Reducing Residual Depressive Symptoms With Web-based Mindful Mood Balance
| Status: | Completed |
|---|---|
| Conditions: | Depression, Depression, Major Depression Disorder (MDD) |
| Therapuetic Areas: | Psychiatry / Psychology, Pulmonary / Respiratory Diseases |
| Healthy: | No |
| Age Range: | 18 - Any |
| Updated: | 1/30/2019 |
| Start Date: | March 2015 |
| End Date: | November 2018 |
Reducing Residual Depressive Symptoms With Web-based Mindful Mood Balance.
Many patients report residual depressive symptoms despite seemingly successful treatment.
With the investigators' previous funding, we developed - Mindful Mood Balance - an online
treatment that targets RDS by teaching specific emotion regulation and depression
self-management skills that are entirely compatible with antidepressant treatment. The
investigators now propose a controlled study to determine whether MMB is more effective than
usual care at reducing RDS and other key outcomes. If successful, MMB's online delivery
format would provide high fidelity and low-cost empirically supported management of residual
symptoms, leading to more robust remission, improved functioning and sustained recovery from
MDD over time.
With the investigators' previous funding, we developed - Mindful Mood Balance - an online
treatment that targets RDS by teaching specific emotion regulation and depression
self-management skills that are entirely compatible with antidepressant treatment. The
investigators now propose a controlled study to determine whether MMB is more effective than
usual care at reducing RDS and other key outcomes. If successful, MMB's online delivery
format would provide high fidelity and low-cost empirically supported management of residual
symptoms, leading to more robust remission, improved functioning and sustained recovery from
MDD over time.
Residual depressive symptoms (RDS) following remission of major depressive disorder (MDD) are
reported by 80-90% of adults receiving first-line antidepressant pharmacotherapy and carry an
elevated risk for a chronic course of illness, rapid relapse and functional impairment.
Strategies for managing residual symptoms, however, have met with mixed success. Mindful Mood
Balance (MMB; R34 MH0877223) is an individually tailored, web-based treatment designed to
train remitted depressed patients to disengage from dysphoria-activated depressogenic
thinking that perpetuates RDS and increases risk for relapse/recurrence. MMB was developed to
increase access to Mindfulness-Based Cognitive Therapy (MBCT; R01 MH066992), an empirically
supported prophylactic group treatment that can be easily sequenced with acute phase
antidepressant pharmacotherapy. Results from our open trial of MMB (N=100) showed an effect
size of d=1.09 for pre to post treatment reductions in depression scores among patients with
RDS and d=1.54 in a quasi-experimental comparison to patients receiving usual care, with an
on average reduction of 1.98 points on the PHQ-9 for MMB patients. The investigators now
propose a pragmatic randomized clinical trial of MMB to evaluate its effectiveness in
reducing RDS in recurrently depressed patients. Patients will be members of Kaiser-Permanente
Colorado (N = 460), aged 18 to 75, who score >5 and <9 on the PHQ-9, in remission from MDD
and will be randomized 1:1 to either the usual depression care pathway (DepCare) or Mindful
Mood Balance (MMB)+DepCare.
The investigators plan to test whether patients receiving MMB+DepCare will show greater
reductions in RDS at both 8 week and 12 months follow up, than those receiving DepCare alone.
The investigators are also interested in examining whether fewer patients in MMB+DepCare will
relapse over the follow up and will have higher end state functioning and quality of life. In
order to examine the costs associated with adding this online treatment to the Depression
Care Pathways at KPCO, the investigators will calculate the marginal costs per additional
number of depression free days (DFDs) for patients. Resolution of RDS can reduce the enormous
personal and social costs experienced by Americans with this persistent symptom burden.
reported by 80-90% of adults receiving first-line antidepressant pharmacotherapy and carry an
elevated risk for a chronic course of illness, rapid relapse and functional impairment.
Strategies for managing residual symptoms, however, have met with mixed success. Mindful Mood
Balance (MMB; R34 MH0877223) is an individually tailored, web-based treatment designed to
train remitted depressed patients to disengage from dysphoria-activated depressogenic
thinking that perpetuates RDS and increases risk for relapse/recurrence. MMB was developed to
increase access to Mindfulness-Based Cognitive Therapy (MBCT; R01 MH066992), an empirically
supported prophylactic group treatment that can be easily sequenced with acute phase
antidepressant pharmacotherapy. Results from our open trial of MMB (N=100) showed an effect
size of d=1.09 for pre to post treatment reductions in depression scores among patients with
RDS and d=1.54 in a quasi-experimental comparison to patients receiving usual care, with an
on average reduction of 1.98 points on the PHQ-9 for MMB patients. The investigators now
propose a pragmatic randomized clinical trial of MMB to evaluate its effectiveness in
reducing RDS in recurrently depressed patients. Patients will be members of Kaiser-Permanente
Colorado (N = 460), aged 18 to 75, who score >5 and <9 on the PHQ-9, in remission from MDD
and will be randomized 1:1 to either the usual depression care pathway (DepCare) or Mindful
Mood Balance (MMB)+DepCare.
The investigators plan to test whether patients receiving MMB+DepCare will show greater
reductions in RDS at both 8 week and 12 months follow up, than those receiving DepCare alone.
The investigators are also interested in examining whether fewer patients in MMB+DepCare will
relapse over the follow up and will have higher end state functioning and quality of life. In
order to examine the costs associated with adding this online treatment to the Depression
Care Pathways at KPCO, the investigators will calculate the marginal costs per additional
number of depression free days (DFDs) for patients. Resolution of RDS can reduce the enormous
personal and social costs experienced by Americans with this persistent symptom burden.
Inclusion Criteria:
- Patients with a PHQ-9 score between 5 and 9
- At least one prior episode of MDD
Exclusion Criteria:
- presence of schizophrenia or current psychosis, organic mental disorder or pervasive
developmental delay
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