2/2-Preventing Depressive Relapse in Pregnant Women with Recurrent Depression

项目摘要 妊娠期抑郁症复发非常普遍，特别是在患有 复发性抑郁症。与抑郁症复发相关的孕产妇精神疾病发病率 怀孕是令人担忧的，怀孕期间未经治疗的情绪障碍的影响也是如此 产后期对儿童发育的影响。而维持性抗抑郁药物治疗是 复发性抑郁症妇女的护理标准，存在关于已知和 胎儿接触这些制剂的未知影响；可以理解的是，许多孕妇和 他们的提供者在治疗期间寻求非药物治疗的替代方案 怀孕了。以正念为基础的认知疗法(MBCT)可有效预防 与常规护理相比，孕妇中的抑郁复发是可扩展的 数字化交付。我们提出了一项比较MBCT和常规护理(UC)的实用有效性试验 接受维持性治疗的复发性抑郁症孕妇(N=500) 抗抑郁药。这项研究将在科罗拉多博尔德大学(UCB；PI)进行 )和马萨诸塞州总医院(MGH；Pi Cohen)使用协作RO1 机制。考虑到每个站点带来的独特专业知识，这种赠款机制是合理的 拟议中的调查。具体地说，UCB网站提供实用方面的专业知识 孕妇的随机试验和MBCT，MGH网站提供了 情绪障碍孕妇的前瞻性监测。我们将解决三个主要问题 目的：1)检查抑郁症复发和减轻症状负担的相对风险 在随机接受数字MBCT或UC的女性之间；2)检查抑郁的风险 停用抗抑郁药的随机接受MBCT治疗的女性之间的复发 治疗和那些停止抗抑郁药物治疗的UC随机分组，并应用 一种治疗选择算法，询问与MBCT相比，什么对谁有效 抗抑郁药物维护；以及3)检查数字MBCT与密钥的关联程度 可能的目标。可降低抑郁症风险的干预措施的系统研究 妊娠期复发，特别是在“高危”人群中，可最大限度地减少 育龄妇女生命中关键时期的复发性抑郁。

PROJECT ABSTRACT Depressive relapse during pregnancy is highly prevalent particularly among women with recurrent depression. Maternal psychiatric morbidity associated with depressive relapse during pregnancy is of concern as is the impact of untreated mood disorder during pregnancy and the postpartum period on child development. While maintenance antidepressant treatment is the standard of care for women with recurrent depression, concerns exist regarding known and unknown effects of fetal exposure to these agents; understandably, many pregnant women and their providers seek non-pharmacologic alternatives to pharmacologic treatment during pregnancy. Mindfulness-based cognitive therapy (MBCT) is efficacious in the prevention of depressive relapse among pregnant women as compared to usual care and is scalable using digital delivery. We propose a pragmatic effectiveness trial comparing MBCT to usual care (UC) among euthymic pregnant women (N=500) with recurrent depression treated with maintenance antidepressants. The study will be conducted at the University of Colorado Boulder (UCB; PI Dimidjian) and Massachusetts General Hospital (MGH; PI Cohen) using the Collaborative RO1 mechanism. This grant mechanism is justified given the unique expertise brought by each site to the proposed investigation. Specifically, the UCB site provides expertise in pragmatic randomized trials and MBCT for pregnant women, and the MGH site provides expertise in prospective monitoring of pregnant women with mood disorders. We will address three primary aims: 1) to examine the relative risk for depressive relapse and reduction of symptom burden between women randomized to digital MBCT or UC; 2) to examine the risk for depressive relapse between women who are randomized to MBCT who discontinue antidepressant treatment and those randomized to UC who discontinue antidepressant treatment, and to apply a treatment selection algorithm to ask what works for whom with respect to MBCT versus antidepressant maintenance; and 3) to examine the extent to which digital MBCT engages key putative targets. Systematic investigation of interventions that can attenuate risk for depressive relapse during pregnancy particularly in “at risk” populations minimizes the morbidity of recurrent depression during critical times in the lives of reproductive aged women.