97-14
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ZOLOFT 6 MONTH FOLLOW-UP: A RANDOMIZED
TRIAL OF THE EFFECTS AND EXPENSE OF ZOLOFT (SERTRALINE) VS INTERPERSONAL
PSYCHOTHERAPY, ALONE OR IN COMBINATION FOR PEOPLE WITH DYSTHYMIA
IN PRIMARY CARE
Browne G, Steiner M, Roberts J, Gafni A,
Byrne C, Dunn E, Jamieson E, Webb M, Bell B, Mills M, Chalklin L,
Wallik D, Kramer J
ABSTRACT
Rostered patients in a Health Service Organization
in southern Ontario, as well as persons recruited from the region,
were screened by phone for 9 psychiatric disorders (major depressive
disorder, dysthymia, generalized anxiety disorder, panic, social
phobia, simple phobia, agoraphobia,alcohol and drug dependence)
using the UM-CIDI short form. Those who scored positive on any disorder
were invited to see a health care provider, those who consented
to the visit were screened for dysthymia and/or major depressive
disorder using a modified SCID-NP. Those who were positive for dysthymia
and consented to participate were randomized to one of three treatment
groups: sertraline alone; IPT alone; or sertraline in combination
with IPT. Patients have follow-up clinic visits at 3 and 6 weeks,
and at 3,6,9,12,15,18,21 and 24 months. Blind assessment of outcome
are made by trained interviewers at baseline, and at 6,12 and 24
months using the Montgomery-Asberg Depression Rating Scale (MADRS).
Of the 5,873 persons screened, 2,536 were positive on at least one
of the 9 disorders; and of those positive, 1,544 consented to the
visit of which 736 were positive for dysthymia and of those, 29
refused to participate. Altogether, 707 dysthymic patients were
randomized: 229 to sertraline alone; 231 to IPT alone; and 247 to
sertraline in combination with IPT. Sertraline was prescribed by
the attending physician at an initial dose of 25mg/day with the
option to increase it gradually up to a maximum of 200 mg/day. Sertraline
plasma levels are measured both at regular and random visits. IPT
was provided by trained staff; a total of up to 16 sessions were
provided within the first three months of the study. This is an
ongoing study.
Preliminary results comparing the responses
in each of the three treatment groups at the 6 month follow-up visit
indicate that Sertraline alone, is easier to comply with than IPT
alone, as effective as Sertraline plus IPT, more effective than
IPT alone and no more expensive from a societal point of view. We
await the two year follow-up to assess the  enduring
nature of these comparative effects and expenses.
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