DEPRES-ST: ​​A randomized controlled trial of schema therapy for patients with intractable depression in psychiatry

​The PhD project aims to investigate a special form of psychotherapy (schedule therapy) in a randomized controlled trial with chronically depressed patients.

The term 'difficult to treat depression' covers patients with either chronic depression (duration of at least 2 years) or treatment-resistant depression (have tried at least two types of antidepressant medication without sufficient effect). This is a patient group that has it more difficult on a wide range of parameters than other people with depression, for example they more often have problems in relationships, they have a higher consumption of health services, including psychiatric hospitalization, and they are more often forced to be in public maintenance.
People with difficult-to-treat depression are also a special patient group, since compared to other patients with depression, they far more often have childhood trauma and at the same time a personality disorder or personality traits that give them challenges in everyday life. Currently, we cannot offer sufficiently effective psychiatric treatment. Research into these special patients is so far lacking, and what research there is defines the patient group very differently, which makes it difficult to compare studies and draw any useful conclusions.

Purpose: The DEPRE-ST study will investigate whether 30 sessions of schema therapy (ST) given to patients with difficult-to-treat depression produces a better effect than the psychotherapeutic treatment the patients would otherwise have received in psychiatry (Treatment As Usual - TAU). ST has been developed for patients who do not have a great enough effect from the usual treatment. It also addresses personality disorders or problematic traits and childhood traumas directly in therapy. Smaller studies have so far shown promising results in patients with chronic depression.

Method: 168 patients with difficult-to-treat depression, referred for treatment in psychiatry, are randomized to receive either ST or TAU. Measurements are made at inclusion, at 6 months (approx. end of TAU), 12 months (approx. end of ST) and follow-up 24 months after inclusion. The treatment is provided at four psychiatric centers both in the Capital Region and Southern Denmark. The therapists are trained for 8 days by leading international schema therapists and then receive ongoing supervision.

Results and conclusions: We expect that ST will give better results than TAU, both on the depression symptoms themselves, but also on factors that could be equally important for the patient - e.g. personal recovery, negative effects of the treatment, psychological well-being, social and occupational functioning. In addition, the study measures changes in 1-2 issues that the patient has defined himself - with the newly translated measurement tool Psychological Outcome Profiles (PSYCHLOPS). A cost-benefit analysis will be prepared of the costs of the treatment compared to its effect on the patient's life and well-being, as well as any resulting socio-economic savings. Finally, data will be used to develop and qualify a new model that will be able to assess the degree of depression's treatment resistance. What is new about the model is that - in contrast to previous models that measure physical and medical treatments - it also includes an assessment of the benefit the patient has had from previous treatment with psychotherapy. The study could have a significant impact on the treatment in psychiatry in the future for the group of patients with difficult-to-treat depression, especially if the treatment proves to be broadly cost-effective in the long term.

​​Foundations that supports the  project:  ​

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