Preventing Depression in MMT Patients on Interferon

描述(由申请人提供)：到目前为止，使用心理社会干预措施来预防主要的抑郁发作，这通常是由丙型肝炎病毒(丙型肝炎病毒)的抗病毒治疗引起的，这一点尚未得到探索。然而，抑郁症的认知行为治疗(CBT-D)已经在许多不同的人群中证明了有效性，包括药物滥用者和有医疗问题的个人，并被发现在预防抑郁症方面是有效的。这项研究计划的长期目标是通过开发和确定针对这一人群量身定做的CBT-D干预的有效性，改善接受美沙酮维持治疗(MMT)治疗丙型肝炎的美沙酮维持治疗(MMT)患者的抑郁预防选择。此外，我们试图提高对抑郁症状与干扰素治疗依从性和非法药物复发之间的关系的了解。在目前的应用中，我们建议开发一种CBT-D干预措施，以满足接受丙型肝炎抗病毒治疗的MMT患者的需求。在该项目的第一阶段(第一年)，我们将开发并试行20名患者的干预措施。在该项目的第二阶段(第2年和第3年)，我们将对60名MMT患者进行初步随机试验，以检验CBT-D干预相对于放松训练(RT)控制条件的有效性，放松训练(RT)控制条件与治疗师接触时间相等。我们预计，与RT条件相比，随机进入CBT-D条件的参与者将降低抑郁症相关抗病毒治疗失败的可能性，报告的抑郁症状水平将更低，完成更多干扰素注射，丙型肝炎病毒RNA水平将更低，非法药物使用天数将更少。如果这项干预措施的效果能够在这项试验和随后的临床试验中得到证实，那么选择接受抗病毒治疗的MMT患者将拥有一种有价值的辅助或替代使用抗抑郁药物来预防抑郁的方法。如果被发现是有效的，这种干预将最大限度地增加MMT患者接受干扰素治疗的机会，从而有助于预防丙型肝炎患者的肝功能衰竭、肝细胞癌和与肝脏相关的死亡。

DESCRIPTION (provided by applicant): To date, the use of psychosocial interventions to prevent the major depressive episodes that are commonly precipitated by antiviral treatment for the hepatitis C virus (HCV) has been unexplored. However, cognitive-behavioral treatments for depression (CBT-D) have demonstrated efficacy in a number of different populations, including substance abusers and individuals with medical problems, and have been found to be efficacious in the prevention of depression. The long-term objective of this research program is to improve depression prevention options for methadone maintenance treatment (MMT) patients undergoing interferon (IFN) treatment for hepatitis C by developing and establishing the efficacy of a CBT-D intervention tailored to this population. Furthermore, we seek to advance knowledge of the relationship between depressive symptoms and IFN treatment adherence and illicit drug use relapse. In the present application, we propose to develop a CBT-D intervention tailored to meet the needs of MMT patients undergoing antiviral treatment for hepatitis C. In the first phase of this project (Year 1), we will develop and pilot the intervention with 20 patients. In the second phase of the project (Years 2 and 3), we will conduct a preliminary, randomized trial with 60 MMT patients to examine the efficacy of the CBT-D intervention relative to the relaxation training (RT) control condition that equates for therapist contact time. We expect that, relative to the RT condition, participants randomized to the CBT-D condition will have decreased likelihood of depression-related antiviral treatment failure, will report lower levels of depressive symptoms, will complete more IFN injections, will have lower HCV RNA levels, and will have fewer illicit drug use days. If the efficacy of this intervention can be established in this trial and in subsequent clinical trials, MMT patients who elect to undergo antiviral therapy will have a valuable adjunct or alternative to the use of antidepressants to prevent depression. If found to be efficacious, this intervention will maximize the receipt of IFN treatment by MMT patients, thereby aiding in the prevention of liver failure, hepatocellular carcinoma, and liver-related death among those with HCV.