COGNITIVE THERAPY AND PHARMACOTHERAPY FOR DEPRESSION

描述(申请人摘要)：认知疗法(CT)和 药物治疗(PT)是两种被广泛研究的治疗方法 抑郁障碍。它解决了五个关键的公共卫生问题： 1)在门诊抑郁症的急诊治疗中，CT和PT一样有效吗？ 2)轻度和中度抑郁的CT检查更有效，PT更多吗 对严重的抑郁症有效吗？3)CT能防止 成功治疗后的症状？4)是否有认知或 生物标记物可以预测对这些疾病的不同反应 治疗？5)什么过程和机制解释了 这些治疗的临床效果如何？ 这些问题将在一项成果研究中得到解决，其中288 非精神病、非双相抑郁的门诊患者(两个地点各有一半) 将被随机分配到CT、PT或安慰剂(PP)组。急性反应 将在16周的积极治疗期内进行评估(仅限8周 对于PP)。将采取措施确保提供所有治疗 始终如一，高质量。PT条件需要使用 帕罗西汀，八周后用碳酸锂强化治疗 到那时，对地昔帕明没有反应的患者。在结束时， 在16周的时间内，PT的响应者将随机分配到 继续PT或停用安慰剂；CT的应答者将 届时将停止治疗。所有应答者都将被跟踪 跨12个月的延续阶段(嵌入24个月的跟踪调查) 以评估不同的复发。认知预测因子和调节因子 将检查反应和复发情况。 主要假设是：(A)短期CT和PT的收益率具有可比性 急性影响与患者的严重程度无关，两者都优于 PP，至少在更严重抑郁的亚样本中；(B)短期CT和 持续的PT在预防复发方面将具有可比性，两者都将 在这方面超过继续服用安慰剂；(C)抑郁措施 CT的模式和代偿(应对)技能的变化将比 PT，这些变化将介导CT的急性反应，以及任何 CT的预防能力；和(D)CT的两个特定类型的组成部分 而非特定的关系因素将预测CT的疗效，而 只有特定于医疗模式的成分才能预测随后的复发。

DESCRIPTION (Applicant's Abstract): Cognitive therapy (CT) and pharmacotherapy (PT) are both widely researched treatments for major depressive disorder. This addresses five critical public health questions: 1) Is CT as effective as PT in the acute treatment of depressed outpatients? 2) Is CT more effective with mild and moderate depression and PT more effective with severe depressions? 3) Does CT prevent the return of symptoms following successful treatment? 4) Are there cognitive or biological markers that can predict differential response to these treatments? 5) What are the processes and mechanisms that account for the clinical effects of these treatments? These question will be addressed in an outcome study in which 288 nonpsychotic, nonbipolar depressed outpatients (half at each of two sites) will be randomly assigned to CT, PT, or pill placebo (PP). Acute response will be assessed across a 16 week active treatment period (eight weeks only for PP). Steps will be taken to ensure that all treatments are delivered with consistent, high quality. The PT condition entails the use of paroxetine, augmented by lithium carbonate after eight weeks for those patients who do not respond to desipramine by that time. At the end of the 16 week period, responders to PT will be randomly assigned either to continuation PT or to withdrawal onto a pill placebo; responders to CT will be withdrawn from treatment at that time. All responders will be followed across a 12 month continuation phase (embedded within a 24-month follow-up) to assess differential relapse. Cognitive predictors and mediators of response and relapse will be examined. The main hypotheses are: (a) short term CT and PT will yield comparable acute effects irrespective of patient severity, and both will be superior to PP, at least in the more severely depressed subsample; (b) short-term CT and continued PT will be comparable in the prevention of relapse, and both will surpass continuation pill placebo in this regard; (c) measures of depressive schemas and of compensatory (coping) skills will change more in CT than in PT, and these changes will mediate the acute response to CT, as well as any preventive capacity of CT; and (d) both modality-specific components of CT and nonspecific relationship factors will predict response to CT, whereas only modality specific components will predict subsequent relapse.