Reducing residual depressive symptoms with web-based Mindful Mood Balance

描述（由申请人提供）：80-90%接受一线抗抑郁药物治疗的成年人报告了重度抑郁症（MDD）缓解后的残留抑郁症状（RDS），并且慢性病程、快速复发和功能障碍的风险升高（Nierenberg et al.，2010年）。然而，控制残留症状的策略取得了混合的成功（Fava等人，2007年）。正念情绪平衡（MMB; R34 MH 0877223）是一种个性化定制的基于网络的治疗方法，旨在训练缓解的抑郁症患者摆脱焦虑症激活的致抑郁思维，这种思维使RDS持续存在并增加复发/复发的风险。MMB的开发是为了增加基于正念的认知疗法（MBCT; R 01 MH 066992）的使用，这是一种经验支持的预防性组治疗，可以很容易地与急性期抗抑郁药物治疗相结合。我们的MMB开放试验（N=100）的结果显示，RDS患者治疗前后抑郁评分降低的效应量为d=1.09，与接受常规治疗的患者相比，d=1.54，MMB患者PHQ-9平均降低1.98分。我们现在提出一个实用的随机临床试验MMB评估其有效性，减少RDS复发性抑郁症患者。患者将是Kaiser-Permanente科罗拉多的成员（N = 460），年龄18至75岁，PHQ-9评分>5且<9，处于MDD缓解期，并将以1：1的比例随机分配至常规抑郁症护理途径（DepCare）或正念情绪平衡（MMB）+DepCare。 我们计划测试接受MMB+DepCare治疗的患者在8周和12个月随访时是否比单独接受DepCare治疗的患者更能降低RDS。我们也有兴趣研究MMB+DepCare是否会有更少的患者在随访中复发，并具有更高的终末状态功能和生活质量。为了研究将这种在线治疗添加到KPCO的抑郁症护理途径中的相关成本，我们将计算患者每增加一个无抑郁症天数（DFD）的边际成本。RDS的解决可以减少美国人在这种持续症状负担下所经历的巨大的个人和社会成本。

DESCRIPTION (provided by applicant): Residual depressive symptoms (RDS) following remission of major depressive disorder (MDD) are reported by 80-90% of adults receiving first-line antidepressant pharmacotherapy and carry an elevated risk for a chronic course of illness, rapid relapse and functional impairment (Nierenberg et al., 2010). Strategies for managing residual symptoms, however, have met with mixed success (Fava et al., 2007). Mindful Mood Balance (MMB; R34 MH0877223) is an individually tailored, web-based treatment designed to train remitted depressed patients to disengage from dysphoria-activated depressogenic thinking that perpetuates RDS and increases risk for relapse/recurrence. MMB was developed to increase access to Mindfulness-Based Cognitive Therapy (MBCT; R01 MH066992), an empirically supported prophylactic group treatment that can be easily sequenced with acute phase antidepressant pharmacotherapy. Results from our open trial of MMB (N=100) showed an effect size of d=1.09 for pre to post treatment reductions in depression scores among patients with RDS and d=1.54 in a quasi-experimental comparison to patients receiving usual care, with an on average reduction of 1.98 points on the PHQ-9 for MMB patients. We now propose a pragmatic randomized clinical trial of MMB to evaluate its effectiveness in reducing RDS in recurrently depressed patients. Patients will be members of Kaiser-Permanente Colorado (N = 460), aged 18 to 75, who score >5 and <9 on the PHQ-9, in remission from MDD and will be randomized 1:1 to either the usual depression care pathway (DepCare) or Mindful Mood Balance (MMB)+DepCare. We plan to test whether patients receiving MMB+DepCare will show greater reductions in RDS at both 8 week and 12 months follow up, than those receiving DepCare alone. We are also interested in examining whether fewer patients in MMB+DepCare will relapse over the follow up and will have higher end state functioning and quality of life. In order to examine the costs associated with adding this online treatment to the Depression Care Pathways at KPCO, we will calculate the marginal costs per additional number of depression free days (DFDs) for patients. Resolution of RDS can reduce the enormous personal and social costs experienced by Americans with this persistent symptom burden.