Major Depression Clinical Trial
Official title:
Secondary Prevention of Depression Applying an Experimental Attentional Bias Modification Procedure
Depression (Major Depressive Disorder; MDD) has been dubbed "the common cold among the mental
illnesses" and it is also a highly recurrent disorder. Secondary prevention has been
identified as a key goal in the long-term management of depression. High recurrence rate
suggests that there are specific vulnerability factors that increase people's risk for
developing repeated episodes of the disorder. Preventive strategies should identify and
ameliorate these factors to reduce the individual's risk of subsequent episodes. Biased
attention for emotional stimuli is central to the cognitive model where increased sensitivity
to negative cues is believed to fuel the negative thoughts and feelings in depression and
play a key role in maintaining the illness. Selective biases in attention can be modified by
a simple computerized technique; The Attention Bias Modification Task (ABM). This project
aims to investigate whether ABM can reduce surrogate and clinical markers of relapse in a
large group highly vulnerable to depressive episodes. The effects of ABM, immediately after
the two weeks intervention, on three key risk factors for depression will be studied:
Residual symptoms, cortisol awakening response and emotion regulation strategies. The
participants will be followed up after 1 month, 6 months and 12 months. The hypothesis that
ABM will reduce subsequent episodes of low mood over the following 12 months in this group in
a manner predicted by early changes in these risk factors will be investigated. It will also
be tested if such effects in the lab may be dependent on candidate genes which affect
serotonin reuptake and which have been implicated in malleability and emotional learning.
Effects on underlying neural correlates of emotion regulation will be studied in an fMRI
experiment in a sub-sample and which will also be stratified by serotonin transporter
genotype (see also NCT02931487). The predictive value of meta cognitions related to
rumination and the possible mediating effects of automatic thoughts and perceived stress will
also be investigated in a sub group (see also NCT02648165).
The characterization of the cognitive, genetic and neural mechanisms underlying the ABM
effect will have key implications for future treatment development and combination with other
treatment modalities like pharmacotherapy.
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