Tavistock Adult Depression Study (TADS): a randomised controlled trial of psychoanalytic psychotherapy for treatment-resistant/treatment-refractory forms of depression.
BMC Psychiatry
; 12: 60, 2012 Jun 11.
Article
in En
| MEDLINE
| ID: mdl-22686185
ABSTRACT
BACKGROUND:
Long-term forms of depression represent a significant mental health problem for which there is a lack of effective evidence-based treatment. This study aims to produce findings about the effectiveness of psychoanalytic psychotherapy in patients with treatment-resistant/treatment-refractory depression and to deepen the understanding of this complex form of depression. METHODS/DESIGN INDEX GROUP Patients with treatment resistant/treatment refractory depression. DEFINITION & INCLUSION CRITERIA Current major depressive disorder, 2 years history of depression, a minimum of two failed treatment attempts, ≥14 on the HRSD or ≥21 on the BDI-II, plus complex personality and/or psycho-social difficulties. EXCLUSION CRITERIA Moderate or severe learning disability, psychotic illness, bipolar disorder, substance dependency or receipt of test intervention in the previous two years.DESIGN:
Pragmatic, randomised controlled trial with qualitative and clinical components. TEST INTERVENTION 18 months of weekly psychoanalytic psychotherapy, manualised and fidelity-assessed using the Psychotherapy Process Q-Sort. CONTROL CONDITION Treatment as usual, managed by the referring practitioner. RECRUITMENT GP referrals from primary care. RCT MAINOUTCOME:
HRSD (with ≤14 as remission). SECONDARYOUTCOMES:
depression severity (BDI-II), degree of co-morbid disorders Axis-I and Axis-II (SCID-I and SCID-II-PQ), quality of life and functioning (GAF, CORE, Q-les-Q), object relations (PROQ2a), Cost-effectiveness analysis (CSRI and GP medical records). FOLLOW-UP 2 years. Plus a). Qualitative study of participants' and therapists' problem formulation, experience of treatment and of participation in trial. (b) Narrative data from semi-structured pre/post psychodynamic interviews to produce prototypes of responders and non-responders. (c) Clinical case-studies of sub-types of TRD and of change.DISCUSSION:
TRD needs complex, long-term intervention and extended research follow-up for the proper evaluation of treatment outcome. This pushes at the limits of the design of randomised therapeutic trials. We discuss some of the consequent problems and suggest how they may be mitigated. TRIAL REGISTRATION Current Controlled Trials ISRCTN40586372.
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Main subject:
Psychoanalytic Therapy
/
Depressive Disorder, Major
/
Depressive Disorder, Treatment-Resistant
Type of study:
Clinical_trials
/
Guideline
/
Observational_studies
/
Prognostic_studies
/
Qualitative_research
Aspects:
Patient_preference
Limits:
Adult
/
Humans
Language:
En
Journal:
BMC Psychiatry
Journal subject:
PSIQUIATRIA
Year:
2012
Document type:
Article