Tavistock Adult Depression Study (TADS): a randomised controlled trial of psychoanalytic psychotherapy for treatment-resistant/treatment-refractory forms of depression.
BACKGROUND
Long-term forms of depression represent a significant mental health problem for which there is a lack of effective evidence-based treatment. This study aims to produce findings about the effectiveness of psychoanalytic psychotherapy in patients with treatment-resistant/treatment-refractory depression and to deepen the understanding of this complex form of depression.
Patients with treatment resistant/treatment refractory depression.
Current major depressive disorder, 2 years history of depression, a minimum of two failed treatment attempts, ≥14 on the HRSD or ≥21 on the BDI-II, plus complex personality and/or psycho-social difficulties.


METHODS
Moderate or severe learning disability, psychotic illness, bipolar disorder, substance dependency or receipt of test intervention in the previous two years.


METHODS
Pragmatic, randomised controlled trial with qualitative and clinical components.
18 months of weekly psychoanalytic psychotherapy, manualised and fidelity-assessed using the Psychotherapy Process Q-Sort.
Treatment as usual, managed by the referring practitioner.
GP referrals from primary care.
HRSD (with ≤14 as remission).


RESULTS
depression severity (BDI-II), degree of co-morbid disorders Axis-I and Axis-II (SCID-I and SCID-II-PQ), quality of life and functioning (GAF, CORE, Q-les-Q), object relations (PROQ2a), Cost-effectiveness analysis (CSRI and GP medical records).


RESULTS
2 years. Plus: a). Qualitative study of participants' and therapists' problem formulation, experience of treatment and of participation in trial. (b) Narrative data from semi-structured pre/post psychodynamic interviews to produce prototypes of responders and non-responders. (c) Clinical case-studies of sub-types of TRD and of change.


CONCLUSIONS
TRD needs complex, long-term intervention and extended research follow-up for the proper evaluation of treatment outcome. This pushes at the limits of the design of randomised therapeutic trials. We discuss some of the consequent problems and suggest how they may be mitigated.


BACKGROUND
Current Controlled Trials ISRCTN40586372.
David
D
Taylor
Jo-anne
JA
Carlyle
Susan
S
McPherson
Felicitas
F
Rost
Rachel
R
Thomas
Peter
P
Fonagy
D000328:Adult; D002985:Clinical Protocols; D003362:Cost-Benefit Analysis; D003865:Major Depressive Disorder / Q000523:psychology / Q000628:therapy*; D061218:Depressive Disorder, Treatment-Resistant / Q000523:psychology / Q000628:therapy*; D005500:Follow-Up Studies; D006801:Humans; D011320:Primary Health Care; D011575:Psychoanalytic Therapy; D012107:Research Design; D016896:Treatment Outcome