My Depression Wellness Toolkit Study
Condition: Major Depression
MeSH terms: Depression; Depressive Disorder
Study type: Interventional

Summary: 
      Major depressive disorder (MDD) continues to have a profound impact on individuals, families,
      and the health care system. Despite marked success in treating active individual episodes of
      unipolar depression, our understanding of the neural and cognitive mechanisms involved in the
      return of symptoms remains extremely limited, and few interventions exist that specifically
      target factors involved in prophylaxis. The research being proposed is among the first that
      is designed to examine neurocognitive markers for depressive relapse vulnerability and link
      them directly to clinical prognosis.

      Hypothesis 1: Cortical midline structures (CMS) network recruitment will be associated with
      behavioural and neural indices of a reflexive attentional bias towards dysphoric stimuli in a
      divided attention task.

      Hypothesis 2: Behavioural and neural indices of dysphoric attentional bias following mood
      challenge will predict depression relapse in prospective 18-month follow up.

      Hypothesis 3: Relative to CBT, Mindfulness Based Cognitive Therapy (MBCT) will normalize CMS
      and right insular/fronto-opercular cortices (INS-FO) network imbalance.

      Hypothesis 4: Relative to CBT, MBCT will normalize to healthy control levels, behavioural and
      neural indices of dysphoric attentional bias, which will be predictive of reduced relapse
      risk across a 24 month follow up.
    

Detailed description: 
      Relapse and recurrence following recovery from Major Depressive Disorder (MDD) are common and
      debilitating outcomes that carry enormous social costs [1-3]. Our CIHR funded program of
      research has studied the nature of psychological vulnerability in affective disorder. We have
      recently identified the activation of a depressive cognitive mode triggered by temporary
      dysphoric states as a reliable risk marker for depressive relapse [4, see attached]. In
      parallel, functional imaging studies have increased our understanding of the neural
      mechanisms underlying normative affective responses [5] and have begun to examine their
      dysregulation in affective disorder [6-8]. Our research has identified potential brain
      biomarkers that predict episode relapse in unipolar depression. However, it remains unknown
      how these potential biomarkers are related to dysphoria-triggered information processing
      modes that also predict relapse, and whether these neurocognitive vulnerabilities are
      amenable to intervention, resulting in more lasting prophylaxis. The present proposal employs
      a cognitive neuroscience approach to examine whether our previously identified neural markers
      of depression relapse and prophylaxis are associated with a dysphoric information processing
      mode. In particular, we will use functional magnetic resonance imaging (fMRI) and behavioural
      probes to undertake a finely tuned examination of mood linked biases in attention toward
      dysphoric stimulus events (i.e., sad faces) to link our previously identified neural markers
      with a specific information processing mode. Further, our preliminary data presented here
      demonstrate a correlation between these mood linked neural markers and relapse, but we cannot
      demonstrate that these markers are causally related to relapse or prophylaxis. To address
      this, we will examine whether these markers and associated dysphoric attentional biases are
      1) modifiable via attentional training designed to overcome reflexive modes of thought and
      perception and 2) are predictive of relapse status across an 24-month prospective follow up
      of treated patients. This research will elucidate the neural and information processing
      correlates that may signal relapse risk in recovered depressed patients. This knowledge will
      increase our limited understanding of the mechanisms underlying enduring depressive relapse
      vulnerability as well as assess potentially efficient strategies for relapse prophylaxis.
    

Intervention name(s): Mindfulness Based Cognitive Therapy; Cognitive Behaviour Therapy
Intervention type(s): Behavioral; Behavioral
Intervention description(s): Mindfulness-Based Cognitive Therapy, a manualized, group skills training program (Segal et al., 2013) that is based on an integration of aspects of cognitive therapy for depression (Beck, 1979) with components of the mindfulness-based stress reduction program (Kabat-Zinn, 1990). Patients participate in 8 weekly sessions, each of which incorporates didactic and experiential learning, along with home practice of skills taught in the program.; CBT is an evidence based depression-specific psychotherapy that examines the relationship between thinking styles and the perpetuation of mood symptoms in major depression. Patients use thought records and activity scheduling, among other tools, to record and reappraise their thinking during situations where negative affect is present, both in session and for homework.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Investigator)
Primary purpose: Treatment
Keywords: Unipolar depression; Mindfulness based cognitive therapy; Cognitive behavioural Therapy; Functional magnetic resonance imaging; Relapse; Depressive relapse; Dysphoric; Cognitive reactivity; Serotonin transporter gene