REVAMP-Follow-Up Study

描述（由申请人提供）：正在进行的NIMH资助的多地点研究的目标，题为“研究评估心理治疗增强药物的效果”（REVAMP）是调查治疗对单独药物无反应的慢性形式的重度抑郁症的心理治疗策略。患者（n = 909）最初治疗的几种药理学策略之一，指导下的分期算法。那些在长达12周的治疗后仍未缓解的患者（估计n = 500）接受下一个算法指导的药物治疗。此外，他们被随机分配到心理治疗的认知行为分析系统（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24个月的自然随访，以研究急性方法在保持患者健康方面的持久性。假设除了转换药物外，接受CBASP增强的患者将具有更好的长期结局（例如，更多的时间在缓解，更低的症状评级，更好的社会适应）比接受药物转换单独的患者，和接受SP增强的患者将落在两者之间。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介导。我们现在正在提交一份竞争性继续申请，以完成最后3年的随访。一些先前的研究已经显示了心理治疗对抑郁症患者的持久影响（尽管不是在慢性形式的MOD中），但其他研究未能发现这种影响，包括NIMH合作治疗研究。这项后续研究将解决一个重要的问题，即12周的CBASP（一种专门为慢性抑郁症开发的治疗方法）是否会在慢性样本中产生持久的效果，而不是单独使用药物治疗或与不太具体的心理治疗相结合。

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.