Burnand, Y.; Andreoli, A.; Kolatte,

Burnand, Y.; Andreoli, a.; Kolatte, E.; Venturini, a. & Rosset, N. (2002). "Psychodynamic psychotherapy and clomipramine in the treatment of major depression." Psychiatric services 53, pp. 585-90.

In this article, the researchers wished to compare the efficacy of treating major depression through the use of both psychodynamic therapy and the pharmaceutical clomipramine with treatment that consisted of clomipramine alone. They used a randomized controlled trial in order to objectively compare the two groups of patients and observe the results of treatment. The trial consisted of seventy four patients with major depression who were otherwise in decent overall and mental health, who were radnomy assigned to one of the two outpatient treatment groups. While both groups were seen to significantly improve during the ten weeks of the study, the group that received both treatments showed better adjustments and had reduced hospitalization rates following the trial, which ended up leading to a savings that more than offset the cost of providing both clomipramine and psychodynamic therapy at the same time.

The authors of this article begin by citing the need in the treatment of mental illness to combine therapy and pharmaceutical techniques; they not a lack of effective integration in many instances to date. They also cite previous research that suggests more effective results from combined therapy and pharmaceutical treatments than pharmaceuticals alone. This led to the development of their hypothesis that combined treatment would be more effective than drug therapies that were not accompanied by psychodynamic therapy. They also suggest that better psychotherapy techniques and practitioners will likely (and have in the past) lead to better long-term outcomes for patients being treated with depression, and that this would produce lower costs of treatment.

Over a two-year period, a research nurse and a psychiatrist screened patients for the study. This resulted in 110 initial participants in the study, which through various reasons was winnowed down to seventy four by the time of analysis. The patients in the two treatment groups both received the same amount of clomipramine (as per usual protocols, and adjusted on an individual basis), as well as intensive nursing care, with the control group receiving no additional care and the experimental group receiving regular psychodynamic therapy. Both groups received supportive care in the form of individual session that provided someone to talk to and to support the patients. Nurses in charge of the basic care of these patients had all undergone specialized training to ensure the same care was delivered to both groups, making the results more reliable. Nursing practices were reviewed and all guidelines had been followed.

The researchers were also careful to note established differences in response to psychodynamic therapy based on the personality of the patient and other factors, and took steps to control this during their analysis of the results, as well. Nurses with an extensive background and proven ability in dealing with patients suffering from major depression were used to treat all the patients, especially in the support sessions, and the nurses treating the patients that were receiving both clomipramine and psychodynamic therapy met once a week with a psychoanalyst to go over protocol and develop techniques. The main goal of the researchers in having the nurses acquire these techniques was an attempt to surmount any barriers to the psychodynamic treatment that might arise, as such blocks are well documented during psychodynamic therapy and could produce unusable results from an otherwise carefully controlled study.

Clomipramine protocol was somewhat more simple, with the dosage beginning at 25mg on the first day of the study and gradually increasing to 125mg by the fifth day. Electrocardiograms were administered to ensure that no adverse effects were taking place, and clinicians were able to adjust patients' levels of clomipramine individually once the idela blood saturation of the drug had been reached. Pateints entering the study were also rated for the degree of their depression, including the timing and severity of recent episodes, and this data was also analyzed as part of the study's results. Days spent hospitalized or away from work due to depression were also monitored, and none of the nurses or clinicians who had worked with the patients were involved in the analysis of the results to ensure that there was no way to taint the data collected or the conclusions drawn from a statistical analysis of this data.