2004, Number 5
Estudio doble ciego con antidepresivo, psicoterapia breve y placebo en pacientes con depresión leve a moderada
López RJ, López BMA, Vargas TBE, Villamil SV
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Language: Spanish
References: 24
Page: 53-61
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ABSTRACT
Background: Depression is the most frequent mental disorder in the world; its overall prevalence is about 8-12%. In Mexico, it has been calculated that 8.3% of the population aged 18-64 years has suffered this disorder along their lifetime. Disregarding country or culture, depression is two to three times more frequent in women than in men, more usual among separated or divorced people, and in those who live alone or in rural areas. Although it can be present at any time, 50% of the subjects start suffering depression when they are between 20 to 50 years old, with 40 years being the average age. The etiology of depression is multifactorial because the biological, genetic and psychosocial factors which are involved release the illness or exacerbate its symptoms at a lesser or greater degree. From a psychoanalytical point of view, Freud postulated that depressed patients directed their anger towards themselves as a result of an identification with the lost object; being this the only way the “self ” has to give up the object. As a result, new psychological theories of depression came into being, together with new kinds of treatment. In the last ten years, the role of psychotherapy in the treatment of depression has been widely discussed, and it has been proposed as a part of an integral handling. Nevertheless, such a treatment depends on the severity of depression and of the benefits obtained with antidepressants. The advantages of a mixed treatment have been proposed for depressed patients showing a partial response to a single treatment, for those with chronic depression and for patients with brief recovery periods. Thus, Bellak’s brief and urgency therapy for the treatment of depression came into being. This kind of therapy uses psychodynamic theoretical elements together with psychodynamic, supportive and cognitive techniques. It takes into account problems concerning the selfesteem regulation, the severe superego, the intra-aggression, the feeling of object loss, the feeling of object delusion, the feeling of deception, the orality, the narcissism dependence, the denial and the interferences in object relationships. Bellak’s therapy acts on the first nine points in contrast to long-term therapies which act mainly on object relationships.Objective: To compare the effectiveness of psychotherapeutic, pharmacological, mixed and placebo treatments of mild to moderate depression.
Material and method: A prospective cohort study was designed. Volunteers were selected from outpatients attending the Centro de Salud Castro Villagrana. During 90 consecutive days, 40 subjects, men and women aged 18 to 60 years, with a diagnosis of mild to moderate depression were treated. Depression was rated according to the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV), and the International Classification of Diseases, tenth edition (ICD-10). Severity of depression was measured with the Hamilton Scale for Severity of Depression (HAM-D). All participants signed an informed consent. Ten patients were randomly assigned to each one of the four treatment groups: Group A: fluoxetine 20 mg/day and a weekly session without psychotherapy. Group B: a weekly session of Bellak’s psychotherapy without pharmacotherapy. Group C: fluoxetine 20 mg/day and a weekly session of Bellak’s psychotherapy (mixed group). Group D: placebo and a weekly session without psychotherapy. For statistical analysis, Student’s t test was used before and after the treatment and the ANOVA for groups comparison.
Results: 62.5% were women and 37.5% males; 37.5% were single, 55% married and 7.5% divorced; 72.5% of the patients had an occupation; average age of the sample was 31.9 years; schooling average was 10.8 years. The mean baseline in HAM-D for the 40 patients was 17.27 points (minimum = 15; maximum = 19). By the third week, an important reduction in HAM-D points appeared for groups A, B and C in comparison to group D (p ‹0.001). In the seventh week, groups A and C presented a decrease in HAM-D points in comparison to group B (p ‹0.05) and with group D (p ‹0.001). In the ninth week, group C presented a bigger decrease in HAM-D points than groups A and B (p ‹0.05) and group D (p ‹0.001). By the eleventh week, there was a different reduction of HAM-D points in groups A, B and C in comparison to group D (p ‹0.001). In weeks 32 and 44, there were no differences among groups A, B and C.
Discussion: Bellak’s psychotherapy had the same therapeutic response than the use of an antidepressant, a lower response than a mixed therapy and a better response than a placebo. Still, results may be modified in the long-term by the natural development of the illness. Psychotherapies have had better results in avoiding relapses and modifying behavoir in the depression disorder. Their advantages and disadvantages are similar to those of some other psychotherapies. The use of psychotherapy in the treatment of depression is important because there are patients who do not accept an antidepressant treatment due to sociocultural factors or to a high sensibility to side effects. Considering this, we suggest carrying out more studies on the benefits of psychotherapy as an alternative for the treatment of depression in Mexico.
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