This is one of two identical applications (except for budget/personnel) submitted as a two-site multi-institutional research project. The two principal investigators are Robert J. DeRubeis, Ph.D., of the University of Pennsylvania, and Steven D. Hollon, Ph.D., of Vanderbilt University. Cognitive therapy (CT) and pharmacotherapy (PT) are both widely researched treatments for major depressive disorder. This addresses five critical public health questions: 1) Is CT as effective as PT in the acute treatment of depressed outpatients? 2) Is CT more effective with mild and moderate depression and PT more effective with severe depressions? 3) Does CT prevent the return of symptoms following successful treatment? 4) Are there cognitive or biological markers that can predict differential response to these treatments? 5) What are the processes and mechanisms that account for the clinical effects of these treatments? These question will be addressed in an outcome study in which 288 nonpsychotic, nonbipolar depressed outpatients (half at each of two sites) will be randomly assigned to CT, PT, or pill placebo (PP). Acute response will be assessed across a 16 week active treatment period (eight weeks only for PP). Steps will be taken to ensure that all treatments are delivered with consistent, high quality. The PT condition entails the use of paroxetine, augmented by lithium carbonate after eight weeks for those patients who do not respond to desipramine by that time. At the end of the 16 week period, responders to PT will be randomly assigned either to continuation PT or to withdrawal onto a pill placebo; responders to CT will be withdrawn from treatment at that time. All responders will be followed across a 12 month continuation phase (embedded within a 24-month follow-up) to assess differential relapse. Cognitive predictors and mediators of response and relapse will be examined. The main hypotheses are: (a) short term CT and PT will yield comparable acute effects irrespective of patient severity, and both will be superior to PP, at least in the more severely depressed subsample; (b) short-term CT and continued PT will be comparable in the prevention of relapse, and both will surpass continuation pill placebo in this regard; (c) measures of depressive schemas and of compensatory (coping) skills will change more in CT than in PT, and these changes will mediate the acute response to CT, as well as any preventive capacity of CT; and (d) both modality-specific components of CT and nonspecific relationship factors will predict response to CT, whereas only modality specific components will predict subsequent relapse.

Agency
National Institute of Health (NIH)
Institute
National Institute of Mental Health (NIMH)
Type
Unknown (R10)
Project #
5R10MH055875-05
Application #
6186113
Study Section
Clinical Psychopathology Review Committee (CPP)
Program Officer
Niederehe, George T
Project Start
1996-09-30
Project End
2002-08-31
Budget Start
2000-09-01
Budget End
2002-08-31
Support Year
5
Fiscal Year
2000
Total Cost
$231,401
Indirect Cost
Name
Vanderbilt University Medical Center
Department
Psychology
Type
Schools of Arts and Sciences
DUNS #
004413456
City
Nashville
State
TN
Country
United States
Zip Code
37212
Porter, Eliora; Chambless, Dianne L; McCarthy, Kevin S et al. (2017) Psychometric Properties of the Reconstructed Hamilton Depression and Anxiety Scales. J Nerv Ment Dis 205:656-664
Sasso, Katherine E; Strunk, Daniel R; Braun, Justin D et al. (2016) A re-examination of process-outcome relations in cognitive therapy for depression: Disaggregating within-patient and between-patient effects. Psychother Res 26:387-98
Keefe, John R; Webb, Christian A; DeRubeis, Robert J (2016) In cognitive therapy for depression, early focus on maladaptive beliefs may be especially efficacious for patients with personality disorders. J Consult Clin Psychol 84:353-64
Fournier, Jay C; DeRubeis, Robert J; Amsterdam, Jay et al. (2015) Gains in employment status following antidepressant medication or cognitive therapy for depression. Br J Psychiatry 206:332-8
Forand, Nicholas R; DeRubeis, Robert J (2014) Extreme response style and symptom return after depression treatment: the role of positive extreme responding. J Consult Clin Psychol 82:500-9
Forand, Nicholas R; Derubeis, Robert J (2013) Pretreatment anxiety predicts patterns of change in cognitive behavioral therapy and medications for depression. J Consult Clin Psychol 81:774-82
Webb, Christian A; Derubeis, Robert J; Hollon, Steven D et al. (2013) Convergence and divergence in the delivery of cognitive therapy in two randomized clinical trials. Behav Res Ther 51:493-8
Fournier, Jay C; DeRubeis, Robert J; Hollon, Steven D et al. (2013) Differential change in specific depressive symptoms during antidepressant medication or cognitive therapy. Behav Res Ther 51:392-8
Gibbons, Carly R; Stirman, Shannon Wiltsey; Derubeis, Robert J et al. (2013) Research setting versus clinic setting: Which produces better outcomes in cognitive therapy for depression? Cognit Ther Res 37:605-612
Webb, Christian A; Derubeis, Robert J; Dimidjian, Sona et al. (2012) Predictors of patient cognitive therapy skills and symptom change in two randomized clinical trials: the role of therapist adherence and the therapeutic alliance. J Consult Clin Psychol 80:373-81

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