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 Remitted patients will then be randomly assigned to receive either maintenance medication, be withdrawn from medication and receive MBCT or be withdrawn and receive placebo and clinical management.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，每次新的抑郁症发作都会使患者的累积复发风险增加 16%，而那些过去经历过 3 次或以上抑郁症的患者处于长期抑郁状态的风险更高（Solomon 2000）。因此，复发性抑郁症患者是有针对性的预防工作的合理群体。迄今为止，预防复发性抑郁症复发的最有效、最广泛使用的方法是维持药物。然而，只要患者继续服药，所提供的保护就会持续。鉴于这种担忧，人们对将药物康复与复发/复发的心理预防相结合的治疗方法越来越感兴趣（Fava 等，1998）。其中一种治疗方法是基于正念的认知疗法（MBCT），这是一种团体干预措施，旨在训练康复的抑郁症患者摆脱可能引发复发/复发的与情绪相关的抑郁思维方式。虽然有关于 MBCT 预防效果的初步数据，但我们不知道与最普遍的抑郁症预防干预措施（即维持药物）相比，这种治疗效果如何。我们计划确定 272 名复发性抑郁症门诊患者的样本，并在本研究的急性治疗阶段提供抗抑郁药物。然后，缓解的患者将被随机分配接受维持药物、停药并接受 MBCT 或停药并接受安慰剂和临床管理。所有患者将在接下来的十八个月内接受随访。我们的主要假设是 MBCT 和维持药物的疗效不会有差异，并且两者都会优于安慰剂和临床管理。我们还将进行分析，以检查 MBCT 有效性背后可能的认知机制，并估计 MBCT 与预防复发的维持药物相比的相对成本。这项研究的结果将具有明确的公共卫生意义，因为 MBCT 可能被证明是对于需要维持治疗以防止复发的复发性抑郁症患者的一种额外有效的治疗方法。