COGNITIVE THERAPY AND PHARMACOTHERAPY FOR DEPRESSION

描述（改编自申请人的摘要）：这是一个五个请求 通过NIH独立科学家奖（K02）获得多年的工资支持。我有 长期以来一直寻求整合抑郁症的心理社会和生物模型，并且 我希望利用RCA来增强我对基础神经生物学的理解， 与其性质和治疗有关的发展问题。我也想 增强我的工作与应用临床环境的相关性（有效性）。 特别是，我感兴趣的是认知疗法是否具有更持久的 治疗抑郁症的效果比药物好。早期的研究表明 这可能是事实，但最近的NIH TDCRP发现认知疗法 在治疗更严重的抑郁症时， 门诊病人和报告几乎没有证据表明任何持久的影响。两组 研究因未能提供最佳实施方案而受到批评， 各自的模式，早期研究中的药物和认知疗法 在TDCRP中。我们目前正在（与宾夕法尼亚大学的同事）进行一项 认知疗法与药物治疗的安慰剂对照比较 治疗更严重的抑郁症门诊患者，寻求解决这两个集 担忧我还与西雅图的尼尔·雅各布森合作， 安慰剂对照试验旨在确定行为激活是否 （这是更简单的实现）进行认知变化的全部重量 疗法此外，我们计划（与宾夕法尼亚大学和拉什大学的同事一起）研究， 在药物中加入认知疗法既可以提高反应的广度， 需要让患者长期服用维持药物。 最后，我们正在与这些站点的同事合作， 治疗对抑郁症患者后代的影响。我们认为 可以做更多的工作来研究与之相关的各种好处， 成功的治疗。我的目标是研究两者的作用 心理和生物过程中的节制和药物治疗 治疗效果，并以最大可能的方式这样做， 对实际临床实践的影响。我希望用我不断增长的专业知识， 神经生物学和发展，以更好地了解背后的过程， 抑郁症的治疗和预防，并利用这种理解， 提高应用环境中临床实践的有效性。

DESCRIPTION (Adapted from the Applicant's Abstract): This is a request for five years of salary support via a NIH Independent Scientist Award (K02). I have long sought to integrate psychosocial and biological models of depression, and I hope to use the RCA to enhance my understanding of basic neurobiology and developmental issues relevant to its nature and treatment. I also want to enhance the relevance of my work to applied clinical settings (effectiveness). In particular, I am interested in whether cognitive therapy has a more enduring effect than drugs in the treatment of depression. Earlier studies suggested that this might be the case, but the recent NIH TDCRP found cognitive therapy to be less effective than drugs in the treatment of more severely depressed outpatients and reported little evidence of any enduring effect. Both sets of studies have been criticized for failing to provide optimal implementations of the respective modalities, drugs in the earlier studies and cognitive therapy in the TDCRP. We are currently conducting (with colleagues at Penn) a placebo-controlled comparison of cognitive therapy versus drugs in the treatment of more severely depressed outpatients that seek to address both sets of concerns. I am also collaborating with Neil Jacobson in Seattle in a similar placebo-controlled trial designed to determine whether behavioral activation (which is simpler to implement) carries the full weight of change in cognitive therapy. Further, we plan to examine (with colleagues at Penn and Rush) whether adding cognitive therapy to drugs can both enhance the breadth of response and obviate the need to keep patients on long-term maintenance medications. Finally, we are collaborating with colleagues at each of these sites to study the impact of treatment on the offspring of our depressed patients. We think that more can be done to study the full range of benefits associated with successful treatment. My goal has been to examine the role of both psychological and biological processes in the moderation and medication of treatment effects and to do so in a manner that has the greatest possible impact on actual clinical practice. I hope to use my growing expertise in neurobiology and development to better understand the processes that underlie the treatment and prevention of depression and to use that understanding to enhance the effectiveness of clinical practice in applied settings.