Continuation treatment consisted of combined NT and IPT, using the same dose of NT (an average of 85 mg/day, but with a range of 20 to 200 mg/day) as during acute therapy, but reducing the frequency of IPT to twice monthly. Patients with stable remission and recovery entered the experimental maintenance phase of the study, via double-blind random assignment to one of four longterm treatment conditions:
Inhibitors,research,lifescience,medical (i) medication clinic with NT; (ii) medication clinic with placebo; (iii) monthly maintenance IPT with NT; and (iv) monthly maintenance IPT with placebo. Patients remained in maintenance therapy for 3 years, or until recurrence of major depression, whichever occurred first. Survival analysis tested differences in rates of recurrence and time to recurrence. Outcomes of therapy at each phase of treatment: acute, continuation, and maintenance Acute
treatment Of 187 patients who signed informed consent to participate, 5 showed spontaneous remission and 2 declined to begin treatment. Thus, 180 patients Inhibitors,research,lifescience,medical actually began acute treatment with NT and IPT, and of these 159 completed learn more acute-phase treatment (140 remitters and 19 nonresponders). Twenty-one patients dropped out of Inhibitors,research,lifescience,medical acute-phase treatment, 8 refusing further treatment, 6 developing medical conditions contraindicating NT, 2 being noncompliant, and 1 each dying or becoming delusional or manic. The median time to remission Inhibitors,research,lifescience,medical in this sample was 12 weeks,16 and the earliest point of statistically reliable discrimination of recovering and nonrecovering patients was 4 weeks.17 Almost one third (30.5%) showed rapid sustained response to combined treatment with NT and IPT, ie, they were well by 4 weeks. Other patients remitted more slowly, by 8 to 10 weeks (22.1%), while the remaining patients showed partial or mixed response. Slower and more variable treatment response was associated with higher pretreatmcnt levels of anxiety, lower levels of social support, greater current age at study entry, and higher percentage of rapid eye movement (REM) sleep before the initiation of treatment.15 Subjects with earlier-onset depressive Inhibitors,research,lifescience,medical illness (ic, first episode prior to age 60) took on
average 5 to 6 weeks longer to achieve remission, possibly a reflection of the greater number of prior lifetime episodes Terminal deoxynucleotidyl transferase (chronicity).18 Because early-onset subjects also had a higher rate of past suicide attempts, we concluded that they need especially careful surveillance during acute treatment, since they are likely to take longer to respond. Continuation treatment Of the 140 remitters who entered continuation treatment, 124 met study criteria for recovery at the end of 16 weeks of continuation treatment. Nine patients relapsed and could not be restabilized. Seven subjects dropped out of treatment, either noncompliant or refusing further treatment altogether. TTms, 124 patients were randomly assigned to a long-term maintenance therapy condition.