Trial of the Clinical and Cost Effectiveness of a Specialist Expert Mood Disorder Team for Refractory Unipolar Depressive Disorder

NCT ID: NCT01047124

Last Updated: 2015-12-09

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

UNKNOWN

Clinical Phase

NA

Total Enrollment

219 participants

Study Classification

INTERVENTIONAL

Study Start Date

2009-09-30

Study Completion Date

2016-09-30

Brief Summary

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The purpose of this study is determine whether a specialised mood disorder service, which offers tailored psychological and pharmacological treatment, is more effective in the treatment of chronic unipolar depressive disorder then treatment as usual.

Detailed Description

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A pragmatic randomised controlled trial of a specialist mood disorder intervention versus treatment as usual will be conducted. Patients will be individually randomised with stratification by mental health trust to either treatment by a specialist team offering tailored psychological and pharmacological treatment or treatment as usual.

The specialist mood disorders team will include a psychiatrist and health professionals providing cognitive behaviour therapy. Together the team will assess participants and then provide a co-ordinated and supervised combination of pharmacological and psychological treatment according to guidelines developed by NICE and the British Association of Psychopharmacology. Each participant will receive a treatment plan that is tailored to his/her specific needs. The participants in the treatment as usual team will have their usual access to the same treatments. The outcome in terms of improvement in depressive symptoms, function and costs will be examined after one year in service users with chronic depression.

Eligible patients will be followed for 12 months and the primary outcomes will be observer rated depressive symptoms and cost effectiveness from a health and social care perspective. Along side the RCT, implementation analysis and audit of the standard care and specialised care for depression will be carried out.

Conditions

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Chronic Unipolar Depressive Disorder

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

SINGLE

Outcome Assessors

Study Groups

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Intervention

Specialist mood disorders team: treatment plan according to need

Group Type EXPERIMENTAL

Specialist Mood Disorders Team

Intervention Type OTHER

The specialist mood disorders team will include a psychiatrist and health professionals providing cognitive behaviour therapy. Together the team will assess participants and then provide a co-ordinated and supervised combination of pharmacological and psychological treatment according to guidelines developed by NICE and the British Association of Psychopharmacology. Each participant will receive a treatment plan that is tailored to his/her specific needs.

Treatment as usual

Group Type NO_INTERVENTION

No interventions assigned to this group

Interventions

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Specialist Mood Disorders Team

The specialist mood disorders team will include a psychiatrist and health professionals providing cognitive behaviour therapy. Together the team will assess participants and then provide a co-ordinated and supervised combination of pharmacological and psychological treatment according to guidelines developed by NICE and the British Association of Psychopharmacology. Each participant will receive a treatment plan that is tailored to his/her specific needs.

Intervention Type OTHER

Other Intervention Names

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Collaborative care for depression

Eligibility Criteria

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Inclusion Criteria

* The responsible medical officer or care coordinator leading care considers the patient to be suffering from a primary unipolar depressive disorder which is not a consequence of having another axis 1 or 2 psychiatric disorder.
* Age over 18 years.
* Able and willing to give oral and written informed consent to participation in the study.
* From the date of first assessment by a health professional working for the index mental health trust, they have been offered or received direct care from one or more health professionals from the Trust three or more occasions for 6 months.
* Meet NICE criteria for moderate depression, namely the presence of five out of nine symptoms of (NICE, 2004), have a Hamilton Depression Rating Scale of at least 20, and score 60 or less on the Global Assessment of Functioning Scale (American Psychiatric Association, 1994).

Exclusion Criteria

* Is receiving emergency care for suicide risk, risk of severe neglect or homicide risk and requires it; however, patients will not be excluded because of such risk provided the risk is adequately contained with their current care setting and the primary medical responsibility for care remains with the referring team.
* Does not speak fluent English.
* Is pregnant
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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National Institute for Health Research, United Kingdom

OTHER_GOV

Sponsor Role collaborator

University of Nottingham

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Richard Morriss

Role: PRINCIPAL_INVESTIGATOR

University of Nottingham

Locations

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Derbyshire Mental Health NHS Trust

Derby, Derbyshire, United Kingdom

Site Status NOT_YET_RECRUITING

Lincolnshire Partnership Trust

Lincoln, Lincolnshire, United Kingdom

Site Status NOT_YET_RECRUITING

Nottinghamshire Healthcare NHS Trust

Nottingham, Nottinghamshire, United Kingdom

Site Status RECRUITING

Countries

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United Kingdom

Central Contacts

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Sarah E Marttunen, MSc

Role: CONTACT

+44(0)1158232478

Richard Morriss

Role: CONTACT

+44(0)115820427

Facility Contacts

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Marttunen

Role: primary

+44(0)1158232478

Marttunen

Role: primary

+44(0)1158232478

Marttunen

Role: primary

+44(0)1158232478

References

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Anderson IM, Ferrier IN, Baldwin RC, Cowen PJ, Howard L, Lewis G, Matthews K, McAllister-Williams RH, Peveler RC, Scott J, Tylee A. Evidence-based guidelines for treating depressive disorders with antidepressants: a revision of the 2000 British Association for Psychopharmacology guidelines. J Psychopharmacol. 2008 Jun;22(4):343-96. doi: 10.1177/0269881107088441. Epub 2008 Apr 15.

Reference Type BACKGROUND
PMID: 18413657 (View on PubMed)

Baker R, Reddish S, Robertson N, Hearnshaw H, Jones B. Randomised controlled trial of tailored strategies to implement guidelines for the management of patients with depression in general practice. Br J Gen Pract. 2001 Sep;51(470):737-41.

Reference Type BACKGROUND
PMID: 11593835 (View on PubMed)

Gilbody S, Bower P, Fletcher J, Richards D, Sutton AJ. Collaborative care for depression: a cumulative meta-analysis and review of longer-term outcomes. Arch Intern Med. 2006 Nov 27;166(21):2314-21. doi: 10.1001/archinte.166.21.2314.

Reference Type BACKGROUND
PMID: 17130383 (View on PubMed)

Greden JF. The burden of disease for treatment-resistant depression. J Clin Psychiatry. 2001;62 Suppl 16:26-31.

Reference Type BACKGROUND
PMID: 11480881 (View on PubMed)

Parker GB, Malhi GS, Crawford JG, Thase ME. Identifying "paradigm failures" contributing to treatment-resistant depression. J Affect Disord. 2005 Aug;87(2-3):185-91. doi: 10.1016/j.jad.2005.02.015.

Reference Type BACKGROUND
PMID: 15979725 (View on PubMed)

Rush AJ, Trivedi MH, Wisniewski SR, Nierenberg AA, Stewart JW, Warden D, Niederehe G, Thase ME, Lavori PW, Lebowitz BD, McGrath PJ, Rosenbaum JF, Sackeim HA, Kupfer DJ, Luther J, Fava M. Acute and longer-term outcomes in depressed outpatients requiring one or several treatment steps: a STAR*D report. Am J Psychiatry. 2006 Nov;163(11):1905-17. doi: 10.1176/ajp.2006.163.11.1905.

Reference Type BACKGROUND
PMID: 17074942 (View on PubMed)

Warden D, Rush AJ, Trivedi MH, Fava M, Wisniewski SR. The STAR*D Project results: a comprehensive review of findings. Curr Psychiatry Rep. 2007 Dec;9(6):449-59. doi: 10.1007/s11920-007-0061-3.

Reference Type BACKGROUND
PMID: 18221624 (View on PubMed)

Sartorius N. The economic and social burden of depression. J Clin Psychiatry. 2001;62 Suppl 15:8-11.

Reference Type BACKGROUND
PMID: 11444765 (View on PubMed)

Schramm E, Schneider D, Zobel I, van Calker D, Dykierek P, Kech S, Harter M, Berger M. Efficacy of Interpersonal Psychotherapy plus pharmacotherapy in chronically depressed inpatients. J Affect Disord. 2008 Jul;109(1-2):65-73. doi: 10.1016/j.jad.2007.10.013. Epub 2007 Dec 11.

Reference Type BACKGROUND
PMID: 18067973 (View on PubMed)

Sheldon TA, Cullum N, Dawson D, Lankshear A, Lowson K, Watt I, West P, Wright D, Wright J. What's the evidence that NICE guidance has been implemented? Results from a national evaluation using time series analysis, audit of patients' notes, and interviews. BMJ. 2004 Oct 30;329(7473):999. doi: 10.1136/bmj.329.7473.999.

Reference Type BACKGROUND
PMID: 15514342 (View on PubMed)

Nixon N, Guo B, Kaylor-Hughes C, Simpson S, Garland A, Dalgleish T, Morriss R. Specialist treatment for persistent depression in secondary care: Sustained effects from a multicentre UK study at 24 and 36 months. J Affect Disord. 2024 Jan 15;345:70-77. doi: 10.1016/j.jad.2023.10.105. Epub 2023 Oct 19.

Reference Type DERIVED
PMID: 37863366 (View on PubMed)

Thomson L, Barker M, Kaylor-Hughes C, Garland A, Ramana R, Morriss R, Hammond E, Hopkins G, Simpson S. How is a specialist depression service effective for persistent moderate to severe depressive disorder?: a qualitative study of service user experience. BMC Psychiatry. 2018 Jun 15;18(1):194. doi: 10.1186/s12888-018-1708-9.

Reference Type DERIVED
PMID: 29902995 (View on PubMed)

Morriss R, Garland A, Nixon N, Guo B, James M, Kaylor-Hughes C, Moore R, Ramana R, Sampson C, Sweeney T, Dalgleish T; NIHR CLAHRC Specialist Mood Disorder Study Group. Efficacy and cost-effectiveness of a specialist depression service versus usual specialist mental health care to manage persistent depression: a randomised controlled trial. Lancet Psychiatry. 2016 Sep;3(9):821-31. doi: 10.1016/S2215-0366(16)30143-2. Epub 2016 Aug 3.

Reference Type DERIVED
PMID: 27498098 (View on PubMed)

Morriss R, Marttunnen S, Garland A, Nixon N, McDonald R, Sweeney T, Flambert H, Fox R, Kaylor-Hughes C, James M, Yang M. Randomised controlled trial of the clinical and cost effectiveness of a specialist team for managing refractory unipolar depressive disorder. BMC Psychiatry. 2010 Nov 29;10:100. doi: 10.1186/1471-244X-10-100.

Reference Type DERIVED
PMID: 21114826 (View on PubMed)

Other Identifiers

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09044

Identifier Type: -

Identifier Source: org_study_id