Psychosocial Treatment for Atypical Depression

描述(申请人提供)：非典型抑郁症(AD)的心理社会干预在临床研究文献中相对被忽视，尽管有证据表明，AD的特点是出现障碍的年龄更早，症状发作的长度更长，症状更严重，对某些类别的抗抑郁药的反应更差，复发和复发的风险增加。此外，患有阿尔茨海默病的人患焦虑症和社会功能障碍的风险更大，这两种疾病都被认为是严重抑郁症病程的不良预后指标。尽管有初步证据表明，AD患者对抑郁症的标准CBT治疗有反应，但相当大比例的患者仍然对治疗无效。因此，针对AD的治疗方法的改进显然是有必要的。这项申请建议开发一种针对AD的量身定制的心理社会干预，其基础是针对严重抑郁症的行为激活和针对社交焦虑的认知行为团体治疗的原则。这项工作将包括3个阶段：1)专注于干预概念化和设计的开发阶段，2)进行初步治疗修订的初步试验阶段，以及3)开放试验阶段，以全面试验干预，检查可行性和可接受性，并为未来的治疗开发建立初步的治疗前后效果大小。我们建议为拟议的治疗发展研究招募40名具有非典型特征的DSM-IV MDD患者。

DESCRIPTION (provided by applicant): Psychosocial interventions for atypical depression (AD) have been relatively ignored in the clinical research literature, despite evidence to suggest that AD is marked by earlier age of disorder onset, greater length of index episode, greater symptom severity, poorer response to certain classes of antidepressants, and increased risk for relapse and recurrence. Moreover, those with AD are at greater risk for a comorbid anxiety disorder as well as impairment in social functioning, both of which have been identified as poor prognostic indicators for course of major depression. Although there is preliminary evidence to suggest that individuals with AD respond to standard CBT for depression, a substantial percentage of patients remain treatment non-responders. Thus, improvements in treatments targeted toward AD are clearly warranted. This application proposes the development of a tailored psychosocial intervention for AD, based upon principles of behavioral activation for major depression and cognitive-behavioral group therapy for social anxiety. This work will consist of 3 phases: 1) A development phase focused on intervention conceptualization and design, 2) An initial pilot phase to conduct a preliminary treatment revision, and 3) An open trial phase in order to fully pilot the intervention, examine feasibility and acceptability, and to establish a preliminary pre- to post-treatment effect size for future treatment development. We propose to recruit 40 individuals with DSM-IV MDD with atypical features for the proposed treatment development study.