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BEHANDLING-God og treffsikker diagnostikk, behandling og rehabilitering

Depressive disorder in primary care – an integrated solution for improving treatment and preventing severe outcome

Alternative title: Depressive lidelser i primærhelsetjenesten: En integrert løsning for å bedre behandlingen og forebygge negative langtidseffekter

Awarded: NOK 16.0 mill.

Depressive disorder is a prevalent psychiatric condition associated with significant disability, mortality and economic burden for society. Given this tremendous disease burden, there is an urgent need for efficient and individualized treatments. We want to develop an efficient treatment and prevention program for primary health care in municipalities supported by digital technology. Although both psychotherapy and antidepressant medications are effective, it is not uncommon for a patient with a depressive disorder to have temporary symptom reduction after treatment but require an extended amount of time for full restoration of function. Considerable progress has been made in characterizing the mechanisms underlying depression vulnerability and this may be harnessed to improve future treatment strategies. Negative attentional biases may constitute causative, vulnerability and maintenance factors for depression rather than simply markers of lowered mood. Thus, modifying biased attention towards negative stimuli could be an underlying mechanisms through which treatment operate. A core aim is to test the effect of a novel intervention for acute depression (Randomized Controlled Trial; RCT) by combining psychological (Attention Bias Modification; ABM) and pharmaceutical approaches in a multicenter primary care study. No study has so far combined pharmacotherapy and ABM in clinically depressed subjects. It is more straightforward to develop control conditions for interventions like ABM as compared to complex psychotherapies, which is a prerequisite to testing treatment effects. The RCT will be low-cost due to application of novel Information, Communication and Technology (ICT) tools for data collection. By building the approach on an integrated ICT solution, we will also provide a “package of tools” that ensures a less costly pipeline for clinical trials in mental illnesses, as well as a rapid implementation into clinical care.

Major Depressive Disorder (MDD) is a debilitating disorder that affects 15% of the population and is a leading cause of disability worldwide. The treatment and management of depression is a major and increasing health care challenge for municipalities. Although both psychotherapy and antidepressant medications are effective, it is not uncommon for a patient with MDD to have temporary symptom reduction after treatment but require an extended amount of time for full restoration of function. A major concern related to long-term outcome is suicide, which is significantly higher in people with MDD than the rest of the population. The core aim is to test the effect of a novel intervention for acute depression (RCT) by combining psychological (Attention Bias Modification) and pharmaceutical approaches customized for primary care setting. Increased synaptic plasticity may be one of the therapeutic mechanisms of antidepressants. However, enhancing plasticity alone may not lead to a sufficient treatment response in all individuals affected by depression. Indeed, entrenched attentional biases seen in depression, such as the tendency to focus on and recall negative information, may persist. The RCT will be low-cost due to application of novel Information, Communication and Technology (ICT) tools for data collection, as well as integration with Norwegian registries and biobanks in order to improve the clinical evaluation and identify disease characteristics relevant for the prevention of severe long-term outcome. The results from this study will have broad ramifications, including devising a strategy for stratification of patients into responders and non-responders that will enable better disease management and efficient use of health care resources. By building the approach on an integrated ICT solution, we will also provide a “package of tools” that ensures a less costly pipeline for clinical trials in mental illnesses, as well as a rapid implementation into clinical care.

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BEHANDLING-God og treffsikker diagnostikk, behandling og rehabilitering