The proposed project will test the feasibility and preliminary efficacy of a depression intervention that combines medication treatment with a psychotherapy designed to personalize treatment for depressed patients whose anxiety symptom profiles place them at risk for non-remission with traditional depression treatments. As part of this study, we will randomly assign 40 adults with major depressive disorder who also endorse significant symptoms of co-occurring anxiety to receive medication treatment (citalopram) combined with either: (a) IPT-PS, an intervention explicitly developed to address co-occurring anxiety symptoms among depressed populations, or (b) a standardized depression psychotherapy control, brief supportive psychotherapy (BSP). Patients will receive up to 20 weeks of clinical care, including medication treatment with citalopram, provided by MD pharmacotherapists trained to provide manualized pharmacotherapy, and up to 16 sessions of individual psychotherapy with either IPT-PS or BSP. Finally, patients will undergo observation-only post-treatment evaluations at 4-month intervals for up to 8 months post-treatment. Recruitment and intake will begin in month 01 and conclude in month 20 (approximately 2 patients per month), allowing months 21-24 to finish the study protocol and conduct study analyses. The number of patients at the key time points of the study are shown in Table 1. We hypothesize that depressed patients with co-occurring anxiety symptoms who are assigned to receive combined treatment with the personalized IPT-PS intervention will show greater reductions in symptoms of depression and anxiety, and greater improvements in work and social function, as compared with those assigned to receive depression-specific psychotherapy with BSP. In addition to these primary aims, the current study will also provide needed infrastructure support to move our research clinic away from pencil-and-paper assessment methods and toward more cost-effective and environmentallysustainable computer-based patient-reported assessment systems. Finally, the proposed trial will pilot novel computer-adaptive testing (CAT) strategies to minimize patient assessment burden while providing clinicians with the personalized patient information needed to optimize treatment selection and delivery. In line with RFA-MH-09-010, the proposed trial was developed to test the feasibility of this novel model of personalized depression care, to refine computer-based assessment methods to support the implementation of personalized depression care models, and to """"""""prepare for subsequent larger studies that will test treatment hypotheses in a more definitive way.""""""""
The co-occurrence of depression and panic-like symptoms is particularly common, and is associated with a more severe form of illness, poorer social functioning, greater risk of suicide, and poorer response to first-line depression treatments. The current study will pilot a personalized model of depression care that will identify these at-risk patients and provide targeted depression treatment. Currently, only 1 of 3 patients will achieve full depression remission with first-line treatment;by personalizing depression care in this manner, we hope to achieve depression remission rates that exceed 60%.
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