***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    Input: Prevention of relapse following depression is a pressing research problem . The authors tested the efficacy of the tricyclic antidepressant amitriptyline and psychotherapy , alone and in combination , in preventing the relapse of 150 neurotic depressed female patients . They found that patients receiving amitriptyline and little psychotherapy had a 12-percent relapse rate , compared to a 16-percent rate for those receiving more psychotherapy and no medication . There was no significant difference between drug therapy alone or drug therapy in combination with psychotherapy . However ,  psychotherapy was beneficial to patients with problems of social adjustment and interpersonal relations .  The need for further research and implication s for treatment are discussed BACKGROUND There is little information on the long-term effects and costs of a combination of Sertraline and interpersonal psychotherapy ( IPT ) for the treatment of dysthymia in primary care . METHODS In a single-blind , r and omized clinical trial , 707 adults ( 18 - 74 years of age inclusive ) with DSM-IV dysthymic disorder , with or without past and /or current major depression , as an acute or chronic episode , in a community-based primary care practice in Ontario , Canada , were r and omized to treatment with either  Sertraline alone ( 50 - 200 mg ) , or IPT alone ( 10 sessions ) , or Sertraline plus IPT combined . In the acute treatment phase ( first 6 months ) all groups received full active treatment . This was followed by an additional 18-month naturalistic follow-up phase . Subjects were assessed for effectiveness of treatment in reducing depressive symptoms using the Montgomery Asberg Depression Rating Scale ( MADRS ) at 6 months and twice again during the 18-month follow-up by blind independent observers . Treatment costs and subjects ' use of other health and social services were also investigated . RESULTS At 6 months , 586 subjects completed the MADRS question naire . There was a significant difference ( P=0.025 ) in mean MADRS scores : 14.3 ( Group I ) ; 14.9 ( Group II ) ; 16.8 ( Group III ) , using analysis of covariance . Response ( 40 % improvement ) rates were 60.2 % for Sertraline alone , 46.6 % for IPT alone , and 57.5 % for Sertraline augmented by IPT ( P=0.02 ) . At 2 years , 525 subjects were retained for follow-up . There was no statistically significant difference between Sertraline alone and Sertraline plus IPT in symptom reduction . However , both were more effective than IPT alone in reducing depressive symptoms ( P=0.03 ) . There was a statistically significant difference between groups in costs for use of health and social services . The IPT treatment groups had the lower costs for use of health and social services . CONCLUSIONS Sertraline or Sertraline plus IPT was more effective than IPT alone after 6 months . Over the long term ( 2 years ) , all three treatments provide reasonably effective treatment for reducing symptoms of dysthymia , but Sertraline or combining Sertraline with IPT is more effective than IPT alone . Of these two more effective treatments , subjects in the Sertraline plus IPT group had less health and social service costs by $ 480 per person over 2 years . These findings underscore the effects of combining pharmacotherapy and psychotherapy and the economic value of this more comprehensive treatment of dysthymia in primary care CONTEXT Despite the importance of mental illness in Africa , few controlled intervention trials related to this problem have been published . OBJECTIVES To test the efficacy of group interpersonal psychotherapy in alleviating depression and dysfunction and to evaluate the feasibility of conducting controlled trials in Africa . DESIGN , SETTING , AND PARTICIPANTS For this cluster r and omized , controlled clinical trial ( February-June 2002 ) , 30 villages in the Masaka and Rakai districts of rural Ug and a were selected using a r and om procedure ; 15 were then r and omly assigned for study ing men and 15 for women . In each village , adult men or women believed by themselves and other villagers to have depressionlike illness were interviewed using a locally adapted Hopkins Symptom Checklist and an instrument assessing function . Based on these interviews , lists were created for each village totaling 341 men and women who met Diagnostic and Statistical Manual of Mental Disorders , Fourth Edition ( DSM-IV ) criteria for major depression or subsyndromal depression . Interviewers revisited them in order of decreasing symptom severity until they had 8 to 12 persons per village , totaling 284 . Of these , 248 agreed to be in the trial and 9 refused ; the remainder died or relocated . A total of 108 men and 116 women completed the study and were reinterviewed . INTERVENTION Eight of the 15 male villages and 7 of the 15 female villages were r and omly assigned to the intervention arm and the remainder to the control arm . The intervention villages received group interpersonal psychotherapy for depression as weekly 90-minute sessions for 16 weeks . MAIN OUTCOME MEASURES Depression and dysfunction severity scores on scales adapted and vali date d for local use ; proportion of persons meeting DSM-IV major depression diagnostic criteria . RESULTS Mean reduction in depression severity was 17.47 points for intervention groups and 3.55 points for controls ( P<.001 ) . Mean reduction in dysfunction was 8.08 and 3.76 points , respectively ( P<.001 ) . After intervention , 6.5 % and 54.7 % of the intervention and control groups , respectively , met the criteria for major depression ( P<.001 ) compared with 86 % and 94 % , respectively , prior to intervention ( P = .04 ) . The odds of postintervention depression among controls was 17.31 ( 95 % confidence interval , 7.63 - 39.27 ) compared with the odds among intervention groups . Results from intention-to-treat analyses remained statistically significant . CONCLUSIONS Group interpersonal psychotherapy was highly efficacious in reducing depression and dysfunction . A clinical trial proved feasible in the local setting . Both findings should encourage similar trials in similar setting s in Africa and beyond OBJECTIVE The authors examined the rate of response to the combination of nortriptyline and interpersonal psychotherapy for acute and continuation treatment of elderly patients with recurrent major depression . METHOD The subjects were 73 elderly patients , 61 of whom completed treatment .  Nortriptyline steady-state blood levels were maintained at 80 - 120 ng/ml , and interpersonal psychotherapy was administered weekly for 9.1 weeks ( medium ) of acute therapy and was decreased from biweekly to triweekly during 16 weeks of continuation therapy . During acute treatment nonresponding patients also received brief adjunctive pharmacotherapy with lithium or perphenazine . RESULTS Of the 61 subjects given adequate trials of nortriptyline and interpersonal psychotherapy  , 48 ( 78.7 % ) achieved full remission ( Hamilton depression rating of 10 or lower over 16 weeks of continuation therapy ) , 10 patients ( 16.4 % ) did not respond ( Hamilton rating never below 15 ) , and three achieved only partial remission ( Hamilton rating of 11 - 14 ) . Early versus late onset was not associated with a difference in response rate . During the placebo-controlled , double-blind transition to maintenance therapy , 19 ( 76.0 % ) of the 25 patients r and omly assigned to placebo maintenance conditions showed continued recovery and six relapsed . None of the 24 patients assigned to nortriptyline conditions relapsed . CONCLUSIONS Use of nortriptyline plus interpersonal psychotherapy for 9.1 weeks ( median ) of acute and 16 weeks of continuation therapy appears to be associated with good response and relatively low attrition but about a 25 % chance of relapse during double-blind discontinuation of nortriptyline . These data require confirmation in a controlled clinical trial of acute and continuation therapy A total of 117 depressed clients , stratified for severity , completed 8 or 16 sessions of manualized treatment , either cognitive-behavioral psychotherapy ( CB ) or psychodynamic-interpersonal psychotherapy ( PI ) . Each of 5 clinician-investigators treated clients in all 4 treatment conditions . On most measures , CB and PI were equally effective , irrespective of the severity of depression or the duration of treatment . However , there was evidence of some advantage to CB on the Beck Depression Inventory ( Beck , Ward , Mendelson , Mock , & Erbaugh , 1961 ) . There was no evidence that CB 's effects were more rapid than those of PI , nor did the effects of each treatment method vary according to the severity of depression . There was no overall advantage to 16-session treatment over 8-session treatment . However , those presenting with relatively severe depression improved substantially more after 16 than after 8 sessions BACKGROUND This study augments a r and omized controlled trial to analyze the cost-effectiveness of 2 st and ardized treatments for major depression relative to each other and to the " usual care " provided by primary care physicians . METHODS A r and omized controlled trial was conducted in which primary care patients meeting DSM-III-R criteria for current major depression were assigned to pharmacotherapy ( where nortriptyline hydrochloride was given ) or interpersonal psychotherapy provided in a st and ardized framework or a primary physician 's usual care . Two outcome measures , depression-free days and quality -adjusted days , were developed using information on depressive symptoms over time . The costs of care were calculated . Cost-effectiveness ratios comparing the incremental outcomes with the incremental costs for the different treatments were estimated . Sensitivity analyses were performed . RESULTS In terms of both economic costs and quality -of-life outcomes , patients assigned to the pharmacotherapy group did slightly better than those assigned to interpersonal psychotherapy . Both st and ardized therapies provided better outcomes than primary physician 's usual care , but each consumed more re sources . No meaningful cost-offsets were found . The incremental direct cost per additional depression-free day for pharmacotherapy relative to usual care ranges from $ 12.66 to $ 16.87 which translates to direct cost per quality -adjusted year gained from $ 11270 to $ 19510 . CONCLUSIONS St and ardized treatments for depression lead to better outcomes than usual care but also lead to higher costs . However , the estimates of the cost per quality -of-life year gained for st and ardized pharmacotherapy are comparable with those found for other treatments provided in routine practice BACKGROUND Postpartum depression causes women great suffering and has negative consequences for their social relationships and for the development of their infants . Research is needed to evaluate the efficacy of psychotherapy for postpartum depression . METHODS A total of 120 postpartum women meeting DSM-IV criteria for major depression were recruited from the community and r and omly assigned to 12 weeks of interpersonal psychotherapy ( IPT ) or to a  waiting list condition ( WLC ) control group .  Subjects completed interview and self-report assessment s of depressive symptoms and social adjustment every 4 weeks . RESULTS Ninety-nine of the 120 patients completed the protocol .  Hamilton Rating Scale for Depression ( HRSD ) scores of women receiving IPT declined from 19.4 to 8.3 , a significantly greater decrease than occurred in the WLC group ( 19.8 to 16.8 ) . The Beck Depression Inventory ( BDI ) scores of women who received IPT declined from 23.6 to 10.6 over 12 weeks , a significantly greater decrease than occurred in the WLC group ( 23.0 to 19.2 ) . A significantly greater proportion of women who received IPT recovered from their depressive episode based on HRSD scores of 6 or lower ( 37 . 5 % ) and BDI scores of 9 or lower ( 43.8 % ) compared with women in the WLC group ( 13.7 % and 13.7 % , respectively ) . Women receiving IPT also had significant improvement on the Postpartum Adjustment Question naire and the Social Adjustment Scale-Self-Report relative to women in the WLC group . CONCLUSIONS These findings suggest that IPT is an efficacious treatment for postpartum depression . Interpersonal psychotherapy reduced depressive symptoms and improved social adjustment , and represents an alternative to pharmacotherapy , particularly for women who are breastfeeding OBJECTIVE The authors compared response rates , the temporal course of response to acute treatment , and relapse rates during continuation treatment of elderly and midlife patients with recurrent major depression . METHOD They analyzed results from two separate controlled studies of maintenance therapies for recurrent major depression , in which 148 elderly patients ( mean age = 67.9 years ) and 214 midlife patients ( mean age = 38.5 years ) were treated in open acute and continuation therapy with a combination of interpersonal psychotherapy and a tricyclic antidepressant ( nortriptyline for the elderly , imipramine for the midlife patients ) . In an intent-to-treat analysis , remission rates during acute treatment and relapse rates during continuation treatment were examined . R and om regression analysis of weekly Hamilton depression scale ratings was used to compare the temporal course of response . RESULTS During acute-phase therapy , 78.4 % ( N = 116 ) of the elderly patients and 69.6 % ( N = 149 ) of the midlife patients had remissions . The midlife patients had a faster reduction of Hamilton depression ratings . Following stabilization , 15.5 % of the elderly patients and 6.7 % of the midlife patients relapsed . Ultimately , 66 
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Conclusion The efficacy of IPT proved to be superior to placebo , similar to medication and did not increase when combined with medication .
Overall , IPT was more efficacious than CBT .
Current evidence indicates that IPT is an efficacious psychotherapy for DSD and may be superior to some other manualized psychotherapies