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Relief of Chronic or Resistant Depression (Re-ChORD): A pragmatic, randomized, open-treatment trial of an integrative program intervention for chronic depression

Murray, Greg; Michalak, Erin E.; Axler, Auby; Yaxley, David; Hayashi, Brenda; Westrin, Åsa LU ; Ogrodniczuk, John S.; Tam, Edwin M.; Yatham, Lakshmi N. and Lam, Raymond W. (2010) In Journal of Affective Disorders 123(1-3). p.243-248
Abstract
Background: Chronic depression is a particularly disabling mood disorder and treatment outcomes are poor with either psychotherapy or pharmacotherapy alone. There is growing evidence that an integrative treatment approach may be optimal. A novel multi-modal, multi-disciplinary treatment program, Re-ChORD, was developed at the University of British Columbia and evaluated in this pilot study. Methods: Re-ChORD consisted of guidelines-based medication management, and group-based interpersonal psychotherapy and occupational therapy. A randomized, parallel-groups, open-treatment trial was conducted comparing Re-ChORD to treatment as usual (TAU). Inclusion criteria were current depression (17-item Ham-D >= 15) and a diagnosis of a chronic... (More)
Background: Chronic depression is a particularly disabling mood disorder and treatment outcomes are poor with either psychotherapy or pharmacotherapy alone. There is growing evidence that an integrative treatment approach may be optimal. A novel multi-modal, multi-disciplinary treatment program, Re-ChORD, was developed at the University of British Columbia and evaluated in this pilot study. Methods: Re-ChORD consisted of guidelines-based medication management, and group-based interpersonal psychotherapy and occupational therapy. A randomized, parallel-groups, open-treatment trial was conducted comparing Re-ChORD to treatment as usual (TAU). Inclusion criteria were current depression (17-item Ham-D >= 15) and a diagnosis of a chronic depressive disorder. The primary outcome variable was clinical remission (17-item Ham-D <= 7) at 4 month assessment. Results: A total of 64 patients were randomised to Re-ChORD (N = 34) and TAU (N = 30). Under both intention to treat (ITT) and completer analyses, the remission rate was significantly higher in the Re-ChORD than TAU groups. Treatment effect size for remission was of medium magnitude (22.2% and 29.6% over TAU under ITT and completer analyses). Limitations: We did not collect sufficient follow-up data to investigate maintenance of gains. Re-ChORD shares elements with other combined treatments, and the present positive findings cannot be interpreted as being specific to the Re-ChORD program. Conclusions: Consistent with growing evidence that integrative treatments are necessary for chronic depressive disorders. Re-ChORD was demonstrated in this pilot study to produce significantly greater rates of remission than treatment as usual. A larger-scale trial is warranted. (C) 2009 Elsevier By. All rights reserved. (Less)
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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Interpersonal psychotherapy, Psychosocial treatments, Remission, Chronic depression, Occupational therapy
in
Journal of Affective Disorders
volume
123
issue
1-3
pages
243 - 248
publisher
Elsevier
external identifiers
  • wos:000277894900033
  • scopus:77952108688
ISSN
1573-2517
DOI
10.1016/j.jad.2009.10.015
language
English
LU publication?
yes
id
36caa722-1f2d-4145-9afe-f4ed6bbe5a6d (old id 1617428)
date added to LUP
2010-06-21 14:52:47
date last changed
2018-06-24 03:18:18
@article{36caa722-1f2d-4145-9afe-f4ed6bbe5a6d,
  abstract     = {Background: Chronic depression is a particularly disabling mood disorder and treatment outcomes are poor with either psychotherapy or pharmacotherapy alone. There is growing evidence that an integrative treatment approach may be optimal. A novel multi-modal, multi-disciplinary treatment program, Re-ChORD, was developed at the University of British Columbia and evaluated in this pilot study. Methods: Re-ChORD consisted of guidelines-based medication management, and group-based interpersonal psychotherapy and occupational therapy. A randomized, parallel-groups, open-treatment trial was conducted comparing Re-ChORD to treatment as usual (TAU). Inclusion criteria were current depression (17-item Ham-D &gt;= 15) and a diagnosis of a chronic depressive disorder. The primary outcome variable was clinical remission (17-item Ham-D &lt;= 7) at 4 month assessment. Results: A total of 64 patients were randomised to Re-ChORD (N = 34) and TAU (N = 30). Under both intention to treat (ITT) and completer analyses, the remission rate was significantly higher in the Re-ChORD than TAU groups. Treatment effect size for remission was of medium magnitude (22.2% and 29.6% over TAU under ITT and completer analyses). Limitations: We did not collect sufficient follow-up data to investigate maintenance of gains. Re-ChORD shares elements with other combined treatments, and the present positive findings cannot be interpreted as being specific to the Re-ChORD program. Conclusions: Consistent with growing evidence that integrative treatments are necessary for chronic depressive disorders. Re-ChORD was demonstrated in this pilot study to produce significantly greater rates of remission than treatment as usual. A larger-scale trial is warranted. (C) 2009 Elsevier By. All rights reserved.},
  author       = {Murray, Greg and Michalak, Erin E. and Axler, Auby and Yaxley, David and Hayashi, Brenda and Westrin, Åsa and Ogrodniczuk, John S. and Tam, Edwin M. and Yatham, Lakshmi N. and Lam, Raymond W.},
  issn         = {1573-2517},
  keyword      = {Interpersonal psychotherapy,Psychosocial treatments,Remission,Chronic depression,Occupational therapy},
  language     = {eng},
  number       = {1-3},
  pages        = {243--248},
  publisher    = {Elsevier},
  series       = {Journal of Affective Disorders},
  title        = {Relief of Chronic or Resistant Depression (Re-ChORD): A pragmatic, randomized, open-treatment trial of an integrative program intervention for chronic depression},
  url          = {http://dx.doi.org/10.1016/j.jad.2009.10.015},
  volume       = {123},
  year         = {2010},
}