Prevention of Relapse in Recurrent Depression with MBCT

通过 MBCT 预防复发性抑郁症复发

• 批准号: 6924589
• 负责人: Zindel Segal
• 金额: $ 45.8万
• 依托单位: CENTRE FOR ADDICTION AND MENTAL HEALTH
• 依托单位国家: 美国
• 财政年份: 2004
• 资助国家: 美国
• 起止时间: 2004-07-20 至 2009-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/6924589
• 关键词: antidepressants; behavioral /social science research tag; clinical depression; clinical research; cognitive behavior therapy; combination therapy; group counseling; group therapy; human subject; human therapy evaluation; mental disorder chemotherapy; mental disorder prevention; patient oriented research; pharmacokinetics; psychopharmacology; relapse /recurrence

DESCRIPTION (provided by applicant): It has been estimated that each new episode of depression increases a patient's cumulative risk for relapse by 16% and those patients who have experienced three or more past depressions are at an elevated risk of staying chronically depressed (Solomon 2000). Patients with recurrent depression are, therefore, a logical group for targeted prevention efforts. To date, the best validated and most widely used approach for preventing relapse in recurrent depression is maintenance medication. However, the protection afforded lasts only as long as patients continue to take their medication. In light of this concern, there has been a growing interest in the use of treatments that combine recovery through medication with psychological prevention of relapse/recurrence (Fava et al., 1998). One such treatment is Mindfulness-Based Cognitive Therapy (MBCT), a group intervention designed to train recovered depressed patients to disengage from mood-linked depressive thinking styles that may trigger relapse/recurrence. While there are preliminary data on MBCT's preventative effects, we do not know how well this treatment fares in comparison with the most pervasive preventive intervention for depression, namely maintenance medication. We plan to identify a sample of 272 recurrently depressed outpatients and, during the acute treatment phase of this study, provide antidepressant medication. Remitted patients will then be randomly assigned to receive either maintenance medication, be withdrawn from medication and receive MBCT or be withdrawn and receive placebo and clinical management. All patients will then be followed for the next eighteen months. Our main hypotheses are that MBCT and maintenance medication will not differ in their efficacy, and that both will outperform placebo and clinical management. We will also perform analyses to examine a possible cognitive mechanism underlying MBCT's effectiveness as well as estimate the relative costs of MBCT compared to maintenance medication for prevention of relapse. Findings from this study would have clear public health significance because MBCT could prove to be an additional effective treatment for recurrently depressed patients who require maintenance courses of treatment to prevent relapse/recurrence.

描述（由申请人提供）：据估计，每一个新的抑郁症发作都会增加患者的复发累积风险，而经历了三种或以上过去抑郁症的患者的长期抑郁症风险较高（Solomon 2000）。因此，复发性抑郁症患者是针对性预防工作的逻辑组。迄今为止，预防复发性抑郁症复发的最佳验证和最广泛使用的方法是维持药物。但是，只要患者继续服用药物，保护就可以持续。鉴于这种关注，人们对使用通过药物与心理预防复发/复发相结合的治疗的使用越来越兴趣（Fava等，1998）。一种这样的治疗方法是基于正念的认知疗法（MBCT），这是一种小组干预措施，旨在训练回收的抑郁症患者，以使情绪连接的抑郁思维方式脱离可能引发复发/复发。尽管有关于MBCT预防效果的初步数据，但我们不知道该治疗票价与最普遍的抑郁症的预防性干预相比，即维持药物。我们计划确定272种反复降低门诊患者的样本，并在本研究的急性治疗阶段提供抗抑郁药。然后，将随机分配汇款患者接受维护药物，退出药物并接受MBCT或被撤回并接受安慰剂和临床管理。然后，将在接下来的18个月内遵循所有患者。我们的主要假设是，MBCT和维护药物的功效不会有所不同，并且两者都表现优于安慰剂和临床管理。我们还将进行分析，以检查MBCT有效性的潜在认知机制，并估计MBCT的相对成本与维持药物相比预防复发。这项研究的发现将具有明显的公共健康意义，因为MBCT可能被证明是需要经常抑郁症的患者的其他有效治疗方法，这些患者需要维护治疗以防止复发/复发。