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Treatment of atypical depression: Post-hoc analysis of a randomized controlled study testing the efficacy of sertraline and cognitive behavioural therapy in mildly depressed outpatients

Published online by Cambridge University Press:  16 April 2020

V. Henkel ,
R. Mergl ,
A.-K. Allgaier ,
M. Hautzinger ,
R. Kohnen ,
J.C. Coyne ,
H.-J. Möller  and
U. Hegerl
V. Henkel
Affiliation:
Department of Psychiatry, Ludwig-Maximilians-University Munich, Nußbaumstr. 7, 80336Munich, Germany
R. Mergl*
Affiliation:
Department of Psychiatry, University of Leipzig, Semmelweisstr. 10, 04103Leipzig, Germany
A.-K. Allgaier
Affiliation:
Department of Child and Adolescent Psychiatry, Ludwig-Maximilians-University Munich, Pettenkoferstr. 8a, 80336Munich, Germany
M. Hautzinger
Affiliation:
Department of Psychology, Eberhard-Karls-University Tuebingen, Christophstr. 2, 72072Tuebingen, Germany
R. Kohnen
Affiliation:
RPS Research Germany GmbH, Scheurlstr. 21, 90478Nuremberg, Germany
J.C. Coyne
Affiliation:
Department of Psychiatry, University of Pennsylvania Health System, 11 Gates, 3400 Spruce Street, PA-19104Philadelphia, USA
H.-J. Möller
Affiliation:
Department of Psychiatry, Ludwig-Maximilians-University Munich, Nußbaumstr. 7, 80336Munich, Germany
U. Hegerl
Affiliation:
Department of Psychiatry, University of Leipzig, Semmelweisstr. 10, 04103Leipzig, Germany
*
*Corresponding author. Tel.: +49 341 9724556; fax: +49 341 9724539. E-mail address: Roland.Mergl@medizin.uni-leipzig.de (R. Mergl).
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Abstract

Objective

Atypical features are common among depressed primary care patients, but clinical trials testing the efficacy of psychopharmacological and/or psychotherapeutic treatment are lacking. This paper examines the efficacy of sertraline and cognitive behavioural therapy (CBT) among depressed patients with atypical features.

Subjects and methods

Analyses involve a double-blind comparison of sertraline versus placebo (N = 47) and a single-blind comparison between CBT versus a guided self-help group (GSG) (N = 48), with primary efficacy endpoints being the Inventory of Depressive Symptomatology (IDSC) and Hamilton Depression Scale (HAMD-17).

Results

In intent-to-treat (ITT) analyses, the decrease on the IDSC scale (and HAMD-17) was greater after CBT compared to GSG: p = 0.01 (HAMD-17: p = 0.01). The difference between selective serotonin reuptake inhibitors (SSRI) versus placebo was not significant: p = 0.22 (HAMD-17: p = 0.36).

Limitations

The number of cases in each treatment group was small, thereby limiting statistical power. Patients medicated with sertraline were 10 to 15 years younger than those included in the other groups of treatment.

Conclusions

CBT may be an effective alternative to GSG for mildly depressed patients with atypical features. Although SSRI were not superior to placebo, it would be premature to rule out SSRI as efficacious in atypical depression.

Keywords

Atypical depressionPrimary health careSertralineCognitive behavioural therapyPost-hoc analysis
Type
Depression
Information
European Psychiatry , Volume 25 , Issue 8 , December 2010 , pp. 491 - 498
Copyright
Copyright © Elsevier Masson SAS 2010

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