staying well after depression (swad)
DESCRIPTION
Staying well after depression (SWAD). CI Professor Mark W illiams PI Professor Ian Russell Sholto Radford Research Officer [email protected]. Depression and suicide . Depression a prevalent Condition Risk of recurrence - PowerPoint PPT PresentationTRANSCRIPT
![Page 1: Staying well after depression (SWAD)](https://reader035.vdocument.in/reader035/viewer/2022062501/56816581550346895dd81f95/html5/thumbnails/1.jpg)
Staying well after depression (SWAD)
CI Professor Mark WilliamsPI Professor Ian Russell
Sholto RadfordResearch Officer [email protected]
![Page 2: Staying well after depression (SWAD)](https://reader035.vdocument.in/reader035/viewer/2022062501/56816581550346895dd81f95/html5/thumbnails/2.jpg)
• Depression a prevalent Condition
• Risk of recurrence 90% for individuals with 3 or more previous episodes.
• Suicide ideation is one of the most consistently recurring symptoms of depression.
• 80% of suicide would not occur without depression.
• Mindfulness-Based Cognitive Therapy (MBCT) is a promising approach to preventing relapse.
Depression and suicide
![Page 3: Staying well after depression (SWAD)](https://reader035.vdocument.in/reader035/viewer/2022062501/56816581550346895dd81f95/html5/thumbnails/3.jpg)
MBCT for preventing relapse
• 3 centre study (Teasdale et al, 2000) • Single centre replication study (Ma & Teasdale,
2004)
Summary of results of both trials: MBCT approximately halved (70% to 39%) the
likelihood of depressive relapse in patients who had had three of more episodes of depression
MBCT now recommended by NICE as a treatment for prevention of depression.
![Page 4: Staying well after depression (SWAD)](https://reader035.vdocument.in/reader035/viewer/2022062501/56816581550346895dd81f95/html5/thumbnails/4.jpg)
MBCT vs Antidepressants (ADs)
123 patients with a history of recurrent depression
MBCT (with or without ADs) was equal if not slightly better at preventing relapse than maintenance antidepressant treatment alone, and better at improving quality of life.
MBCT is more expensive than maintenance ADs in first 12 mths; then MBCT becomes more cost effective
(Kuyken et al 2008)
![Page 5: Staying well after depression (SWAD)](https://reader035.vdocument.in/reader035/viewer/2022062501/56816581550346895dd81f95/html5/thumbnails/5.jpg)
Research questions
•MBCT - effective relapse prevention of major depression and incidence of suicidal symptoms.
•Comparison with equally plausible treatment without meditation (CPE) “dismantling”.
•Understand potential moderators and mediators of treatment outcome.
![Page 6: Staying well after depression (SWAD)](https://reader035.vdocument.in/reader035/viewer/2022062501/56816581550346895dd81f95/html5/thumbnails/6.jpg)
DesignMulti centre trial (Bangor Oxford) RCT –
Participants randomised to three conditions:-
• Treatment as usual (TAU)• Mindfulness-Based Cognitive Therapy (MBCT) + TAU• Cognitive Psycho Education (CPE) + TAU
Stratification - Centre, cohort, history of suicidality (none, ideation, attempt), antidepressants in past 7 days
![Page 7: Staying well after depression (SWAD)](https://reader035.vdocument.in/reader035/viewer/2022062501/56816581550346895dd81f95/html5/thumbnails/7.jpg)
Interventions Both 8 week courses, 2 hour sessions, 2
MBCT – manualised treatment combines training in mindfulness with cognitive therapy – 1 hour per day home practice (meditation + smaller tasks to cultivate mindfulness.
CPE – Includes all elements of MBCT except experiential cultivation of mindfulness. Learn psychological process involved in relapse, mood monitoring, disengaging from unhelpful patterns of processing.
![Page 8: Staying well after depression (SWAD)](https://reader035.vdocument.in/reader035/viewer/2022062501/56816581550346895dd81f95/html5/thumbnails/8.jpg)
Assessment •Assessment – treatment effects monitored Pre intervention T0, Post intervention T1, 3
months T2, six months T3, nine months T4, twelve months T5.
Blind assessors – SCID + battery of questionnaires and cognitive tasks
![Page 9: Staying well after depression (SWAD)](https://reader035.vdocument.in/reader035/viewer/2022062501/56816581550346895dd81f95/html5/thumbnails/9.jpg)
Sample and recruitment • Using 2:2:1 ratio – 5% significance level 300
participants 99% power for detection of difference CPE –MBCT with 20% attrition 375 target.
• Referral – advertisements in community, clinics + GP surgeries, referral from GP’s and mental health clinicians, talks a t professional meetings.
• Preliminary phone screening - recruiters• Detailed assessment (SCID) - assessors
![Page 10: Staying well after depression (SWAD)](https://reader035.vdocument.in/reader035/viewer/2022062501/56816581550346895dd81f95/html5/thumbnails/10.jpg)
Inclusion criteria Exclusion criteria
Age 18 - 70 History of, schizophrenia, Schizoaffective disorder, Bipolar 1, current severe substance abuse, primary diagnosis of OCD or eating disorder , regular self harm.
DSM-IV criteria major depression >3 episodes (2 in past 5 years 1 in past 2 years
Positive continuing response to CBT
NIMH guidelines for recovery (1 week in past 8 of core symptom or suicidal feelings + 1 other symptom.
Psychotherapy of counselling more than once per month.
Giving informed consent +Consent from GP
Cannot complete baseline assessment
![Page 11: Staying well after depression (SWAD)](https://reader035.vdocument.in/reader035/viewer/2022062501/56816581550346895dd81f95/html5/thumbnails/11.jpg)
Participants randomised n = 274 did not attend at least one follow up n =19 Variable BreakdownGender Female =198 (72%) Male =76 (28%)
Age Female Mean = 42.40 Minimum = 18 Maximum = 68
Age Male Mean = 46.12 Minimum = 18 Maximum 66
Antidepressants used at baseline
No = 154 (56%) Yes 120 ( 44%)
Suicidality – history None = 53 (20%) Ideation =138 (50%) Attempt =83 (30%)
Number of previous episodes MDD (n= 240)
Mean = 7 Minimum = 3 Maximum =45
![Page 12: Staying well after depression (SWAD)](https://reader035.vdocument.in/reader035/viewer/2022062501/56816581550346895dd81f95/html5/thumbnails/12.jpg)
AnalysisIntention to treat analysis (ITT)
• Primary outcome – time to relapse or recurrence of MDD in weeks. • Continuous quantitative measure of outcome also used (HRSD) for
severity and to strengthen the dichotomised outcome.
• Other quantitative measures used include BDI-II , BHS,BSS, EQ5D.
• Secondary outcome- recurrence of suicidal ideation.• Firstly - in participants who relapse • Secondly - severity of suicidal symptoms for all participants Beck scale for
suicide ideation (BSS) + MINNI suicide-tracking measure• Thirdly – suicidal cognitions between groups with AnCova. T1 and T5 with
T0 as covariate
![Page 13: Staying well after depression (SWAD)](https://reader035.vdocument.in/reader035/viewer/2022062501/56816581550346895dd81f95/html5/thumbnails/13.jpg)
Mediation
Assessing cognitive measures Mindfulness, suppression, self compassion,
rumination, autobiographical memory and executive capacity
Regression on both the dichotomous outcome (binary logisitc) of relapse and on worst HRSD score (linear) during follow up.
![Page 14: Staying well after depression (SWAD)](https://reader035.vdocument.in/reader035/viewer/2022062501/56816581550346895dd81f95/html5/thumbnails/14.jpg)
Summary •Recurrent depression is common and
serious particularly for those who become suicidal when depressed.
•Urgent need to develop treatments that produce sustainable reductions in risk of recurrence
•And to identify the critical therapeutic factors to refine the approach for the future