CBASP Augmentation for Treatment of Chronic Depression

描述（由申请人提供）：慢性抑郁症影响约5 美国成年人的百分比，并与显着 功能障碍和高保健利用率。最近的工作支持 已建立的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达到完全缓解。 在这些试验中缓解：大约50%没有反应， 另外20%的人仅获得部分缓解。近期多地 研究表明，药物和 心理治疗产生的反应明显好于单一疗法。 不幸的是，联合治疗是昂贵的。可能更有效 采用阶梯式方法，患者首先接受药物治疗， 无反应者和部分反应者接受连续性心理治疗。我们 建议进行第一次大规模的连续性心理治疗研究， 慢性抑郁症患者对治疗没有反应或只有部分反应， 药物的初步试验。 这项多中心试验将比较12周的连续治疗与 心理治疗认知行为分析系统（CBASP）， 心理治疗与治疗慢性抑郁症的最佳证据， 支持性心理治疗（SP）的持续治疗， 单独药物治疗，在慢性形式的抑郁症患者。 单独的试验将在对初始治疗无效的患者中进行。 5-羟色胺再摄取抑制剂（SSRI）的开放试验， 只是部分回应。此外，我们将进行自然主义的后续行动， 治疗后6个月和12个月的评估。 本项目的具体目标包括：（1）比较 对单独持续SSRI的连续性心理治疗;（2）确定是否 与抗感染SP相比，抗感染CBASP是特异性有效的;（3） 测试CBASP的假设作用机制，以及探索 潜在的反应调节剂，以及（4）比较的成本效益 治疗难治性慢性抑郁症的三种治疗条件。的 检查的结果将包括生殖医学和社会心理学 功能此外，我们还将进行探索性分析， 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次大规模的研究，以测试任何有效的 治疗难治性慢性抑郁症，并研究其价值 心理治疗增强在药物治疗无反应者与任何形式的 萧条

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 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 SSRI 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.