The goal of the ongoing NIMH funded multi-site study entitled """"""""Research Evaluating the Effect of Augmenting Medication with Psychotherapy"""""""" (REVAMP) is to investigate psychotherapeutic strategies for treating chronic forms of major depression unresponsive to medication alone. Patients (n = 909) are treated initially with one of several pharmacologic strategies, as guided by a staged algorithm. Those who do not remit after up to 12 weeks of treatment (estimated n = 500) receive the next algorithm-guided pharmacotherapy. In addition they are randomized to Cognitive Behavioral Analysis System of Psychotherapy (CBASP), Supportive Psychotherapy (SP), or Clinical Management (CM). At exit from this 12-week randomized therapy trial all consenting patients enter a 24-month naturalistic follow-up to investigate the durability of the acute approaches in keeping patients well. It is hypothesized that patients who received augmentation with CBASP in addition to switching medication will have better long-term outcomes (e.g., more time in remission, lower symptom ratings, better social adjustment) than patients receiving a medication switch alone, and patients who received SP augmentation will fall in between. We also hope to test whether the long-term effects of CBASP are mediated by teaching patients more effective social problem-solving skills. We now are submitting a competing continuation application to complete the final 3 years of the follow-up. Some prior studies have showed enduring effects of psychotherapy in depressed patients (although not in chronic forms of MOD), but other studies have failed to find such an effect, including the NIMH Collaborative Treatment Study. This follow-up study will address the important question of whether augmentation with 12 weeks of CBASP, a therapy developed specifically for chronic depression, leads to enduring effects in a chronic sample over that provided by pharmacotherapy alone or in combination with a less specific form of psychotherapy.
|Dunlop, Boadie W; Hill, Eric; Johnson, Benjamin N et al. (2015) Mediators of sexual functioning and marital quality in chronically depressed adults with and without a history of childhood sexual abuse. J Sex Med 12:813-23|
|Shankman, Stewart A; Campbell, Miranda L; Klein, Daniel N et al. (2013) Dysfunctional attitudes as a moderator of pharmacotherapy and psychotherapy for chronic depression. J Psychiatr Res 47:113-21|
|Steidtmann, Dana; Manber, Rachel; Arnow, Bruce A et al. (2012) Patient treatment preference as a predictor of response and attrition in treatment for chronic depression. Depress Anxiety 29:896-905|
|Klein, Daniel N; Leon, Andrew C; Li, Chunshan et al. (2011) Social problem solving and depressive symptoms over time: a randomized clinical trial of cognitive-behavioral analysis system of psychotherapy, brief supportive psychotherapy, and pharmacotherapy. J Consult Clin Psychol 79:342-52|
|Kocsis, James H; Gelenberg, Alan J; Rothbaum, Barbara O et al. (2009) Cognitive behavioral analysis system of psychotherapy and brief supportive psychotherapy for augmentation of antidepressant nonresponse in chronic depression: the REVAMP Trial. Arch Gen Psychiatry 66:1178-88|
|Klein, Daniel N; Arnow, Bruce A; Barkin, Jennifer L et al. (2009) Early adversity in chronic depression: clinical correlates and response to pharmacotherapy. Depress Anxiety 26:701-10|
|Kocsis, James H; Gelenberg, Alan J; Rothbaum, Barbara et al. (2008) Chronic forms of major depression are still undertreated in the 21st century: systematic assessment of 801 patients presenting for treatment. J Affect Disord 110:55-61|