Patterns of symptomatic change in depressed patients in a private inpatient mood disorders program

This naturalistic study of 352 depressed patients admitted to a mood disorders program in a private psychiatric hospital demonstrated that, for the majority of patients, combining cognitive group therapy with ongoing supportive individual, psychoeducational, milieu, and pharmacological interventions resulted in rapid overall improvement and discharge within a few weeks. Improvement was manifested across cognitive and vegetative factor scores of the Beck Depression Inventory. However, patterns of symptom remission differed for subgroups defined by different lengths of stay. For example, patients hospitalized for 4 weeks showed good initial response, followed by a plateau in improvement, and, finally, continued response. These patients eventually reached the same level of functioning at discharge as did more rapidly responding patients with briefer stays. In contrast, a subset of patients (10% of the sample) hospitalized 5 weeks or more showed less overall improvement (especially in vegetative symptoms), plateauing at a moderately symptomatic level. These data suggest that in a minority of depressed individuals, continuing physiological disturbances may underlie dysthymia or residual depression. However, in contrast to the high rates (20-30%) of chronicity reported from tertiary care settings, these data indicate the relatively good initial treatment response of depressed patients admitted to a private psychiatric hospital.