Select comorbid personality disorders and the treatment of chronic depression with nefazodone, targeted psychotherapy, or their combination

Maddux, Rachel E.; Riso, Lawrence P.; Klein, Daniel N.; Markowitz, John C.; Rothbaum, Barbara O.; Arnow, Bruce A.; Manber, Rachel; Blalock, Janice A.; Keitner, Gabor I.; Thase, Michael E.

doi:10.1016/j.jad.2009.01.010

« Previous Next »Journal of Affective Disorders
Volume 117, Issue 3 , Pages 174-179, October 2009

Select comorbid personality disorders and the treatment of chronic depression with nefazodone, targeted psychotherapy, or their combination

Rachel E. Maddux
- Department of Psychology, Lund University, Lund, Sweden
Lawrence P. Riso
- College of Psychology and Behavioral Sciences, Argosy University, Washington DC, United States
- Corresponding author. Argosy University, 1550 Wilson Boulevard, Suite 600, Arlington, VA 22209. Tel.: +1 703 526 5852; fax: +1 703 243 8973.
Daniel N. Klein
- Department of Psychology, Stony Brook University, Stony Brook, New York, United States
John C. Markowitz
- Department of Psychiatry, Weill Medical College of Cornell University, New York, New York, United States
Barbara O. Rothbaum
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia, United States
Bruce A. Arnow
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California, United States
Rachel Manber
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California, United States
Janice A. Blalock
- Department of Behavioral Science, University of Texas, Houston, Texas, United States
Gabor I. Keitner
- Department of Psychiatry and Human Behavior, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, United States
Michael E. Thase
- Department of Psychiatry, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, United States

Received 26 August 2008; received in revised form 31 December 2008; accepted 4 January 2009.

Abstract

Background

Individuals with chronic depression respond poorly to both medication and psychotherapy. The reasons for the poorer response, however, remain unclear. One potential factor is the presence of comorbid Axis II personality disorders (PDs), which occur at high rates among these patients.

Methods

This study examines the moderating influence of co-occurring PDs, primarily in cluster C, among 681 chronically depressed adult outpatients who were randomly assigned to 12 weeks of treatment with nefazodone, a specialized psychotherapy for chronic depression, or their combination.

Results

At baseline, 50.4% (n=343) of patients met criteria for one or more Axis II disorders. Following 12 weeks of treatment, patients with comorbid PDs had statistically lower depression scores (M=12.2, SD=+9.2) than patients without comorbid PDs (M=13.5, SD=+8.7). There was no differential impact of a comorbid PD on responsiveness to medication versus psychotherapy. The results did not change when the data were analyzed using an intent-to-treat sample or when individual personality disorders were examined separately.

Limitations

Patients with severe borderline, antisocial, and schizotypal PDs were excluded from study entry; therefore, these data primarily apply to patients with cluster C PDs and may not generalize to other Axis II conditions.

Conclusions

Comorbid Axis II disorders did not negatively affect treatment outcome and did not differentially affect response to psychotherapy versus medication. Treatment formulations for chronically depressed patients with certain PDs may not need to differ from treatment formulations of chronically depressed patients without co-occurring PDs.

Keywords: Chronic depression, Personality disorder, Axis II, Nefazodone, CBASP, Treatment