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）缓解后残留的抑郁症状（RDS），并且慢性病程、快速复发和功能障碍的风险增加（Nierenberg et al., 2010）。然而，管理残留症状的策略取得了不同程度的成功（Fava等人，2007年）。正念情绪平衡（MMB; R34 MH0877223）是一种个性化的、基于网络的治疗方法，旨在训练缓解的抑郁症患者摆脱烦躁不安激活的抑郁源性思维，这种思维使RDS永久化并增加复发/复发的风险。MMB的开发是为了增加正念认知疗法（MBCT; R01 MH066992）的可及性，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进行排序。我们的MMB开放试验（N=100）结果显示，治疗前后RDS患者抑郁评分下降的效应量为d=1.09，准实验比较中接受常规治疗的患者抑郁评分下降的效应量为d=1.54， MMB患者的PHQ-9平均下降1.98分。我们现在提出一项实用的MMB随机临床试验，以评估其在减少复发性抑郁症患者RDS方面的有效性。患者将是Kaiser-Permanente Colorado的成员（N = 460），年龄在18至75岁之间，PHQ-9评分为bb0.5和<9，MDD缓解，将按1:1随机分配到常规抑郁治疗途径（DepCare）或正念情绪平衡(MMB)+DepCare。我们计划测试接受MMB+DepCare的患者在随访8周和12个月时RDS的降低是否比单独接受DepCare的患者更大。我们也有兴趣检查MMB+DepCare的患者是否会在随访中复发，是否会有更高的最终状态功能和生活质量。为了检查将这种在线治疗加入KPCO抑郁症护理途径的相关成本，我们将计算患者每增加的无抑郁天数（DFDs）的边际成本。解决RDS可以减少美国人因这种持续症状负担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.