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Does Depression Require Hospitalization?

Inpatients have higher response rate than day-clinic patients

A study published in the current issue of Psychotherapy and Psychosomatics has analyzed the difference between day-clinic and inpatient stays in patients with depression.

Depending on the severity of depression, patients may be treated at different levels of care with psychotherapy and/or antidepressant medications.

While previous studies compared the efficacy of different levels of care for the psychotherapy of personality disorders, sufficient data are lacking for the comparison of day-clinic and inpatient psychotherapy for depression.

The new pilot study evaluated the feasibility of randomization in a routine hospital setting and compared the preliminary efficacy of day-clinic and inpatient psychotherapy for depression.

The study involved 44 patients. Of these, 43 had a major depressive episode, and the remaining patient was primarily diagnosed with dysthymia. Comorbid diagnoses included anxiety (46%), personality disorder (33%), somatoform (14%), and obsessive–compulsive (7%).

The patients were randomly assigned to either the day-clinic or inpatient setting and were treated for 8 weeks with multimodal psychotherapy. The therapy unit combined inpatient and day-clinic treatment, and the therapeutic staff was the same for both treatment arms. Both groups received equal amounts of psychotherapeutic interventions. At admission, 22 patients (50%) were taking antidepressant medications.

In the completer cohort, 11 patients (31%) had a change in antidepressant medication during treatment. Antidepressants were reduced or terminated in six patients (17%) and were increased or started in four patients (11%). One patient had a change of drug class.

At termination, 51% of the completer patients were taking antidepressant medications.

There were no differences between the two groups with regard to the change during therapy or the medication at termination. Changing medication was not related to the initial severity of the patients’ depression, and beginning or increasing medication was not significantly related to symptom reduction.

Depression severity decreased from baseline to the 4-week follow-up. There were no differences between day-clinic and inpatient psychotherapy with regard to change over time. Eight inpatients (50% of the completers) and six day-clinic patients (35% of the completers) were classified as responders. In both groups, three patients (17% of inpatients and 18% of day-clinic completers) achieved remission.

According to the authors, these results may encourage the incorporation of a scientific evaluation in routine clinical settings. In addition, the findings suggest that it may be beneficial to consider different levels of care for the treatment of severe depression.

The authors call for further research in larger samples to test for moderator effects. They note that, because inpatient psychotherapy is more expensive than day treatments, it will be crucial to find out who benefits more in each setting.

Source: Medical Xpress; July 7, 2014.

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