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John C. Markowitz, MD; James H. Kocsis, MD; Baruch Fishman, PhD; Lisa A. Spielman, PhD; Lawrence B. Jacobsberg, MD, PhD; Allen J. Frances, MD; Gerald L. Klerman, MD; Samuel W. Perry, MD

Arch Gen Psychiatry. 1998;55:452-457.

Background  This randomized clinical trial compared 16-week interventions with interpersonal psychotherapy, cognitive behavioral therapy, supportive psychotherapy, and supportive psychotherapy with imipramine for human immunodeficiency virus (HIV)-positive patients with depressive symptoms.

Methods  Subjects (N=101; 85 male, 16 female) with known HIV seropositivity for at least 6 months were randomized to 16 weeks of treatment. Inclusion criteria were 24-item Hamilton Depression Rating Scale score of 15 or higher, clinical judgment of depression, and physical health sufficient to attend outpatient sessions. Therapists were trained in manualized therapies specific for HIV-positive patients. Treatment adherence was monitored.

Results  Subjects randomized to interpersonal psychotherapy (n=24) and supportive psychotherapy with imipramine (n=26) had significantly greater improvement on depressive measures than those receiving supportive psychotherapy (n=24) or cognitive behavioral therapy (n=27). Similar results appeared in the completer subsample.

Conclusions  Depressive symptoms appear treatable in HIV-positive patients. Interpersonal psychotherapy may have particular advantages as a psychotherapy for patients who have experienced the significant life events of HIV infection.

From Cornell University Medical College, New York, NY. Drs Klerman and Perry are deceased.

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