Research on the Biological Mechanism of the Efficacy of Psychotherapy for Depression Based on the fNIRS

Study Overview
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Brief Summary
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In this project, the investigators will implement medication therapy, psychotherapy, and a combination of medication therapy with psychotherapy, specifically utilizing IPT, in patients with depression. Simultaneously, the investigators will conduct comprehensive fNIRS assessments on all patients to evaluate changes in their brain function and determine the level of effectiveness of psychotherapy. The investigators will also employ standardized psychological assessments to evaluate patients, allowing for a comparison of the effectiveness of fNIRS assessments and providing clarity on the efficacy of psychotherapy in patients with depression, as the investigatorsll as the differential efficacy of different treatment approaches, and establishing the biological markers of psychotherapy. Additionally, the investigators will collect blood samples, cranial magnetic resonance images, and electroencephalograms from patients before and after treatment, which will contribute to further exploration of treatment mechanisms in the future.

Detailed Description
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This study utilizes the Near-Infrared Functional Imaging System (fNIRS) as a biological marker for psychotherapy. The investigators propose the following scientific hypothesis: In patients with depression, levels of oxygenated hemoglobin and deoxygenated hemoglobin in different brain regions may fluctuate at different stages of the disease progression and treatment, along with changes in the activation levels of different brain regions. Neuroimaging studies on the neurobiological mechanisms of depression suggest a reduction in gray matter volume in emotion processing areas such as the limbic system, hippocampus, anterior cingulate cortex, dorsolateral prefrontal cortex, and basal ganglia. Previous neuroimaging studies have found that successful cognitive-behavioral therapy (CBT) accompanied changes in gray matter volume in the brain, as observed through fMRI. Interpersonal Psychotherapy (IPT), which is a component of the third wave of CBT, is expected to exhibit more significant expression in cognitive task-based fNIRS during IPT treatment for depression. In this project, the investigators will implement medication therapy, psychotherapy, and a combination of medication therapy with psychotherapy, specifically utilizing IPT, in patients with depression. Simultaneously, the investigators will conduct comprehensive fNIRS assessments on all patients to evaluate changes in their brain function and determine the level of effectiveness of psychotherapy. The investigators will also employ standardized psychological assessments to evaluate patients, allowing for a comparison of the effectiveness of fNIRS assessments and providing clarity on the efficacy of psychotherapy in patients with depression, as the investigatorsll as the differential efficacy of different treatment approaches, and establishing the biological markers of psychotherapy. Additionally, the investigators will collect blood samples, cranial magnetic resonance images, and electroencephalograms from patients before and after treatment, which will contribute to further exploration of treatment mechanisms in the future.

Official Title
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Research on the Biological Mechanism of the Efficacy of Psychotherapy for Depression Based on the Near-Infrared Functional Imaging System (fNIRS)

Conditions
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Depressive Disorder

Intervention / Treatment
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* Drug: Antidepressant
* Other: Psychotherapy IPT
* Other: The combination of antidepressant and IPT


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Meet the diagnostic criteria for depression according to the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, 5th edition). Have at least a junior high school education or higher. Age between 16 and 50 years old. Grew up in a Chinese-speaking environment and are proficient in Mandarin Chinese for effective communication. Exclusion Criteria: Physical illnesses that significantly impact communication and mobility. Co-occurring psychiatric disorders other than depression. History of substance dependence or substance addiction.

Ages Eligible for Study
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Minimum Age: 16 Years
Maximum Age: 50 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: medication therapy group<br>Patients randomized to the medication therapy group will receive standardized treatment with antidepressant medications according to clinical guidelines. | Drug: Antidepressant<br>* Patients will receive standardized treatment with antidepressant, and their treatment efficacy will be assessed by a blinded psychological assessor using validated rating scales. The assessment will be conducted monthly, and evaluations will be tracked for a period of three months.<br>|
| Active Comparator: Interpersonal Psychotherapy group<br>The participants will receive standardized IPT treatment for 12 weeks. IPT therapists have received training from IPT workshops in both China and the United States and obtained the corresponding certifications. IPT therapists focus on the interpersonal domains associated with the onset and maintenance of depression. They guide clients in identifying the connections between their emotional changes and interpersonal difficulties, exploring problems, actively seeking potential interpersonal support and assistance, improving interpersonal skills, helping clients alleviate symptoms, enhance their quality of life, and adapt better to society. | Other: Psychotherapy IPT<br>* The participants will receive standardized IPT treatment for 12 weeks. Patients will receive standardized treatment, and their treatment efficacy will be assessed by a blinded psychological assessor using validated rating scales. The assessment will be conducted monthly, and evaluations will be tracked for a period of three months.<br>|
| Experimental: combination of medication therapy and Interpersonal Psychotherapy group<br>Patients randomized to this group will receive standardized treatment with antidepressant medications according to clinical guidelines. The participants will also receive standardized IPT treatment for 12 weeks. IPT therapists have received training from IPT workshops in both China and the United States and obtained the corresponding certifications. IPT therapists focus on the interpersonal domains associated with the onset and maintenance of depression. They guide clients in identifying the connections between their emotional changes and interpersonal difficulties, exploring problems, actively seeking potential interpersonal support and assistance, improving interpersonal skills, helping clients alleviate symptoms, enhance their quality of life, and adapt better to society. | Other: The combination of antidepressant and IPT<br>* The participants will receive standardized IPT treatment for 12 weeks. Also，long-term antidepressant will be administered in accordance with clinical guidelines. Patients will receive standardized treatment, and their treatment efficacy will be assessed by a blinded psychological assessor using validated rating scales. The assessment will be conducted monthly, and evaluations will be tracked for a period of three months.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Changes in fNIRS (functional Near-Infrared Spectroscopy) after treatment. | The instrument used in this study is a 52-channel Near-Infrared Spectroscopy (fNIRS) brain imaging system. It indirectly calculates the relative changes in levels of oxygenated and deoxygenated hemoglobin in different brain regions by detecting two different wavelengths of near-infrared light (695 nanometers and 830 nanometers). These changes reflect alterations in brain function. The instrument primarily utilizes 17 optical emitters and 16 optical detectors to acquire data. The emitters and detectors are positioned 3.0 centimeters apart, and the measurement area between the probes is defined as a channel. The NIRS probes are arranged in a 3×11 matrix, forming 52 measurement channels. Following the international 10-20 system, the lowest channel is aligned with the Fp1-Fp2 line. The probe coverage of this instrument allows for the measurement of relative changes in oxygenated and deoxygenated hemoglobin signals in bilateral frontal and temporal cortical regions. | Baseline, 4-weeks, 8-weeks,12-weeks. | 
| Change in remission rate of Hamilton Depression Scale (24-items) (HAM-D24) score after treatment. | The Hamilton Depression Scale (24-items) (HAM-D24), is a 24 item diagnostic questionnaire used to measure the severity of depressive episodes in patients with mood disorders. Higher HAM-D24 score indicates more severe depression, and each item yields a score of 0 to 4. Remission is defined as HAM-D24 ≤8. | Baseline, 4-weeks, 8-weeks,12-weeks. | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in remission rate of Patient Health Questionnaire-9 (PHQ-9) score after treatment. | The Patient Health Questionnaire-9 (PHQ-9) is a screening tool used to assess symptoms of depression. It consists of nine questions that are designed to measure the severity of depressive symptoms experienced by an individual. Each question corresponds to one of the nine criteria for major depressive disorder as outlined in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Each question is scored on a scale from 0 to 3, with higher scores indicating greater severity of symptoms. The total score ranges from 0 to 27, with higher scores indicating a higher likelihood of clinical depression. The PHQ-9 is widely used in both clinical and research settings to assess the presence and severity of depressive symptoms, monitor treatment progress, and aid in the diagnosis of depression. | Baseline, 4-weeks, 8-weeks,12-weeks. | 
| Change in remission rate of the Beck Depression Inventory (BDI) score after treatment. | The Beck Depression Inventory (BDI) is a widely used self-assessment tool for screening depression. Developed by American psychologist Aaron T. Beck in 1961, it aims to measure the severity of depressive symptoms experienced by an individual. The BDI consists of 21 items, each describing different aspects of depressive symptoms such as mood, loss of interest in activities, self-evaluation, changes in weight, sleep quality, and more. Individuals are required to rate their experiences based on a four-point scale ranging from 0 to 3, reflecting the intensity of each symptom. The total score on the BDI can range from 0 to 63, with higher scores indicating more severe depressive symptoms. The questionnaire is designed to assess the presence and severity of depression, monitor treatment progress, and aid in the diagnosis of depression. | Baseline, 4-weeks, 8-weeks,12-weeks. | 
| Change in remission rate of the Beck Scale for Suicidal Ideation (SSI) score after treatment. | The Beck Scale for Suicidal Ideation (SSI) is a self-report questionnaire designed to assess the presence and severity of suicidal thoughts and ideation. It was developed by Aaron T. Beck, a renowned psychologist, to aid in the evaluation of suicidal risk. The SSI consists of 19 items that explore different dimensions of suicidal ideation, including the intensity, frequency, duration, and specificity of suicidal thoughts. The questionnaire assesses both passive (e.g., I wish I were dead) and active (e.g., I have a plan to kill myself) suicidal ideation. Each item is rated on a scale from 0 to 2, with higher scores indicating a greater severity of suicidal ideation. The total score on the SSI can range from 0 to 38, providing an overall assessment of the individual's suicidal thoughts. | Baseline, 4-weeks, 8-weeks,12-weeks. | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Functional Near-Infrared Spectroscopy, fNIRS, depression, Biological Mechanism, Psychotherapy