TY - JOUR
T1 - Cognitive behavioral analysis system of psychotherapy and brief supportive psychotherapy for augmentation of antidepressant nonresponse in chronic depression
T2 - The REVAMP trial
AU - Kocsis, James H.
AU - Gelenberg, Alan J.
AU - Rothbaum, Barbara O.
AU - Klein, Daniel N.
AU - Trivedi, Madhukar H.
AU - Manber, Rachel
AU - Keller, Martin B.
AU - Leon, Andrew C.
AU - Wisniewski, Steven R.
AU - Arnow, Bruce A.
AU - Markowitz, John C.
AU - Thase, Michael E.
N1 - Publisher Copyright:
© 2009 American Medical Association. All rights reserved.
PY - 2009
Y1 - 2009
N2 - Context: Previous studies have found that few chronically depressed patients remit with antidepressant medications alone. Objective: To determine the role of adjunctive psychotherapy in the treatment of chronically depressed patients with less than complete response to an initial medication trial. Design: This trial compared 12 weeks of (1) continued pharmacotherapy and augmentation with cognitive behavioral analysis system of psychotherapy (CBASP), (2) continued pharmacotherapy and augmentation with brief supportive psychotherapy (BSP), and (3) continued optimized pharmacotherapy (MEDS) alone. We hypothesized that adding CBASP would produce higher rates of response and remission than adding BSP or continuing MEDS alone. Setting: Eight academic sites. Participants: Chronically depressed patients with a current DSM-IV-defined major depressive episode and persistent depressive symptoms for more than 2 years. Interventions: Phase 1 consisted of open-label, algorithm- guided treatment for 12 weeks based on a history of antidepressant response. Patients not achieving remission received next-step pharmacotherapy options with or without adjunctive psychotherapy (phase 2). Individuals undergoing psychotherapy were randomized to receive either CBASP or BSP stratified by phase 1 response, ie, as nonresponders (NRs) or partial responders (PRs). Main Outcome Measures: Proportions of remitters, PRs, and NRs and change on Hamilton Scale for Depression (HAM-D) scores. Results: In all, 808 participants entered phase 1, of which 491 were classified as NRs or PRs and entered phase 2 (200 received CBASP and MEDS, 195 received BSP and MEDS, and 96 receivedMEDSonly). Mean HAM-D scores dropped from 25.9 to 17.7 in NRs and from 15.2 to 9.9 in PRs. No statistically significant differences emerged among the 3 treatment groups in the proportions of phase 2 remission (15.0%), partial response (22.5%), and nonresponse (62.5%) or in changes on HAM-D scores. Conclusions: Although 37.5% of the participants experienced partial response or remitted in phase 2, neither form of adjunctive psychotherapy significantly improved outcomes over that of a flexible, individualized pharmacotherapy regimen alone. A longitudinal assessment of later-emerging benefits is ongoing. Trial Registration: clinicaltrials.gov Identifier: NCT00057551.
AB - Context: Previous studies have found that few chronically depressed patients remit with antidepressant medications alone. Objective: To determine the role of adjunctive psychotherapy in the treatment of chronically depressed patients with less than complete response to an initial medication trial. Design: This trial compared 12 weeks of (1) continued pharmacotherapy and augmentation with cognitive behavioral analysis system of psychotherapy (CBASP), (2) continued pharmacotherapy and augmentation with brief supportive psychotherapy (BSP), and (3) continued optimized pharmacotherapy (MEDS) alone. We hypothesized that adding CBASP would produce higher rates of response and remission than adding BSP or continuing MEDS alone. Setting: Eight academic sites. Participants: Chronically depressed patients with a current DSM-IV-defined major depressive episode and persistent depressive symptoms for more than 2 years. Interventions: Phase 1 consisted of open-label, algorithm- guided treatment for 12 weeks based on a history of antidepressant response. Patients not achieving remission received next-step pharmacotherapy options with or without adjunctive psychotherapy (phase 2). Individuals undergoing psychotherapy were randomized to receive either CBASP or BSP stratified by phase 1 response, ie, as nonresponders (NRs) or partial responders (PRs). Main Outcome Measures: Proportions of remitters, PRs, and NRs and change on Hamilton Scale for Depression (HAM-D) scores. Results: In all, 808 participants entered phase 1, of which 491 were classified as NRs or PRs and entered phase 2 (200 received CBASP and MEDS, 195 received BSP and MEDS, and 96 receivedMEDSonly). Mean HAM-D scores dropped from 25.9 to 17.7 in NRs and from 15.2 to 9.9 in PRs. No statistically significant differences emerged among the 3 treatment groups in the proportions of phase 2 remission (15.0%), partial response (22.5%), and nonresponse (62.5%) or in changes on HAM-D scores. Conclusions: Although 37.5% of the participants experienced partial response or remitted in phase 2, neither form of adjunctive psychotherapy significantly improved outcomes over that of a flexible, individualized pharmacotherapy regimen alone. A longitudinal assessment of later-emerging benefits is ongoing. Trial Registration: clinicaltrials.gov Identifier: NCT00057551.
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U2 - 10.1001/archgenpsychiatry.2009.144
DO - 10.1001/archgenpsychiatry.2009.144
M3 - Article
C2 - 19884606
AN - SCOPUS:70350639046
SN - 0003-990X
VL - 66
SP - 1178
EP - 1188
JO - Archives of General Psychiatry
JF - Archives of General Psychiatry
IS - 11
ER -