Quantitative Electroencephalogram (QEEG) Predictors of Response to Psychotherapy Versus Antidepressant Treatment in Depression

• Hamilton Depression Rating Scale (HAM-D-17) Scores [ Time Frame: 12 weeks ] [ Designated as safety issue: No ]
  The Hamilton Depression Rating Scale is a clinician-rated scale used to rate depression severity. The maximum score is a 50 and the minimum score is a 0, where higher scores indicate greater severity. Scores from 14 to 18 indicate moderately severe depression.
• QEEG Metrics (ATR, EEG Bispectrum, Cordance Estimates) [ Time Frame: 12 weeks ] [ Designated as safety issue: No ]

• Hamilton Depression Rating Scale (HAM-D-17) scores [ Time Frame: 12 weeks ] [ Designated as safety issue: No ]
• QEEG Metrics (ATR, EEG Bispectrum, Cordance Estimates) [ Time Frame: 12 weeks ] [ Designated as safety issue: No ]

The purpose of this research study is to find out if a test can predict whether someone with depression will get better with treatment. We also want to find out whether there are changes in the brains of depressed patients having different types of treatment (drug therapy vs. talk therapy). We hope that a test called QEEG (Quantitative Electroencephalogram) can tell us if a treatment is going to work, even before the person starts to feel better.

Hypothesis 1: Response to treatment will correlate with changes in QEEG metrics.

Hypothesis 2: QEEG parameters, different from those that predict response to pharmacotherapy, will be associated with response to CBT.

To our knowledge, QEEG has not been studied in the prediction of response to CBT, an important and widely used non-pharmacologic approach to treating depression. Establishing QEEG technology as a predictor of response to CBT could help to guide treatment selection for individual patients. It is probable that certain patient populations are more likely to respond to either psychotherapeutic or psychopharmacological interventions, while others may benefit from a combination of treatment modalities. This study will provide preliminary information about the utility of QEEG as a predictor of response in psychotherapy and will furnish the knowledge base of QEEG changes related to clinical variables, providing pilot data for a study in a larger sample. We have hypothesized that clinical response will correlate with changes in QEEG metrics from beginning to two weeks after treatment, and that QEEG parameters, different from those that predict response to pharmacotherapy, will be associated with response to CBT.

• Behavioral: Cognitive Behavioral Therapy (CBT)
  The CBT group will receive weekly 50-minute individual sessions over the course of 12 weeks conducted by experienced therapists who are trained in manual based CBT.
• Drug: Escitalopram
  The medication group will receive open label treatment of escitalopram, 10-20 mg/day, flexible dose, for 12 weeks, and will be seen every two weeks by a study physician.
• Device: Quantitative electroencephalogram (QEEG)
  The QEEG will be administered 5 times during the study (week 0, 1, 2, 8 and endpoint) allowing us to assess whether there are any correlations between QEEG patterns and changes in clinical functioning.

• Active Comparator: Cognitive Behavioral Therapy (CBT)
  Interventions:

  • Behavioral: Cognitive Behavioral Therapy (CBT)
  • Device: Quantitative electroencephalogram (QEEG)
• Active Comparator: Escitalopram
  Interventions:

  • Drug: Escitalopram
  • Device: Quantitative electroencephalogram (QEEG)

Inclusion Criteria:

• Subjects will be adults, ages 18 to 75 years.
• Written informed consent
• MDD, current according to the fourth version of the Diagnostic and Statistical Manual for Mental Disorders (DSM-IV)
• 17-item Hamilton Depression Rating Scale (HAM-D-17) score of > 14 at baseline.
• Subjects who are not currently taking any antidepressant or other psychotropic medications and who have been free of these medications for 4 weeks prior to screening visit.

Exclusion Criteria:

• Women who are pregnant, lactating, or planning a pregnancy during the study.
• Women of child bearing potential who are not using a medically accepted means of contraception (to include oral contraceptive or implant, condom, diaphragm, spermicide, intrauterine device, tubal ligation, or a partner with vasectomy).
• Any uncontrolled psychiatric disorder.
• Current use of psychotropic medications.
• Psychotic features in the current episode or a history of psychotic features.
• Alcohol or substance abuse or dependence within the past three months.
• History of head trauma or seizure disorder.
• History of intolerance of the study medication.
• Failure to respond to escitalopram up to 20 mg for at least 6 weeks.
• Failure to respond to 2 or more adequate antidepressant trials (6 weeks or longer on a therapeutic dose, equivalent to fluoxetine 40mg) in the current episode.
• Currently enrolled in other depression-focused psychotherapy and unwilling to cease treatment.
• Subjects who, per clinical judgment, are not appropriate candidates for CBT or SSRIs.
• History or current diagnosis of the following DSM-IV psychiatric illness: organic mental disorder, schizophrenia, schizoaffective disorder, delusional disorder, psychotic disorders not otherwise specified, bipolar disorder, patients with mood congruent or mood incongruent psychotic features, patients with substance dependence disorders, including alcohol, active within the last 3 months.
• Serious suicide or homicide risk, as assessed by the evaluating clinician or a score of 4 on the third item of the HAM-D.
• Serious or unstable medical illness, including cardiovascular, hepatic, renal, respiratory, endocrine, neurologic or hematologic disease