Background Although many studies suggest that, on average, depression-specific psychotherapy and antidepressant pharmacotherapy are efficacious, we know relatively little about which patients are more likely to respond to one versus the other. We sought to determine whether measures of spectrum psychopathology are useful in deciding which patients with unipolar depression should receive pharmacotherapy vs. depression-specific psychotherapy. Methods 318 adult outpatients with major depression were randomly assigned to escitalopram pharmacotherapy or interpersonal psychotherapy at academic medical centers at Pittsburgh, Pennsylvania and Pisa, Italy. The outcomes of primary interest were predictors and moderators time to remission on monotherapy at 12 weeks. Results Participants with higher scores on the need for medical reassurance factor of the PAS-SR had more rapid remission with IPT and those with lower scores on the psychomotor activation factor of the MOODS-SR experienced more rapid remission with SSRI. Nonspecific predictors of longer time to remission with monotherapy included several panic spectrum and mood spectrum factors and the social phobia spectrum total score. Higher baseline HRSD-17 and-25, and Work and Social Adjustment Scale scores also predicted longer time to remission, while being married predicted shorter time to remission. Conclusions This exploratory study identified several nonspecific predictors, but few moderators of psychotherapy vs. pharmacotherapy outcome. It offers useful indicators of the characteristics of patients that are generally difficult to treat, but only limited guidance as to who benefits from IPT versus SSRI pharmacotherapy.

A lifetime burden of panic-agoraphobic spectrum symptoms predicted a poorer response to interpersonal psychotherapy and an 8-week delay in sequential treatment response among women with recurrent depression. These results lend clinical validity to the spectrum construct and highlight the need for alternate psychotherapeutic and pharmacologic strategies to treat depressed patients with panic spectrum features.

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This paper reports on the feasibility, acceptability and psychometric properties of the Structured Clinical Interview for Panic‐Agoraphobic Spectrum (SCI‐PAS). This interview was designed to assess the lifetime presence of symptoms and other clinical features considered to comprise the panic‐agoraphobic spectrum. The interview has 114 items grouped into nine domains. A total of 422 subjects, from 11 centres located throughout Italy, participated in this study. Data were collected from three groups of subjects: psychiatric patients meeting DSM‐IV criteria for panic disorder (n = 141), cardiovascular patients (n = 140), including 29 with post‐myocardial infarction, and university students (n = 141). The inter‐rater reliability and the internal consistency of the SCI‐PAS measures were assessed using the intra‐class correlation coefficient and the Kuder‐Richardson coefficient, respectively. Discriminant validity was assessed by comparing results in patients with panic disorder to those in the other groups. The interview required an average of 25 (±5) minutes to administer. Patients and clinicians found the scale to be highly useful, providing information not previously obtained. Internal consistency was good (>0.70) for six out of nine SCI‐PAS domains. The inter‐rater reliability was excellent (>0.70) for all the domains except for ‘other phobias’ (0.467). Patients with panic disorder scored significantly higher on each domain, and on the overall panic spectrum, than did the control subjects. In conclusion, the SCI‐PAS is a useful clinical interview, which can be administered in a reasonable period of time. This assessment further demonstrates good internal consistency, discriminant validity, and inter‐rater reliability. Copyright © 1999 Whurr Publishers Ltd.