REVAMP Follow-up Study

描述(由申请者提供)：NIMH正在进行的一项多地点研究的目的是评估用心理疗法加强药物治疗的效果(REVAMP)，目的是调查治疗慢性形式的严重抑郁症的心理治疗策略，这些慢性形式的抑郁症对药物治疗无效。患者(n=909)在阶段性算法的指导下，最初使用几种药物策略之一进行治疗。那些在长达12周的治疗后没有缓解的患者(估计n=500)将接受下一次算法指导的药物治疗。此外，他们被随机分为心理治疗认知行为分析系统(CBASP)、支持性心理治疗(SP)或临床管理(CM)。在退出这项为期12周的随机治疗试验时，所有同意的患者进入为期24个月的自然主义随访，以调查急性方法在保持患者健康方面的持久性。据假设，在更换药物的同时接受CBASP强化治疗的患者将比单独接受药物替代治疗的患者具有更好的长期结果(例如，更多的缓解时间、更低的症状评分、更好的社会适应)，而接受SP强化治疗的患者将介于两者之间。我们还希望测试CBASP的长期效果是否通过教授患者更有效的社会问题解决技能来实现。我们现在正在提交竞争续展申请，以完成最后3年的后续行动。先前的一些研究表明，心理治疗对抑郁症患者具有持久的效果(尽管不是慢性MOD)，但其他研究未能发现这种效果，包括NIMH协同治疗研究。这项后续研究将解决一个重要的问题，即在慢性样本中，与单独使用药物治疗或与不太具体的心理治疗相结合，使用12周CBASP(一种专门为慢性抑郁症开发的疗法)是否会产生持久的效果。

DESCRIPTION (provided by applicant): The goal of the ongoing NIMH funded multi-site study entitled "Research Evaluating the Effect of Augmenting Medication with Psychotherapy" (REVAMP) is to investigate psychotherapeutic strategies for treating chronic forms of major depression unresponsive to medication alone. Patients (n = 909) are treated initially with one of several pharmacologic strategies, as guided by a staged algorithm. Those who do not remit after up to 12 weeks of treatment (estimated n = 500) receive the next algorithm-guided pharmacotherapy. In addition they are randomized to Cognitive Behavioral Analysis System of Psychotherapy (CBASP), Supportive Psychotherapy (SP), or Clinical Management (CM). At exit from this 12-week randomized therapy trial all consenting patients enter a 24-month naturalistic follow-up to investigate the durability of the acute approaches in keeping patients well. It is hypothesized that patients who received augmentation with CBASP in addition to switching medication will have better long-term outcomes (e.g., more time in remission, lower symptom ratings, better social adjustment) than patients receiving a medication switch alone, and patients who received SP augmentation will fall in between. We also hope to test whether the long-term effects of CBASP are mediated by teaching patients more effective social problem-solving skills. We now are submitting a competing continuation application to complete the final 3 years of the follow-up. Some prior studies have showed enduring effects of psychotherapy in depressed patients (although not in chronic forms of MOD), but other studies have failed to find such an effect, including the NIMH Collaborative Treatment Study. This follow-up study will address the important question of whether augmentation with 12 weeks of CBASP, a therapy developed specifically for chronic depression, leads to enduring effects in a chronic sample over that provided by pharmacotherapy alone or in combination with a less specific form of psychotherapy.