Effects of Adding Motivational Interviewing to Antidepressant Treatment for Hispanic Adults With Depression
Condition: Depression
MeSH terms: Depression; Depressive Disorder
Study type: Interventional

Summary: 
      This study will evaluate the effectiveness of adding motivational interviewing to
      antidepressant treatment for major depressive disorder in Hispanic adults.
    

Detailed description: 
      Depression is a serious illness that affects a person's mood, thoughts, and physical
      well-being. There are multiple types of depressive disorders, with major depressive disorder
      being one of the most common. The following symptoms may be signs of major depression:
      persistent feelings of anxiety, guilt, or hopelessness; irregular sleep and appetite
      patterns; lethargy; disinterest in previously enjoyed activities; excessive irritability and
      restlessness; suicidal thoughts; and inability to concentrate. Despite the widespread use of
      drug treatment for major depression in the United States, it continues to be underutilized in
      the Hispanic population. The retention rate in antidepressant therapy (ADT) among the
      Hispanic population is half that of the Caucasian population. It is believed that cultural
      factors and ambivalence toward seeking treatment interfere with ADT retention in Hispanic
      adults. Motivational antidepressant therapy (MADT) involves the use of motivational
      interviewing (MI) to discuss treatment with patients. This study will compare the
      effectiveness of culturally-specific MADT versus standard antidepressant therapy (SADT) in
      treating Hispanic adults with major depression.

      Participants in this single-blind study will be randomly assigned to receive either MADT or
      SADT. A psychiatrist will conduct all medication visits and will recommend an initial
      antidepressant for each participant. Depending on treatment assignment, psychiatrists will
      use either the MADT or SADT approach in the medication visits. During the visits,
      participants will complete questionnaires, undergo vital sign measurements, and receive
      medication. Medication visits will occur weekly during the first two weeks, every 2 weeks for
      the next 6 weeks, and then on a monthly basis until the end of the study. In addition to
      visits with the psychiatrist, participants will complete 15-minute individual interviews with
      a clinician from the Hispanic Treatment Program. Individual interviews will take place every
      2 weeks in the first month of treatment, monthly until the third month, and then every other
      month thereafter. The association between treatment, retention, and response will be assessed
      after 3 months of treatment. Preliminary outcome data will be obtained after 6 more months of
      continued treatment. After the end of treatment, participants may randomly be asked to
      participate in a small "focus group" to discuss personal experiences with study treatments.
    

Intervention name(s): Standard antidepressant therapy (SADT); Motivational antidepressant therapy (MADT)
Intervention type(s): Drug; Behavioral
Intervention description(s): Treatment with medication will follow the Texas Medication Algorithm (TMA) for Depression. Antidepressant medications may include the following: citalopram (Celexa), escitalopram (Lexapro), paroxetine (Paxil CR), sertraline (Zoloft), venlafaxine XR (Effexor XR), bupropion SR (Wellbutrin SR), duloxetine (Cymbalta), nortriptyline (Pamelor), and mirtazapine (Remeron).; The same medication treatment for depression will be offered and supplemented with techniques from motivational interviewing.
Intervention MeSH terms: Antidepressive Agents
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Outcomes Assessor)
Primary purpose: Health Services Research
Keywords: Hispanic Americans; Major Depressive Disorder; Antidepressant Therapy; Motivational Interviewing; Treatment Retention; Treatment Adherence