The overall aim of this research is to further our knowledge of the best treatments for mood disorders. The more specific goal of this project is to determine the most effective post-hospital treatments for depressed inpatients. Despite their high morbidity, poor response to usual treatments, and high treatment costs, depressed inpatients have been markedly under-studied in clinical trials. While previous studies have suggested that combined psychosocial + pharmacological treatment maybe the most efficacious treatment, these studies have been limited in several respects and have not explored the parameters of the most effective combined treatments. To address these issues, we propose to conduct a clinical trial investigating the efficacy of combined psychosocial + medication treatments for post-discharge treatment for depressed inpatients. In addition to the basic comparison of component increases the efficacy of combined treatment. Thus, we propose to recruit 150 hospitalized patients with major depression and compare the efficacy of three treatment conditions: 1) Pharmacotherapy Alone (medication + clinical management), 2) Combined Individual (cognitive therapy + medication + clinical management, and 3) Combined Individual + Family (cognitive therapy + family therapy + medication + clinical management). Patients will be recruited while in the hospital and treated for 24 weeks on an outpatient basis. Responders to acute treatment will receive an additional 8 weeks of continuation/maintenance treatment. We hypothesize the following: 1. Patients who received combined treatment will have a better response to treatment than patients who receive pharmacotherapy alone (Pharmacotherapy Alone vs. Combined Individual, Combined Individual + Family). 2. Patients who receive additional individual therapy + family therapy will respond better than patients who receive additional therapy only (Combined Individual vs. Combined Individual + Family).
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