Defense Date


Document Type


Degree Name

Doctor of Philosophy



First Advisor

Dr. Scott Vrana


Despite the development of several effective treatments for depression, symptoms often persist in a number of individuals. Unfortunately, these residual symptoms are associated with several negative outcomes, including persistence of depressive illness. Few studies have examined the exact nature of individual residual symptoms across specific treatment modalities, and studies have failed to distinguish between depression courses. The current study expands on previous findings by examining, among a chronically depressed population, differences in individual residual symptoms and clusters between treatment modality (medication, psychotherapy, combination) and treatment response (full response, partial response). Five hundred and nineteen chronically depressed participants completed the study. Participants were randomly assigned to receive treatment with nefazodone, CBASP, or the combination of both. Residual symptoms were assessed with two depression severity ratings, a clinician administered interview and a self-report questionnaire. The frequency and severity of individual residual symptoms and clusters were examined between treatment and response groups. The emergence of symptoms after treatment was compared between treatment groups. Residual symptoms were common, reported in over 90% of the sample. The most common residual symptoms reflected both core depressive symptoms and co-morbid symptoms not specific to depression. In general, similar residual symptoms were reported among partial and full responders. The only individual residual symptoms that differed between treatment groups were early insomnia, OCD symptoms, hopelessness, hypersomnia, concentration, and decreased libido. Treatment groups also differed on two factors of the HDRS. The Nefazodone group reported a greater number of Disturbed Thinking items than the CBASP group. The CBASP group reported more items on the Psychic Depression factor compared to the Nefazodone group for full responders only. Analyses revealed that the Nefazodone group was more likely to report the emergence of guilt and psychic anxiety after treatment than the CBASP and Combination group, and the emergence of weight loss occurred more frequently among participants in the Nefazodone and Combination groups when compared with the CBASP group. Results suggest residual weight loss may be a side effect of medication and CBASP may offer protection against the development of guilt and anxiety.


© The Author

Is Part Of

VCU University Archives

Is Part Of

VCU Theses and Dissertations

Date of Submission

June 2008

Included in

Psychology Commons