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是“研究评估药物与心理治疗的增强效果”（REVAMP），目的是研究治疗对药物无反应的慢性重度抑郁症的心理治疗策略。患者（n = 909）在分期算法的指导下，最初使用几种药理学策略之一进行治疗。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认知行为分析系统（CBASP）、支持性心理治疗（SP）或临床管理（CM）。在这项为期12周的随机治疗试验结束时，所有同意的患者进入24个月的自然随访，以调查急性方法在保持患者健康方面的持久性。假设与单独接受药物转换的患者相比，接受CBASP增强治疗的患者具有更好的长期结果（例如，缓解时间更长，症状评分更低，社会适应更好），而接受SP增强治疗的患者则介于两者之间。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调节。我们现在正在提交一份竞争性的延续申请，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效果（尽管不是慢性形式的MOD），但其他研究没有发现这种效果，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（一种专门针对慢性抑郁症的治疗方法）是否会比单独的药物治疗或与不太具体的心理治疗相结合，在慢性样本中产生持久的效果。

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.