Prevention of Relapse in Recurrent Depression with MBCT

描述（由申请人提供）：据估计，每一次新的抑郁症发作会使患者复发的累积风险增加16%，而那些经历过三次或三次以上抑郁症的患者长期处于抑郁状态的风险较高（Solomon 2000）。因此，复发性抑郁症患者是有针对性的预防工作的合理群体。迄今为止，最有效和最广泛使用的预防复发性抑郁症复发的方法是维持药物治疗。然而，只要病人继续服药，这种保护就会持续下去。鉴于这种担忧，人们越来越关注将药物治疗与心理预防复发/复发相结合的治疗方法（Fava et al., 1998）。其中一种治疗方法是正念认知疗法（MBCT），这是一种团体干预，旨在训练康复的抑郁症患者摆脱可能引发复发的与情绪相关的抑郁思维方式。虽然有关于MBCT预防效果的初步数据，但我们不知道这种治疗与最普遍的抑郁症预防干预（即维持药物）相比效果如何。我们计划确定272例复发性抑郁症门诊患者的样本，并在本研究的急性治疗阶段提供抗抑郁药物。然后，缓解的患者将被随机分配接受维持药物、停药并接受MBCT或停药并接受安慰剂和临床管理。所有患者将在接下来的18个月里接受随访。我们的主要假设是MBCT和维持药物在疗效上没有区别，两者都将优于安慰剂和临床管理。我们还将进行分析，以检验MBCT有效性可能的认知机制，并估计MBCT与维持药物预防复发的相对成本。这项研究的发现将具有明确的公共卫生意义，因为MBCT可能被证明是需要维持治疗以防止复发/复发的复发性抑郁症患者的额外有效治疗方法。

DESCRIPTION (provided by applicant): It has been estimated that each new episode of depression increases a patient's cumulative risk for relapse by 16% and those patients who have experienced three or more past depressions are at an elevated risk of staying chronically depressed (Solomon 2000). Patients with recurrent depression are, therefore, a logical group for targeted prevention efforts. To date, the best validated and most widely used approach for preventing relapse in recurrent depression is maintenance medication. However, the protection afforded lasts only as long as patients continue to take their medication. In light of this concern, there has been a growing interest in the use of treatments that combine recovery through medication with psychological prevention of relapse/recurrence (Fava et al., 1998). One such treatment is Mindfulness-Based Cognitive Therapy (MBCT), a group intervention designed to train recovered depressed patients to disengage from mood-linked depressive thinking styles that may trigger relapse/recurrence. While there are preliminary data on MBCT's preventative effects, we do not know how well this treatment fares in comparison with the most pervasive preventive intervention for depression, namely maintenance medication. We plan to identify a sample of 272 recurrently depressed outpatients and, during the acute treatment phase of this study, provide antidepressant medication. Remitted patients will then be randomly assigned to receive either maintenance medication, be withdrawn from medication and receive MBCT or be withdrawn and receive placebo and clinical management. All patients will then be followed for the next eighteen months. Our main hypotheses are that MBCT and maintenance medication will not differ in their efficacy, and that both will outperform placebo and clinical management. We will also perform analyses to examine a possible cognitive mechanism underlying MBCT's effectiveness as well as estimate the relative costs of MBCT compared to maintenance medication for prevention of relapse. Findings from this study would have clear public health significance because MBCT could prove to be an additional effective treatment for recurrently depressed patients who require maintenance courses of treatment to prevent relapse/recurrence.