Women disadvantaged by poverty, as well as racial or ethnic minority status, are more likely to experience depression than the rest of the U.S. population. At the same time, they are less likely to seek or remain in treatment for depression in traditional mental health settings. This article explores a therapeutic, psychosocial engagement strategy developed to address the barriers to treatment engagement and the application of this strategy to a special population--women of color and white women who are depressed and living on low incomes. The conceptual foundations of this intervention-ethnographic and motivational interviewing--as well as its key techniques and structure are reviewed. Finally, a case example description and promising pilot data demonstrate the usefulness of this strategy.

Bipolar disorder (BD) is a major mood disorder that is characterized by manic and depressive symptoms which fluctuate in severity and over time. The affective burden of the illness is compounded by cognitive, psychosocial, and occupational dysfunction, along with increased rates of suicide, medical comorbidity, and premature mortality. [1][2][3][4][5][6][7] Current guidelines for the management of BD include treatments that are limited by suboptimal efficacy rates, medication intolerance, delayed onset of action, iatrogenic mood switches, and variable patient acceptability. There is a pressing public health need for measures to combat these shortcomings. The fields of chronobiology and chronotherapy offer alternative treatment strategies which may address these limitations. The primary aim of this project was to systematically review efficacy and tolerability evidence of the major chronotherapies for BD and propose practice recommendations based on this review. This commences with a brief introduction to chronobiology to provide a rudimentary overview of the basic science which underlies this field of treatment. | Introduction to the circadian systemThe basic science of chronobiology is the study of biological rhythms, biological timekeeping systems, and their effects on human health and disease. 8 The human time-keeping system is a strongly conserved, phylogenetically ancient, hierarchically organized, and open neurobiological network. It evolved to enable organisms to anticipate and coordinate their internal physiology

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Objective-The authors sought to determine whether a greater frequency of interpersonal psychotherapy (IPT) sessions during maintenance treatment has a greater prophylactic effect than a previously validated once-a-month treatment.Method-A total of 233 women 20-60 years of age with recurrent unipolar depression were treated in an outpatient research clinic. After participants had achieved remission with weekly IPT or, if required, with weekly IPT plus antidepressant pharmacotherapy, they were randomly assigned to weekly, twice-monthly, or monthly maintenance IPT monotherapy for 2 years or until a recurrence of their depression occurred.Results-Among participants who remitted with IPT alone and entered maintenance treatment (N=99), 19 (26%) of the 74 who remained in the study throughout the 2-year maintenance phase experienced a recurrence of depression. Among participants who required the addition of a selective serotonin reuptake inhibitor to achieve remission (N=90), 32 (36%) sustained that remission through continuation treatment and drug discontinuation and began maintenance treatment; of these, 13 (50%) of the 26 who remained in the study throughout the maintenance phase experienced a recurrence. Survival analysis of time to recurrence by randomized treatment frequency showed no effect on recurrence-free survival in either treatment subgroup.Conclusions-These results suggest that maintenance IPT, even at a frequency of only one visit per month, is a good method of prophylaxis for women who can achieve remission with IPT alone. In contrast, among those who require the addition of pharmacotherapy, IPT monotherapy represents a significantly less efficacious approach to maintenance treatment.The long-term treatment of recurrent depression has become an important focus of psychiatric research and practice. There is now substantial evidence that the most effective pharmacotherapeutic approach for prophylaxis is to maintain the full dose of the antidepressant with which remission was achieved (1-4). However, not all patients are willing or able to remain on maintenance pharmacotherapy indefinitely. Many women prefer treatment with psychotherapy (5, 6). Similarly, among patients with medical illnesses that require complex pharmacotherapy regimens, psychotherapy may be the preferred mode of treatment. Jarrett et al. (7) and Hollon et al. (8) demonstrated the efficacy of continuation treatment "booster" sessions following acute treatment with cognitive therapy (9), and our own results (10) pointed to the possible utility of interpersonal psychotherapy (IPT) (11) as a long-term maintenance strategy. In our earlier study (12) examining the efficacy of maintenance IPT among patients randomly assigned to monthly sessions of maintenance IPT alone after acute treatment with IPT and imipramine, the median time to recurrence was 54 weeks in a 3-year maintenance phase. Among those whose treatment was characterized by ideal therapeutic conditions during sessions-that is, an intensive focus on interpersonal concerns-med...

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