title: Disrupting the rhythm of depression using Mobile Cognitive Therapy for recurrent depression: randomized controlled trial design and protocol.
abstract: BACKGROUND
  Major depressive disorder (MDD) is projected to rank second on a list of 15 major diseases in terms of burden in 2030. The major contribution of MDD to disability and health care costs is largely due to its highly recurrent nature. Accordingly, efforts to reduce the disabling effects of this chronic condition should shift to preventing recurrence, especially in patients at high risk of recurrence. Given its high prevalence and the fact that interventions are necessary during the remitted phase, new approaches are needed to prevent relapse in depression.
  
  
  METHODS
  The best established effective and available psychological intervention is cognitive therapy. However, it is costly and not available for most patients. Therefore, we will compare the effectiveness and cost-effectiveness of self-management supported by online CT accompanied by SMS based tele-monitoring of depressive symptomatology, i.e. Mobile Cognitive Therapy (M-CT) versus treatment as us usual (TAU). Remitted patients (n = 268) with at least two previous depressive episodes will be recruited and randomized over (1) M-CT in addition to TAU versus (2) TAU alone, with follow-ups at 3, 12, and 24 months. Randomization will be stratified for number of previous episodes and type of treatment as usual. Primary outcome is time until relapse/recurrence over 24 months using DSM-IV-TR criteria as assessed by the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID). For the economic evaluation the balance between costs and health outcomes will be compared across strategies using a societal perspective.
  
  
  CONCLUSIONS
  Internet-based interventions might be helpful in empowering patients to become their own disease managers in this lifelong recurrent disorder. This is, as far as we are aware of, the first study that examines the (cost) effectiveness of an E-mental health program using SMS monitoring of symptoms with therapist support to prevent relapse in remitted recurrently depressed patients.
  
  
  BACKGROUND
  Netherlands Trial Register (NTR): NTR2503.
authors.affiliation: Department of Clinical and Experimental Psychology, Groningen University, Groningen, The Netherlands. C.L.H.Bockting@rug.nl
authors.forename: Claudi L H
authors.initials: CL
authors.lastname: Bockting
authors.forename: Gemma D
authors.initials: GD
authors.lastname: Kok
authors.forename: Lillian
authors.initials: L
authors.lastname: van der Kamp
authors.forename: Filip
authors.initials: F
authors.lastname: Smit
authors.forename: Evelien
authors.initials: E
authors.lastname: van Valen
authors.forename: Robert
authors.initials: R
authors.lastname: Schoevers
authors.forename: Harm
authors.initials: H
authors.lastname: van Marwijk
authors.forename: Pim
authors.initials: P
authors.lastname: Cuijpers
authors.forename: Heleen
authors.initials: H
authors.lastname: Riper
authors.forename: Jack
authors.initials: J
authors.lastname: Dekker
authors.forename: Aaron T
authors.initials: AT
authors.lastname: Beck
mesh_terms: D002985:Clinical Protocols; D015928:Cognitive Behavioral Therapy / Q000191:economics / Q000379:methods*; D003362:Cost-Benefit Analysis; D003866:Depressive Disorder / Q000628:therapy; D003865:Major Depressive Disorder / Q000191:economics / Q000517:prevention & control / Q000628:therapy*; D006801:Humans; D009426:Netherlands; D012107:Research Design; D055502:Secondary Prevention; D012648:Self Care / Q000379:methods; D017216:Telemedicine / Q000379:methods; D016896:Treatment Outcome