title: Cognitive behavioral analysis system of psychotherapy and brief supportive psychotherapy for augmentation of antidepressant nonresponse in chronic depression: the REVAMP Trial.
abstract: BACKGROUND
  Previous studies have found that few chronically depressed patients remit with antidepressant medications alone.
  
  
  OBJECTIVE
  To determine the role of adjunctive psychotherapy in the treatment of chronically depressed patients with less than complete response to an initial medication trial.
  
  
  METHODS
  This trial compared 12 weeks of (1) continued pharmacotherapy and augmentation with cognitive behavioral analysis system of psychotherapy (CBASP), (2) continued pharmacotherapy and augmentation with brief supportive psychotherapy (BSP), and (3) continued optimized pharmacotherapy (MEDS) alone. We hypothesized that adding CBASP would produce higher rates of response and remission than adding BSP or continuing MEDS alone.
  
  
  METHODS
  Eight academic sites.
  
  
  METHODS
  Chronically depressed patients with a current DSM-IV-defined major depressive episode and persistent depressive symptoms for more than 2 years.
  
  
  METHODS
  Phase 1 consisted of open-label, algorithm-guided treatment for 12 weeks based on a history of antidepressant response. Patients not achieving remission received next-step pharmacotherapy options with or without adjunctive psychotherapy (phase 2). Individuals undergoing psychotherapy were randomized to receive either CBASP or BSP stratified by phase 1 response, ie, as nonresponders (NRs) or partial responders (PRs).
  
  
  METHODS
  Proportions of remitters, PRs, and NRs and change on Hamilton Scale for Depression (HAM-D) scores.
  
  
  RESULTS
  In all, 808 participants entered phase 1, of which 491 were classified as NRs or PRs and entered phase 2 (200 received CBASP and MEDS, 195 received BSP and MEDS, and 96 received MEDS only). Mean HAM-D scores dropped from 25.9 to 17.7 in NRs and from 15.2 to 9.9 in PRs. No statistically significant differences emerged among the 3 treatment groups in the proportions of phase 2 remission (15.0%), partial response (22.5%), and nonresponse (62.5%) or in changes on HAM-D scores.
  
  
  CONCLUSIONS
  Although 37.5% of the participants experienced partial response or remitted in phase 2, neither form of adjunctive psychotherapy significantly improved outcomes over that of a flexible, individualized pharmacotherapy regimen alone. A longitudinal assessment of later-emerging benefits is ongoing.
authors.affiliation: Department of Psychiatry, Weill Cornell Medical College, 1300 York Ave, New York, NY 10065, USA. jhk2002@med.cornell.edu
authors.forename: James H
authors.initials: JH
authors.lastname: Kocsis
authors.forename: Alan J
authors.initials: AJ
authors.lastname: Gelenberg
authors.forename: Barbara O
authors.initials: BO
authors.lastname: Rothbaum
authors.forename: Daniel N
authors.initials: DN
authors.lastname: Klein
authors.forename: Madhukar H
authors.initials: MH
authors.lastname: Trivedi
authors.forename: Rachel
authors.initials: R
authors.lastname: Manber
authors.forename: Martin B
authors.initials: MB
authors.lastname: Keller
authors.forename: Andrew C
authors.initials: AC
authors.lastname: Leon
authors.forename: Steven R
authors.initials: SR
authors.lastname: Wisniewski
authors.forename: Bruce A
authors.initials: BA
authors.lastname: Arnow
authors.forename: John C
authors.initials: JC
authors.lastname: Markowitz
authors.forename: Michael E
authors.initials: ME
authors.lastname: Thase
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000928:Antidepressive Agents / Q000627:therapeutic use*; D002908:Chronic Disease; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D003131:Combined Modality Therapy; D003865:Major Depressive Disorder / Q000175:diagnosis / Q000523:psychology / Q000628:therapy*; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011569:Psychiatric Status Rating Scales; D011614:Psychotherapy, Brief / Q000379:methods; D016896:Treatment Outcome
chemical_list: D000928:Antidepressive Agents