Neural Correlates of Psychodynamic Psychotherapy for Depression

Study Description

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Brief Summary:

The purpose of this study is to see whether we can predict which patients with depression will get better when we treat them with psychodynamic psychotherapy. We will use neuroimaging (a method of looking at brain activity) in this study. We want to see whether there are changes in the brains of patients receiving this type of therapy. We hypothesize that these changes may predict how well certain parts of the psychotherapy treatment process works.

Condition or disease	Intervention/treatment	Phase
Major Depressive Disorder	Behavioral: Psychodynamic Psychotherapy	Not Applicable

Detailed Description:

In this study, we will treat patients with brief psychodynamic psychotherapy. Psychodynamic psychotherapy is a type of treatment that may be as helpful as medications in treating depression. It focuses on thoughts, feelings, and behaviors as well as both current and past relationships. Psychotherapy explores better ways of coping with feelings, expressing needs, and interacting with others in order to cope with depression and other life problems. Subjects will go to 16 weekly, 45-minute, individual sessions of psychodynamic psychotherapy over the course of the study. At five times throughout the study, subjects will come in for extra visits, which last approximately 1.5 hours and which include: speaking with a study doctor about depressive symptoms, filling out extra questionnaires, and performing positron emission tomography (PET)and a Quantitative Electroencephalogram (QEEG). The QEEG is a machine that measures the electrical activity of the brain. This task will take approximately 15 minutes.

Study Design

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Study Type :	Interventional (Clinical Trial)
Actual Enrollment :	35 participants
Intervention Model:	Single Group Assignment
Masking:	None (Open Label)
Primary Purpose:	Treatment
Official Title:	Neural Correlates of Psychodynamic Psychotherapy for Depression
Study Start Date :	August 2008
Actual Primary Completion Date :	February 2013
Actual Study Completion Date :	February 2013

Arms and Interventions

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Arm	Intervention/treatment
Experimental: Psychodynamic psychotherapy	Behavioral: Psychodynamic Psychotherapy; Screened and eligible patients will receive 16 individual sessions of psychodynamic psychotherapy, each lasting 45-50 minutes.

Outcome Measures

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Primary Outcome Measures :

1. Correlation between changes in HAMD-17 and changes in QEEG measurements (theta cordance) from treatment initiation to two weeks after starting treatment [ Time Frame: Weeks 0 through 16 ]
2. PET: Treatment-related change in FDG metabolism within regions-of-interest identified at baseline as related to depression severity. [ Time Frame: Week 0, Week 16 ]

Eligibility Criteria

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Ages Eligible for Study:	18 Years to 60 Years (Adult)
Sexes Eligible for Study:	All
Accepts Healthy Volunteers:	No

Criteria

Inclusion Criteria:

• Subjects will be adults, ages 18 to 60 years;
• Able to provide written informed consent;
• MDD, current according to the fourth version of the Diagnostic and Statistical Manual for Mental Disorders (DSM-IV);
• QIDS-SR score of >= 12 at screen;
• Current major depressive episode (MDE) length of < 5 year;
• Treated with an SSRI, SNRI, or bupropion at adequate doses (defined as 20 mg/day or more of fluoxetine, citalopram, or paroxetine; 10 mg/day or more of escitalopram; 50 mg/day or more of sertraline; 75 mg/day or more of venlafaxine; 15 mg/day of mirtazapine; or 40 mg/day of duloxetine; or 100mg/day of bupropion(wellbutrin)) during the current episode for at least 8 weeks; and,
• At the time of screen visit, patients must be on a stable dose of SSRI, SNRI, or bupropion for the past 4 weeks.

Exclusion Criteria:

• Pregnant women or 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). Women of childbearing age who wish to enter the study will be required to undergo a pregnancy test (beta-HCG) prior to initiating treatment; an additional blood pregnancy test (beta HCG) will be completed if subject wants to do PET scan
• Patients who, in the investigator's judgment, pose a current, serious suicidal or homicidal risk. These patients will be immediately referred to appropriate clinical treatment;
• Patients who, in the opinion of the therapist, are not depressed at the time of their first psychotherapy visit;
• Patients who are currently being treated by a psychotherapist individually or who have received individual psychotherapy during the past 6 months. Couples therapy and family therapy will not be considered exclusionary criteria;
• Patients with neurological illnesses, including a history of seizure or head trauma with loss of consciousness;
• Patients with unstable diabetes, kidney disease, or significant medical illness;
• Patients with history of allergy to FDG
• The following DSM-IV diagnoses: substance use disorders active within the last six months, any bipolar disorder (current or past), any psychotic disorder (current or past), any post-traumatic stress disorder (current or past), any obsessive compulsive disorder (current or past), or any panic disorder (current, past allowed). Generalized anxiety disorder or adjustment disorder are not exclusionary;
• Patients currently requiring other psychotropic medications, including anticonvulsants, benzodiazepines, antipsychotics, stimulants, or sedative hypnotics (other than diphenhydramine);however, patients will be permitted to take trazodone in addition to their primary antidepressant if it is taken as a sleep aid, rather than a primary antidepressant;
• Psychotic features in the current episode, or a history of psychotic features, as assessed by SCID;
• Patients who have undergone > 3 previous adequate attempts at psychodynamic psychotherapy (deemed "adequate" by the screening physician), which were considered unhelpful or unsuccessful by patient report (according to patient report);
• Patients with a history of antidepressant-induced hypomania; and
• Patients with a history of medication non-compliance.
• Patients with Axis II pathology (personality disorder) that, in the opinion of the screening physician, would interfere with subjects' ability to participate in the treatment and/or comply with the protocol, such as severe borderline or narcissistic personality disorder.
• Patients who have had electroconvulsive therapy (ECT) within the 12 months preceding baseline

Contacts and Locations

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Locations

United States, Massachusetts
Depression Clinical and Research Program
Boston, Massachusetts, United States, 02114

Sponsors and Collaborators

Massachusetts General Hospital

Hope for Depression Research Foundation

Investigators

Principal Investigator:	Joshua Roffman, MD	Massachusetts General Hospital Department of Psychiatry
Principal Investigator:	Janet Witte, MD, MPH	Massachusetts General Hospital Department of Psychiatry

More Information

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Responsible Party:	Joshua L. Roffman MD, MMSc, Staff psychiatrist, Massachusetts General Hospital
ClinicalTrials.gov Identifier:	NCT00812227 History of Changes
Other Study ID Numbers:	2008-P-001181
First Posted:	December 22, 2008
Last Update Posted:	May 13, 2013
Last Verified:	May 2013

Keywords provided by Joshua L. Roffman MD, MMSc, Massachusetts General Hospital:

Depression; Psychotherapy; Neuroimaging; Subjects with Major Depressive Disorder (MDD)

Additional relevant MeSH terms:

Depression; Depressive Disorder; Depressive Disorder, Major	Behavioral Symptoms; Mood Disorders; Mental Disorders