title: Relief of chronic or resistant depression (Re-ChORD): a pragmatic, randomized, open-treatment trial of an integrative program intervention for chronic depression.
abstract: 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.
authors.affiliation: Faculty of Life and Social Sciences, Swinburne University of Technology, Melbourne, Australia.
authors.forename: Greg
authors.initials: G
authors.lastname: Murray
authors.forename: Erin E
authors.initials: EE
authors.lastname: Michalak
authors.forename: Auby
authors.initials: A
authors.lastname: Axler
authors.forename: David
authors.initials: D
authors.lastname: Yaxley
authors.forename: Brenda
authors.initials: B
authors.lastname: Hayashi
authors.forename: Asa
authors.initials: A
authors.lastname: Westrin
authors.forename: John S
authors.initials: JS
authors.lastname: Ogrodniczuk
authors.forename: Edwin M
authors.initials: EM
authors.lastname: Tam
authors.forename: Lakshmi N
authors.initials: LN
authors.lastname: Yatham
authors.forename: Raymond W
authors.initials: RW
authors.lastname: Lam
mesh_terms: 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
chemical_list: D000928:Antidepressive Agents