The present paper is a review of recent investigations dealing with interpersonal psychotherapy (IPT) in the treatment of Major Depressive Disorder (MDD), with the aim to analyze data of efficacy of monotherapy and combined therapy in short and long-term studies and to provide reliable indications for clinical practice. Depression is now considered a very serious public health problem, with effects on social costs and quality of life comparable to major chronic diseases. Major depressive disorder is a very frequent condition, with a lifetime prevalence from 5 to 12% in males and from 10 to 25% in females. Mean age at onset ranges from 20 to 30 years, but episodes may occur at any age, with noticeable differences in clinical picture between younger and older patients. Age of patients can also influence response to treatment, in particular to psychotherapy. Interpersonal psychotherapy is a model of brief psychotherapy that was proposed in the eighties by Klerman and colleagues to treat major depression without bipolar and psychotic features. These authors assumed that the onset of depressive episodes is related to major problems in interpersonal relationships. So, the main objective is to improve depressive symptoms and to prevent recurrences by readjusting interpersonal strategies. Several studies indicated that IPT is an effective treatment for mild to moderate depressive symptoms in the acute phase. It was found significantly superior to placebo, to supportive therapy and in many studies it showed the same efficacy as tricyclics and serotonergic antidepressants. So, IPT can be used as an efficacious single therapy for depressed patients. When considering prevention of recurrences, it is still better than placebo, but some data suggest lower efficacy than antidepressants. As for comparison among different types of brief psychotherapy, IPT is one of the most widely used therapies for major depression and showed an efficacy equivalent to cognitive-behaviour techniques. Few systematic studies have been performed assessing the efficacy of brief dynamic therapies. At this moment a large number of patients with major depression receive a combination of drugs and psychotherapy. A few investigations have compared combined therapy to single treatments with favourable results, but further data on large samples should be collected to allow reliable conclusions on this topic. In particular, these data should define if difference in effect size between combined and single therapy can justify the higher costs of combining two treatments. Some authors preferred to perform sequential treatment by administering an antidepressant in the acute phase and adding IPT only in a second time or in patients who did not respond completely to pharmacotherapy. This approach is supported by the fact that antidepressants induce an improvement of symptoms that can increase patients’ motivation and adherence to psychotherapy. Anyway, the choice of combining drugs and IPT from the beginning or using a sequential approach is still debated and mainly depends on the preference of single clinicians.

La psicoterapia interpersonale nel trattamento del disturbo depressivo maggiore: revisione della letteratura

BELLINO, Silvio;BOZZATELLO, PAOLA;BOGETTO, Filippo
2008-01-01

Abstract

The present paper is a review of recent investigations dealing with interpersonal psychotherapy (IPT) in the treatment of Major Depressive Disorder (MDD), with the aim to analyze data of efficacy of monotherapy and combined therapy in short and long-term studies and to provide reliable indications for clinical practice. Depression is now considered a very serious public health problem, with effects on social costs and quality of life comparable to major chronic diseases. Major depressive disorder is a very frequent condition, with a lifetime prevalence from 5 to 12% in males and from 10 to 25% in females. Mean age at onset ranges from 20 to 30 years, but episodes may occur at any age, with noticeable differences in clinical picture between younger and older patients. Age of patients can also influence response to treatment, in particular to psychotherapy. Interpersonal psychotherapy is a model of brief psychotherapy that was proposed in the eighties by Klerman and colleagues to treat major depression without bipolar and psychotic features. These authors assumed that the onset of depressive episodes is related to major problems in interpersonal relationships. So, the main objective is to improve depressive symptoms and to prevent recurrences by readjusting interpersonal strategies. Several studies indicated that IPT is an effective treatment for mild to moderate depressive symptoms in the acute phase. It was found significantly superior to placebo, to supportive therapy and in many studies it showed the same efficacy as tricyclics and serotonergic antidepressants. So, IPT can be used as an efficacious single therapy for depressed patients. When considering prevention of recurrences, it is still better than placebo, but some data suggest lower efficacy than antidepressants. As for comparison among different types of brief psychotherapy, IPT is one of the most widely used therapies for major depression and showed an efficacy equivalent to cognitive-behaviour techniques. Few systematic studies have been performed assessing the efficacy of brief dynamic therapies. At this moment a large number of patients with major depression receive a combination of drugs and psychotherapy. A few investigations have compared combined therapy to single treatments with favourable results, but further data on large samples should be collected to allow reliable conclusions on this topic. In particular, these data should define if difference in effect size between combined and single therapy can justify the higher costs of combining two treatments. Some authors preferred to perform sequential treatment by administering an antidepressant in the acute phase and adding IPT only in a second time or in patients who did not respond completely to pharmacotherapy. This approach is supported by the fact that antidepressants induce an improvement of symptoms that can increase patients’ motivation and adherence to psychotherapy. Anyway, the choice of combining drugs and IPT from the beginning or using a sequential approach is still debated and mainly depends on the preference of single clinicians.
2008
14
2
170
184
Major depressive disorder; interpersonal therapy; Antidepressants; Combined therapy; Sequential therapy
Bellino S; Zizza M; Bozzatello P; Bogetto F.
File in questo prodotto:
File Dimensione Formato  
Bellino S. L'IPT nel trattamento della depressione maggiore. GIP, 2008.pdf

Accesso riservato

Tipo di file: POSTPRINT (VERSIONE FINALE DELL’AUTORE)
Dimensione 218.67 kB
Formato Adobe PDF
218.67 kB Adobe PDF   Visualizza/Apri   Richiedi una copia

I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.

Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/2318/56920
Citazioni
  • ???jsp.display-item.citation.pmc??? ND
  • Scopus 0
  • ???jsp.display-item.citation.isi??? ND
social impact