Psychosocial Treatment for Atypical Depression

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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.