Chronic depression affects approximately 5 percent of adults in the United States and is associated with significant functional impairment and high health care utilization. Recent work supports the efficacy of established antidepressant medications with chronic depression. However, only a minority of patients with chronic depression attain full remission in these trials: approximately 50 percent do not respond, and an additional 20 percent achieve only a partial response. A recent multi-site study (Keller et al., 2000) demonstrated that the combination of medication and psychotherapy produced a significantly better response than either monotherapy. Unfortunately, combination treatment is expensive. It may be more efficient to employ a stepped approach, in which patients first receive medication, and only non-responders and partial responders receive adjunctive psychotherapy. We propose to conduct the first large-scale study of adjunctive psychotherapy in chronic depressives who fail to respond, or respond only partially, to an initial trial of medication. This multi-center trial will compare 12 weeks of adjunctive treatment with the Cognitive Behavioral Analysis System of Psychotherapy (CBASP), the form of psychotherapy with the best evidence for treating chronic depression, with adjunctive treatment with Supportive Psychotherapy (SP) and continued pharmacotherapy alone, in patients with chronic forms of major depression. Separate trials will be conducted in patients who fail to respond to an initial open trial of serotonin reuptake inhibitor (SSRI) and in patients who achieve only a partial response. In addition, we will conduct naturalistic follow-up assessments at 6- and 12-months post-treatment.
The specific aims of the project include: (1) comparing the efficacy of adjunctive psychotherapy to continued SSR] alone; (2) determining whether adjunctive CBASP is specifically efficacious compared to adjunctive SP; (3) testing the hypothesized mechanism of action of CBASP, as well as exploring potential moderators of response, and (4) comparing the cost-effectiveness of the three treatment conditions for treatment resistant chronic depression. The outcomes examined will include both symptomatology and psychosocial functioning. In addition, we will conduct exploratory analyses comparing the effect of the three treatment conditions on relapse and post-treatment service utilization. This would be the first large-scale study ever to test the efficacy of any therapy for treatment resistant chronic depression, and to study the value of psychotherapy augmentation in medication non-responders with any form of depression.

Agency
National Institute of Health (NIH)
Institute
National Institute of Mental Health (NIMH)
Type
Research Project--Cooperative Agreements (U01)
Project #
5U01MH062491-03
Application #
6798658
Study Section
Special Emphasis Panel (ZMH1-ITV-D (01))
Program Officer
Rudorfer, Matthew V
Project Start
2002-09-24
Project End
2006-06-30
Budget Start
2004-07-01
Budget End
2005-06-30
Support Year
3
Fiscal Year
2004
Total Cost
$148,923
Indirect Cost
Name
Virginia Commonwealth University
Department
Psychology
Type
Schools of Arts and Sciences
DUNS #
105300446
City
Richmond
State
VA
Country
United States
Zip Code
23298
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