Prevention of Recurrence in Depression with Drugs and CT

描述(由候选人提供)：这是通过NIH独立科学家奖(K02)再提供五年支持的请求。长期以来，我一直在寻求整合抑郁症的心理、社会和生物学模型。我想增进我对抑郁症本质和治疗中的神经生物学和发育过程的理解，并对基本的遗传因素有更好的认识。我还想继续增强我工作的临床现实主义(有效性)。我感兴趣的是认知疗法(CT)是否比抗抑郁药物(ADM)有更持久的效果，以及这种持久效果是否可以延伸到预防高危青少年的抑郁。我们最近完成了一项安慰剂对照试验，结果表明，在治疗中重度抑郁症方面，CT与ADM一样有效，在预防治疗终止后的后续复发方面，CT与继续ADM一样有效，比ADM停药更好。我还与西雅图的同事完成了一项试验，该试验在很大程度上复制了这些发现，并进一步表明，在治疗更复杂的患者时，行为激活(BA)可能优于CT。我们正在与宾夕法尼亚大学和拉什大学的同事进行一项多点试验，询问在ADM中加入CT是否可以消除让患者继续服用维持性药物的需要。我们继续研究治疗对抑郁症患者后代的影响，并计划检查调节CT持久效果的遗传因素和神经生物学过程。最后，我们正在进行一项研究，以确定CBT是否可以用于预防高危青少年抑郁的发生，并计划与西雅图的同事一起，对BA和ADM(单独和联合使用)治疗青少年抑郁症进行安慰剂对照比较。我始终的目标是研究心理和生物过程在缓和和调解治疗效果中的作用，并以对实际临床实践具有最大可能影响的方式这样做。

DESCRIPTION (provided by candidate): This is a request for five more years of support via a NIH Independent Scientist Award (K02). I have long sought to integrate psychosocial and biological models of depression. I want to enhance my understanding of neurobiology and developmental processes in the nature and treatment of depression and to gain a better sense of basic genetic factors. I also want to continue to enhance the clinical realism (effectiveness) of my work. I am interested in whether cognitive therapy (CT) has a more enduring effect than antidepressant medications (ADM) and whether that enduring effect can extend to the prevention of depression in at-risk adolescents. We recently completed a placebo-controlled trial that showed that CT is as efficacious as ADM in the treatment moderate to severe depression and good as continuation ADM and better than ADM withdrawal in the prevention of subsequent relapse following treatment termination. I also completed a trial with colleagues in Seattle that largely replicated these findings and further suggested that behavioral activation (BA) may be superior to CT in the treatment of more complex patients. We are conducting a multisite trial with colleagues at Penn and Rush that asks whether adding CT to ADM can eliminate the need to keep patients on maintenance medications. We continue to study the impact of treatment on the offspring of our depressed patients and we plan to examine the genetic factors that moderate and the neurobiological processes that mediate CT's enduring effect. Finally, we are conducting a study to see if CBT can be used to prevent the onset of depression in at-risk adolescents and also plan to implement a placebo-controlled comparison of BA and ADM (alone and in combination) in the treatment of adolescent depression with colleagues in Seattle. My goal throughout has been to examine the role of both psychological and biological processes in the moderation and mediation of treatment effects and to do so in a manner that has the greatest possible impact on actual clinical practice.