A Psychosocial Treatment for Atypical Depression

描述（由申请人提供）：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 的特点是疾病发病年龄较早、发作时间较长、症状严重程度较高、对某些类别的抗抑郁药反应较差以及复发和复发的风险增加。此外，AD 患者合并焦虑症和社交功能受损的风险更大，这两者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 患者对标准 CBT 治疗抑郁症有反应，但仍有相当一部分患者对治疗无反应。因此，显然有必要改进针对 AD 的治疗方法。该申请建议根据重度抑郁症的行为激活原则和社交焦虑症的认知行为团体治疗原则，开发针对 AD 的定制心理社会干预措施。这项工作将包括 3 个阶段：1) 开发阶段，重点关注干预概念化和设计；2) 初步试点阶段，进行初步治疗修订；3) 开放试验阶段，以充分试点干预措施，检查可行性和可接受性，并为未来治疗开发建立初步的治疗前后效果大小。我们建议招募 40 名具有非典型特征的 DSM-IV MDD 患者来进行拟议的治疗开发研究。

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.