Track topics on Twitter Track topics that are important to you
This is a randomized controlled trial with blinded ratings of response will be used to evaluate whether Intensive Short-term Dynamic psychotherapy (ISTDP) is effective and whether it is efficacious compared to medical treatment as usual in patients not remitting with 1 or more trials of antidepressant.
Major depression is a common morbid condition resulting in chronicity, recurrent disability, loss of physical health and in many cases, death through suicide or medical conditions.The existing first line treatments include various psychotherapies and anti-depressant medication. The literature on anti-depressant medication has been fraught with controversy and difficulty over recent years. Many proponents argue that publication bias renders anti-depressant treatment of questionable value across the continuum of mild to severe depressed patients. Nonetheless, anti-depressant treatment is considered a bona fide first line agent. In some real world studies, however, anti-depressant medications have not fared well. Based on large scale studies including the STAR-D study, remission rates and recovery rates were disappointing in first line and second line anti-depressant trials. In the real world, a large portion of patients on anti-depressant medication stay on these medications long term and have mild to modest benefits.
There is a growing body of literature suggesting that a combination of psychotherapy and medication may be superior to medication alone. This is however somewhat controversial. Other studies suggest that the presence of personality factors and personality disorders render psychotherapy the treatment of choice in these cases. Indeed, personality factors and the process of anger turning inward toward oneself are common amongst chronically depressed patients (Gilbert) and can predict a negative outcome or limited outcome to pharmacotherapy and, indeed, first line psychotherapies.
Short Term Psychodynamic Psychotherapy (STPP) is a category of brief treatment that focuses on unconscious emotional processes that can impact on a person and produce or exacerbate major depression. One just published study of STPP found it to significantly enhance serotonin binding while Fluoxetine did not do so: this finding may explain the general finding of maintained gains in long-term follow-up after STPP in depression (Karlsson et al, 2009). Three studies have demonstrated direct treatment intervention outcome relationships between STPP and subsequent improvements in depressive symptoms (Barber et al., 1996; Gaston et al., 1998; Hilsenroth et al., 2003). A recent meta-analysis suggests that STPP treatment may be quite effective for depression but that further, high-quality, randomized control trials are required (Driessen et al, 2010).
One subtype of STPP is a method called Intensive Short Term Dynamic Psychotherapy (ISTDP). ISTDP has been studied in eighteen published clinical studies. It has been demonstrated efficacious in patients with personality disorders, panic disorder and somatoform disorders in randomized control trials. In a single case series of patients with treatment resistant depression, patients fared well with ISTDP with 8 of 10 achieving remission (Abbass, 2006). This published study was performed in conjunction with Mood Disorder Service here at Capital Health. These patients responded to a relatively short course of treatment with reduction and stoppage of the majority of medication. Four of five patients were able to return to work from disabilities which averaged two years.
This study will test the hypothesis that ISTDP yields a superior outcome compared to medical treatment as usual in treatment refractory depression.
Allocation: Randomized, Control: Active Control, Intervention Model: Parallel Assignment, Masking: Single Blind (Outcomes Assessor), Primary Purpose: Treatment
Intensive Short-term Dynamic Psychotherapy, Medical treatment as Usual
Capital District Health Authority
Not yet recruiting
Capital District Health Authority, Canada
Published on BioPortfolio: 2014-08-27T03:13:01-0400
Objective: Somatization of emotions accounts for excess Emergency department (ED) visits. Intensive Short-term Dynamic Psychotherapy (ISTDP) has methods to diagnose and manage somatization...
This is a pilot study to collect preliminary short-term data concerning the safety and performance of the Green Sun Dynamic brace in a sample of subjects with adolescent idiopathic scolios...
The purpose of this study is to collect information about safety and effectiveness for long term use of Norditropin®. Participants will attend the medical institution according to usual p...
Objective: To evaluate the safety and cost-effectiveness of Short Stay Intensive Care (SSIC) treatment for low-risk coronary artery bypass patients Design: Randomized clinical equivalence ...
LOSS is a pragmatic clinical evaluation of intensive medical approaches to weight loss for individuals with extreme obesity (body mass index [BMI] 40-60 kg/m2). The intensive medical trea...
The prognostic value of the acute phase protein Pentraxin 3 (PTX-3) is not well evaluated in patients with septic shock, which reveal an unacceptably high short- and long-term mortality. New Sepsis-3 ...
Inpatient psychotherapy might trigger adverse effects among others due to short but intensive treatment. Thus, in this pilot study, certain adverse effects of the multidisciplinary inpatient Cognitive...
There is the first evidence of changes in the kinetics of B cell antigen receptor (BCR) internalisation of neoplastic cells in chronic lymphocytic leukemia (CLL) after the short-term and long-term adm...
Catecholamines have been the mainstay of pharmacological treatment of cardiogenic shock (CS). Recently, use of epinephrine has been associated with detrimental outcomes. In the present study we aimed ...
For patients with treatment-resistant schizophrenia (TRS) who do not respond to drug therapy, electroconvulsive therapy (ECT) is often employed as an additional treatment. The aims of the present stud...
The absence of a useful purpose or useful result in a diagnostic procedure or therapeutic intervention. The situation of a patient whose condition will not be improved by treatment or instances in which treatment preserves permanent unconsciousness or cannot end dependence on intensive medical care. (From Ann Intern Med 1990 Jun 15;112(12):949)
A generic term for the treatment of mental illness or emotional disturbances primarily by verbal or nonverbal communication.
Organization of medical and nursing care according to the degree of illness and care requirements in the hospital. The elements are intensive care, intermediate care, self-care, long-term care, and organized home care.
Travel by a group of physicians to a foreign country for the purpose of making a special study or of undertaking a special project of a short-term duration; not to be confused with MISSIONS AND MISSIONARIES which covers permanent medical establishments and personnel maintained by religious organizations.
Voluntary authorization by a person not of usual legal age for diagnostic or investigative procedures, or for medical and surgical treatment. (from English A, Shaw FE, McCauley MM, Fishbein DB Pediatrics 121:Suppl Jan 2008 pp S85-7).
Alternative Medicine Cleft Palate Complementary & Alternative Medicine Congenital Diseases Dentistry Ear Nose & Throat Food Safety Geriatrics Healthcare Hearing Medical Devices MRSA Muscular Dyst...
Within medicine, nutrition (the study of food and the effect of its components on the body) has many different roles. Appropriate nutrition can help prevent certain diseases, or treat others. In critically ill patients, artificial feeding by tubes need t...
Pharmacy is the science and technique of preparing as well as dispensing drugs and medicines. It is a health profession that links health sciences with chemical sciences and aims to ensure the safe and effective use of pharmaceutical drugs. The scope of...