Personalized Indications for CBT and Antidepressants in Treating Depression
Status:
Unknown status
Trial end date:
2021-05-01
Target enrollment:
Participant gender:
Summary
Depression currently affects close to 2 million Canadians and is the leading cause of
disability worldwide. Pharmacological treatments (antidepressant medication) and
psychological treatments such as cognitive-behavioural therapy are available for depression,
but the majority of those who receive treatment have an unsatisfactory response. On average,
the combination of pharmacological and psychological treatment achieves better results than
either treatment alone. However, the apparently superior results of combination treatment may
be due to the fact that different individuals preferentially respond to pharmacological or
psychological treatment. The invesitagtors have discovered several clinical factors and
biomarkers that predict poor response to commonly used antidepressant medication: history of
childhood maltreatment, loss of interest and reduced activity, a biomarker of systemic
inflammation, and a genetic marker of sensitivity to environment. Indirect evidence suggests
that the same factors may indicate the need for psychological treatment, but their usefulness
as differential predictors of psychological and pharmacological treatment outcomes remains to
be established.
The investigators will test the hypothesis that a pre-determined set of clinical variables
(history of childhood maltreatment, loss of interest and reduced activity) and biomarkers
(serum C-reactive protein, a marker of systemic inflammation, and short alleles of the
serotonin transporter gene promoter polymorphism) differentially predicts response to
antidepressants and to cognitive-behavioural psychotherapy with clinically significant
accuracy.
If this hypothesis is supported, the resulting predictor will allow personalized selection of
treatment for depression, leading to improved outcomes and healthcare efficiency. Additional
objectives include replication of additional predictors and integrative analyses aimed at
refining the treatment choice algorithms.
Phase:
Phase 4
Details
Lead Sponsor:
Nova Scotia Health Authority
Collaborators:
Centre for Addiction and Mental Health Queen's University St. Joseph's Healthcare in Hamilton, Ontario The Centre for Addiction and Mental Health in Toronto, Ontario. University Health Network, Toronto