Depression Agency-Based Collaboration

• Major depressive disorder [ Time Frame: 12 months ] [ Designated as safety issue: No ]
  Patient Health Questionnaire score > 9 with confirming diagnostic interview
  
  
• Generalized anxiety disorder [ Time Frame: 12 months ] [ Designated as safety issue: No ]
  Generalized anxiety disorder score >=10, and meets criteria for SCID or PRIME-MD diagnosis
  
  

The research will determine (i) if a course of problem solving therapy (PST) and Brief Behavioral Therapy for Insomnia (BBTI), with boosters, reduces incidence of major depressive episodes over 12 months relative to usual care, and (ii) the extent to which behavioral therapies achieve these effects through enhancement of protective factors, such as greater self-efficacy, better targeting of services to address needs, and greater control over home environments.

Periodic blood draws will be used to assess biosignatures of depression. Guiding our investigations of pharmacogenetics, inflammation, and proteomics are synergistic interactions among the serotonergic system, the HPA axis, systemic inflammation, growth factors such as brain derived neuro-trophic factor (BDNF), psychosocial stressors, and vascular co-morbidity. Genetic variation in vasopressin receptors, potentially involved in both cardiovascular risk and social attachment, is also associated with recurrence of depression. Similarly, genetic variation in inflammation may influence antidepressant response and medical co-morbidity.