CBASP Augmentation for Treatment of Chronic Depression

描述(申请人提供)：慢性抑郁症患者约5人 美国成年人的百分比，并与显著的 功能障碍和较高的卫生保健利用率。最近的工作支持 已有的抗抑郁药物对慢性抑郁症的疗效。 然而，只有少数慢性抑郁症患者达到完全缓解 这些试验的缓解：大约50%没有反应， 另外20%的人只能得到部分回应。最近的一个多站点 研究表明，药物和药物的结合 心理疗法比任何一种单一疗法产生的反应都要好得多。 不幸的是，联合治疗费用昂贵。可能更有效率的是 采用循序渐进的方法，患者首先接受药物治疗，并且只有 无反应者和部分反应者接受辅助性心理治疗。我们 建议在中国开展首个大规模的辅助性心理治疗研究 慢性抑郁症患者对一种疾病没有反应或只有部分反应 药物治疗的初步试验。 这项多中心试验将比较12周的辅助治疗和 心理治疗认知行为分析系统(CBASP) 心理疗法是治疗慢性抑郁症的最好证据， 辅助性心理治疗(SP)及继续 对于慢性形式的严重抑郁症患者，单独进行药物治疗。 对对初始治疗无效的患者将进行单独的试验 5-羟色胺再摄取抑制剂(SSRI)的公开试验和在获得 只是部分反应。此外，我们还将进行自然主义的后续行动 在治疗后6个月和12个月进行评估。 该项目的具体目标包括：(1)比较 单独对持续SSRI进行辅助心理治疗；(2)确定 与附加式SP相比，附加式CBASP特别有效；(3) 检验CBASP的假想作用机制，并对其进行探索 潜在的反应调解人，以及(4)比较以下项目的成本效益 治疗难治性慢性抑郁症的三种治疗条件。这个 检查的结果将包括症状学和心理社会学。 功能正常。此外，我们将进行探索性分析，比较 三种治疗条件对复发率及治疗后服务的影响 利用率。 这将是有史以来第一次大规模研究，以测试任何 治疗难治性慢性抑郁症，并研究其价值 对任何形式的药物治疗无效的患者进行心理治疗 抑郁症。

Description (provided by applicant): Chronic depression affects approximately 5 percent of adults in the United States and is associated with significant functional impairment and high health care utilization. Recent work supports the efficacy of established antidepressant medications with chronic depression. However, only a minority of patients with chronic depression attain full remission in these trials: approximately 50 percent do not respond, and an additional 20 percent achieve only a partial response. A recent multi-site study demonstrated that the combination of medication and psychotherapy produced a significantly better response than either monotherapy. Unfortunately, combination treatment is expensive. It may be more efficient to employ a stepped approach, in which patients first receive medication, and only non-responders and partial responders receive adjunctive psychotherapy. We propose to conduct the first large-scale study of adjunctive psychotherapy in chronic depressives who fail to respond, or respond only partially, to an initial trial of medication. This multi-center trial will compare 12 weeks of adjunctive treatment with the Cognitive Behavioral Analysis System of Psychotherapy (CBASP), the form of psychotherapy with the best evidence for treating chronic depression, with adjunctive treatment with Supportive Psychotherapy (SP) and continued pharmacotherapy alone, in patients with chronic forms of major depression. Separate trials will be conducted in patients who fail to respond to an initial open trial of serotonin reuptake inhibitor (SSRI) and in patients who achieve only a partial response. In addition, we will conduct naturalistic follow-up assessments at 6- and 12-months post-treatment. The specific aims of the project include: (1) comparing the efficacy of adjunctive psychotherapy to continued SSRI alone; (2) determining whether adjunctive CBASP is specifically efficacious compared to adjunctive SP; (3) testing the hypothesized mechanism of action of CBASP, as well as exploring potential moderators of response, and (4) comparing the cost-effectiveness of the three treatment conditions for treatment resistant chronic depression. The outcomes examined will include both symptomatology and psychosocial functioning. In addition, we will conduct exploratory analyses comparing the effect of the three treatment conditions on relapse and post-treatment service utilization. This would be the first large-scale study ever to test the efficacy of any therapy for treatment resistant chronic depression, and to study the value of psychotherapy augmentation in medication non-responders with any form of depression.