Relief of chronic or resistant depression (Re-ChORD): a pragmatic, randomized, open-treatment trial of an integrative program intervention for chronic depression.
BACKGROUND
Chronic depression is a particularly disabling mood disorder and treatment outcomes are poor with either psychotherapy or pharmacotherapy alone. There is growing evidence that an integrative treatment approach may be optimal. A novel multi-modal, multi-disciplinary treatment program, Re-ChORD, was developed at the University of British Columbia and evaluated in this pilot study.


METHODS
Re-ChORD consisted of guidelines-based medication management, and group-based interpersonal psychotherapy and occupational therapy. A randomized, parallel-groups, open-treatment trial was conducted comparing Re-ChORD to treatment as usual (TAU). Inclusion criteria were current depression (17-item Ham-D > or = 15) and a diagnosis of a chronic depressive disorder. The primary outcome variable was clinical remission (17-item Ham-D < or = 7) at 4 month assessment.


RESULTS
A total of 64 patients were randomised to Re-ChORD (N=34) and TAU (N=30). Under both intention to treat (ITT) and completer analyses, the remission rate was significantly higher in the Re-ChORD than TAU groups. Treatment effect size for remission was of medium magnitude (22.2% and 29.6% over TAU under ITT and completer analyses).


CONCLUSIONS
We did not collect sufficient follow-up data to investigate maintenance of gains. Re-ChORD shares elements with other combined treatments, and the present positive findings cannot be interpreted as being specific to the Re-ChORD program.


CONCLUSIONS
Consistent with growing evidence that integrative treatments are necessary for chronic depressive disorders, Re-ChORD was demonstrated in this pilot study to produce significantly greater rates of remission than treatment as usual. A larger-scale trial is warranted.
Murray
Greg
G
Faculty of Life and Social Sciences, Swinburne University of Technology, Melbourne, Australia.
Michalak
Erin E
EE
Axler
Auby
A
Yaxley
David
D
Hayashi
Brenda
B
Westrin
Asa
A
Ogrodniczuk
John S
JS
Tam
Edwin M
EM
Yatham
Lakshmi N
LN
Lam
Raymond W
RW
D000328:Adult; D000368:Aged; D000928:Antidepressive Agents / Q000627:therapeutic use*; D001955:British Columbia; D002908:Chronic Disease; D003131:Combined Modality Therapy; D015897:Comorbidity; D003299:Cooperative Behavior; D003865:Major Depressive Disorder / Q000534:rehabilitation*; D019263:Dysthymic Disorder / Q000534:rehabilitation*; D005260:Female; D006801:Humans; D033183:Interdisciplinary Communication; D008297:Male; D008875:Middle Aged; D009788:Occupational Therapy; D010348:Patient Care Team; D011615:Psychotherapy, Group; D012008:Recurrence; D055815:Young Adult
D000928:Antidepressive Agents