A placebo-controlled, randomized clinical trial comparing sertraline and imipramine for the treatment of dysthymia

Background: Despite the high prevalence of dysthymia and its associated morbidity, few controlled trials have evaluated the efficacy of antidepressant medication for this disorder. A 12-week, double-blind, placebocontrolled, randomized, multicenter trial was performed to evaluate the safety and efficacy of sertraline hydrochloride and imipramine hydrochloride in treating dysthymia. Methods: A total of 416 outpatients (271 women and 145 men) aged 25 to 65 years with DSM-III-R-defined, early-onset, primary dysthymia without concurrent major depression were randomized to 12 weeks of treatment with sertraline, imipramine, or placebo. Results: Both active treatments resulted in significantly reduced scores on the 17-item Hamilton Rating Scale for Depression (P=.04 and P=.01 for sertraline and imipramine vs placebo, respectively), the Montgomery Asberg Depression Rating Scale (P=.01 and P=.003 vs placebo, respectively), Hopkins Symptom Checklist (P<.05), and the self-rated version of the Inventory of Depressive Symptoms (P<.05). With the use of a Clinical Global Impressions improvement score of 1 or 2 (very much or much improved) to define response, response rates were 59% for sertraline, 64% for imipramine, and 44% for placebo (P= .02 for sertraline vs placebo and P< .001 for imipramine vs placebo). A significantly greater proportion of patients receiving imipramine than those receiving sertraline or placebo discontinued treatment because of adverse events (P=.001 and P<.001, respectively). Conclusions: Pharmacotherapy provides considerable relief from the symptoms of dysthymia in patients suffering from this chronic affective disorder, with both sertraline and imipramine being more effective than placebo. The greater tolerability of sertraline is an important consideration because of the chronicity of dysthymia, which may require prolonged treatment with antidepressant medication.