Treatment of Primary Dysthymia With Group Cognitive Therapy and Pharmacotherapy: Clinical Symptoms and Functional Impairments

• Published in: The American journal of psychiatry Vol. 156; no. 10; pp. 1608 - 1617
• Main Authors: Ravindran, Arun V., Anisman, Hymie, Merali, Zul, Charbonneau, Yoland, Telner, John, Bialik, Robert J., Wiens, Andrew, Ellis, Jack, Griffiths, Jenna
• Format: Journal Article Conference Proceeding
• Language: English
• Published: Washington, DC American Psychiatric Publishing 01.10.1999; American Psychiatric Association
• Subjects: Adult; Antidepressive Agents - therapeutic use; Associated treatments; Biological and medical sciences; Cognitive group therapy; Cognitive Therapy; Combined Modality Therapy; Depression; Double-Blind Method; Drugs; Dysthymic Disorder - psychology; Dysthymic Disorder - therapy; Female; Humans; Male; Medical sciences; Mental disorders; Middle Aged; Patients; Placebos; Prescription drugs; Psychiatry; Psychology. Psychoanalysis. Psychiatry; Psychopathology. Psychiatry; Psychotherapy, Group; Sertraline - therapeutic use; Therapy; Treatment; Treatment Outcome; Treatments; Mood disorder; Human; Cognitive therapy; Serotonin; Psychotropic; Treatment efficiency; Group psychotherapy; Reuptake inhibitor; Sertraline; Stress; Quality of life; Chemotherapy; Dysthymia; Treatment; Primary; Antidepressant agent; Behavior therapy; Combined treatment; Coping; Comparative study
• ISSN: 0002-953X; 1535-7228
• DOI: 10.1176/ajp.156.10.1608

OBJECTIVE: This study assessed the efficacy of antidepressant treatment (sertraline) and group cognitive behavior therapy, alone or in combination, in primary dysthymia. The clinical features of dysthymia, as well as the functional impairments associated with the illness (e.g., quality of life, stress perception, coping styles), were evaluated. METHOD: Patients (N=97) diagnosed with primary dysthymia, but no other current comorbid disorder, received either sertraline or placebo in a double-blind design over 12 weeks. In addition, a subgroup of the patients (N=49) received a structured, weekly group cognitive behavior therapy intervention. RESULTS: Treatment with sertraline, with or without group cognitive behavior therapy, reduced the functional impairment of depression. The reductions were similar in the drug-cognitive therapy group and in subjects who received the drug alone. Furthermore, while group cognitive behavior therapy alone reduced the depression scores, this effect was not significantly greater than the effect of the placebo. The drug treatment also induced pronounced improvement in the functional measures, and in some respects these effects were augmented by group cognitive behavior therapy. Among patients who responded favorably to cognitive behavior therapy, the improvements in the functional measures were similar to those who responded to drug treatment, whereas such functional changes were not seen among patients who responded to placebo. CONCLUSIONS: Sertraline treatment effectively reduces the clinical symptoms and functional impairments associated with dysthymia. Although the group cognitive behavior therapy intervention was less effective in alleviating clinical symptoms, it augmented the effects of sertraline with respect to some functional changes, and in a subgroup of patients it attenuated the functional impairments characteristic of dysthymia.