MAINTENANCE PSYCHOTHERAPY IN RECURRENT DEPRESSION

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Although several forms of treatment have shown promise in ameliorating the long-term course of recurrent depression, a better understanding of the preventative capacity of psychotherapy seems particularly critical for women given the many psychosocial vulnerability factors for depression observed in women and the adverse implications of antidepressant maintenance treatment throughout the childbearing years. Our recently completed study of Maintenance Therapies in Recurrent Depression points to the possible utility of interpersonal psychotherapy as a maintenance strategy, particularly in women. The specific aim of this proposal is to expand our knowledge regarding the prophylactic capacity of maintenance interpersonal psychotherapy (IPT-M) in women. In order to determine whether a higher "dose" of IPT-M than was employed in our recent trial can further extend survival time and prevent recurrence, depressed women in at least their second discrete episode of unipolar depression, will be assigned to one of three levels of IPT-M (high dose = weekly; medium dose = biweekly; low dose = monthly). After weekly acute and continuation treatment, subjects will be randomly assigned to one of the three IPT-M frequencies. We hypothesize that increased frequency of IPT-M will be associated with longer time to recurrence, and fewer instances of symptomatic exacerbation not meeting criteria for a new episode. We further hypothesize that, three variables are likely to moderate this effect: 1) women with low delta sleep ratio (number of delta wave counts in the first NREM period divided by number of delta wave counts in the second NREM period) will show shorter time to recurrence; 2) women with more severe life events will show shorter time to recurrence; and 3) women in patient/therapist dyads rated as low on specificity of IPT will show shorter time to recurrence. By limiting our investigation to those women with recurrent depression who respond to acute IPT, we hope to focus on the population most likely to seek and benefit from non-pharmacologic maintenance strategies.