The Newcastle chronic depression study: results of a treatment regime

A trial is described of new therapeutic approaches in treatment-resistant chronic depression. Phenelzine, L-tryptophan and lithium ("5HT-cocktail") was used as the major pharmacological strategy, and a regime aimed at reducing vanadium concentrations was added in the second part of the trial. Patients were randomly assigned to cognitive behaviour therapy in addition. All but 1 of the patients who ultimately entered the trial were unipolar depressives; 2 bipolar patients were withdrawn in the initial drug-free period because of the development of mixed affective states. Eleven of 20 patients showed an improvement to less than 50% of their initial scores on the Hamilton Rating Scale for Depression, and all those who improved did so in the first 6 weeks. Cognitive behaviour therapy did not seem to influence the response, but it is recognized that the short duration of therapy may be inadequate in these circumstances. It is suggested that intensive drug treatment is a necessary preliminary in management and may allow the effective use of rehabilitation aimed at the secondary handicaps of chronic depression.