relapse rates and time to relapse during maintenance therapywere compared between the two treatment groups.

Results
Acute-phase treatment results did not differ significantly accordingto chronic depression subtype. Remission persisted with a highdegree of stability during the continuation phase. Relapse ratesduring the maintenance phase were 52% for the placebo groupand 11% for the active desipramine group ( ${varkappa}$ ²=8.1, P=.004). Mostplacebo relapses occurred during the first 6 months of maintenancetherapy. Active medication was significantly more effectivethan placebo in that subgroup entering the maintenance phasein full remission and in those patients who fulfilled criteriafor a diagnosis of pure dysthymia or double depression on entryto the study.

Conclusion
Long-term maintenance treatment with desipramine appeared tobe effective in the prevention or postponement of relapse ofdepression in patients who responded to desipramine during theacute and continuation phases.

Author Affiliations

From the Department of Psychiatry, New York Hospital-Cornell Medical Center, New York.

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