Practicing Alternative Techniques to Heal From Depression: The PATH-D Study

This study is a randomized, controlled trial of Mindfulness-Based Cognitive Therapy (MBCT)
versus Health-Enhancement Program (HEP) for patients with treatment-resistant major
depressive disorder (MDD). Both arms of the study will continue to receive the standard
medication management treatment as usual (TAU) throughout the study. MBCT is a new
technique that has been found to be effective for prevention of relapse in individuals in
complete recovery from depression. MBCT is a group-based, 8-week intervention that uses
mindfulness meditation as its core therapeutic ingredient. It teaches people to have a
different relationship to depressive thoughts and feelings. This study will use an active
condition called the Health Enhancement Program (HEP) which was specifically developed to
serve as a comparison condition for mindfulness interventions. HEP has been shown to
decrease global stress levels and to increase perceived health. Stress has been considered
a contributor to depression. One hundred and seventy four patients with MDD who have
failed two or more adequate antidepressant trials will be identified and randomly assigned
to one of two groups: MBCT+TAU or HEP+TAU. All patients who enroll in the study will
undergo follow-up assessments at 3, 6, 9 and 12 months following the intervention. A
supplemental portion of the study will enroll 88 patients to undergo functional magnetic
resonance imagining (fMRI) scans immediately before and after treatment to better understand
the neural pathways implicated in depression and those that may be affected through
treatment.