CBASP Augmentation for Treatment of Chronic Depression

CBASP 强化治疗慢性抑郁症

• 批准号: 6666685
• 负责人: Daniel N Klein
• 金额: $ 34.81万
• 依托单位: STATE UNIVERSITY NEW YORK STONY BROOK
• 依托单位国家: 美国
• 财政年份: 2002
• 资助国家: 美国
• 起止时间: 2002-09-24 至 2006-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/6666685
• 关键词: antidepressants; behavioral /social science research tag; clinical depression; clinical research; clinical trials; cognitive behavior therapy; combination therapy; cooperative study; functional ability; health care service utilization; human subject; human therapy evaluation; longitudinal human study; mental disorder chemotherapy; patient oriented research; psychopharmacology; psychotherapy; serotonin inhibitor

Description (provided by applicant): Chronic depression affects approximately 5 percent of adults in the United States and is associated with significant functional impairment and high health care utilization. Recent work supports the efficacy of established antidepressant medications with chronic depression. However, only a minority of patients with chronic depression attain full remission in these trials: approximately 50 percent do not respond, and an additional 20 percent achieve only a partial response. A recent multi-site study (Keller et al., 2000) demonstrated that the combination of medication and psychotherapy produced a significantly better response than either monotherapy. Unfortunately, combination treatment is expensive. It may be more efficient to employ a stepped approach, in which patients first receive medication, and only non-responders and partial responders receive adjunctive psychotherapy. We propose to conduct the first large-scale study of adjunctive psychotherapy in chronic depressives who fail to respond, or respond only partially, to an initial trial of medication. This multi-center trial will compare 12 weeks of adjunctive treatment with the Cognitive Behavioral Analysis System of Psychotherapy (CBASP), the form of psychotherapy with the best evidence for treating chronic depression, with adjunctive treatment with Supportive Psychotherapy (SP) and continued pharmacotherapy alone, in patients with chronic forms of major depression. Separate trials will be conducted in patients who fail to respond to an initial open trial of serotonin reuptake inhibitor (SSRI) and in patients who achieve only a partial response. In addition, we will conduct naturalistic follow-up assessments at 6- and 12-months post-treatment. The specific aims of the project include: (1) comparing the efficacy of adjunctive psychotherapy to continued SSR] alone; (2) determining whether adjunctive CBASP is specifically efficacious compared to adjunctive SP; (3) testing the hypothesized mechanism of action of CBASP, as well as exploring potential moderators of response, and (4) comparing the cost-effectiveness of the three treatment conditions for treatment resistant chronic depression. The outcomes examined will include both symptomatology and psychosocial functioning. In addition, we will conduct exploratory analyses comparing the effect of the three treatment conditions on relapse and post-treatment service utilization. This would be the first large-scale study ever to test the efficacy of any therapy for treatment resistant chronic depression, and to study the value of psychotherapy augmentation in medication non-responders with any form of depression.

描述（由申请人提供）：慢性抑郁症影响大约 5 美国成年人的百分比，并且与显着相关 功能障碍和高医疗保健利用率。近期工作支持 现有抗抑郁药物对慢性抑郁症的疗效。 然而，只有少数慢性抑郁症患者能够完全康复。 这些试验中的缓解：大约 50% 没有反应，并且 另外 20% 的人仅获得部分响应。最近的多站点 研究（Keller 等人，2000）表明，药物治疗和 心理治疗比任何一种单一疗法产生的反应明显更好。 不幸的是，联合治疗非常昂贵。这样做可能会更有效率 采用阶梯式方法，患者首先接受药物治疗，然后仅 无反应者和部分反应者接受辅助心理治疗。我们 提议在美国进行第一个大规模的辅助心理治疗研究 慢性抑郁症患者对某种药物没有反应或仅部分反应 初步尝试药物治疗。 这项多中心试验将比较 12 周的辅助治疗与 心理治疗认知行为分析系统（CBASP），其形式 心理治疗具有治疗慢性抑郁症的最佳证据， 支持性心理治疗 (SP) 的辅助治疗并继续 对于患有慢性重度抑郁症的患者，仅进行药物治疗。 将对初始治疗没有反应的患者进行单独的试验 血清素再摄取抑制剂（SSRI）的公开试验以及在达到以下目标的患者中进行的试验： 仅部分回应。此外，我们还会进行自然跟进 治疗后 6 个月和 12 个月进行评估。 该项目的具体目标包括：（1）比较 单独持续 SSR 的辅助心理治疗； (2) 判断是否 与辅助 SP 相比，辅助 CBASP 特别有效； (3) 测试 CBASP 的假设作用机制，并探索 反应的潜在调节因素，以及（4）比较成本效益 治疗难治性慢性抑郁症的三种治疗条件。这 检查的结果将包括症状学和社会心理 发挥作用。此外，我们将进行探索性分析比较 三种治疗条件对复发和治疗后服务的影响 利用率。 这将是有史以来第一个大规模研究来测试任何药物的功效 治疗难治性慢性抑郁症，并研究其价值 任何形式的药物治疗无反应者的心理治疗增强 沮丧。