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Effects of Adding Motivational Interviewing to Antidepressant Treatment for Hispanic Adults With Depression

Information source: New York State Psychiatric Institute
ClinicalTrials.gov processed this data on August 23, 2015
Link to the current ClinicalTrials.gov record.

Condition(s) targeted: Depression

Intervention: Standard antidepressant therapy (SADT) (Drug); Motivational antidepressant therapy (MADT) (Behavioral)

Phase: N/A

Status: Completed

Sponsored by: New York State Psychiatric Institute

Official(s) and/or principal investigator(s):
Roberto Lewis-Fernandez, MD, Principal Investigator, Affiliation: New York State Psychiatric Institute

Summary

This study will evaluate the effectiveness of adding motivational interviewing to antidepressant treatment for major depressive disorder in Hispanic adults.

Clinical Details

Official title: Motivational Antidepressant Therapy for Hispanics

Study design: Allocation: Randomized, Endpoint Classification: Efficacy Study, Intervention Model: Parallel Assignment, Masking: Single Blind (Outcomes Assessor), Primary Purpose: Health Services Research

Primary outcome:

Number of days in ADT (retention)

Hamilton Depression Scale -17-item version (symptoms)

Sheehan Disability Scale (impairment)

Perceived quality of life

Secondary outcome:

Client Satisfaction Questionnaire (patient satisfaction)

Composite Adherence Score (medication adherence)

Detailed description: Depression is a serious illness that affects a person's mood, thoughts, and physical well-being. There are multiple types of depressive disorders, with major depressive disorder (MDD) being one of the most common. The following symptoms may be signs of MDD: persistent feelings of anxiety, guilt, or hopelessness; irregular sleep and appetite patterns; lethargy; disinterest in previously enjoyed activities; excessive irritability and restlessness; suicidal thoughts; and inability to concentrate. Despite the widespread use of drug treatment for MDD in the United States, it continues to be underutilized in the Hispanic population. The retention rate in antidepressant therapy (ADT) among the Hispanic population is half that of the Caucasian population. It is believed that cultural factors and ambivalence toward seeking treatment interfere with ADT retention in Hispanic adults. Motivational antidepressant therapy (MADT) involves the use of motivational interviewing (MI) to discuss treatment with patients. This study will compare the effectiveness of culturally-specific MADT versus standard antidepressant therapy (SADT) in treating Hispanic adults with MDD. Participants in this single-blind study will be randomly assigned to receive either MADT or SADT. A psychiatrist will conduct all medication visits and will recommend an initial antidepressant for each participant. Depending on treatment assignment, psychiatrists will use either the MADT or SADT approach in the medication visits. During the visits, participants will complete questionnaires, undergo vital sign measurements, and receive medication. Medication visits will occur weekly during the first two weeks, every 2 weeks for the next 6 weeks, and then on a monthly basis until the end of the study. In addition to visits with the psychiatrist, participants will complete 15-minute individual interviews with a clinician from the Hispanic Treatment Program. Individual interviews will take place every 2 weeks in the first month of treatment, monthly until the third month, and then every other month thereafter. The association between treatment, retention, and response will be assessed after 3 months of treatment. Preliminary outcome data will be obtained after 6 more months of continued treatment. After the end of treatment, participants may randomly be asked to participate in a small "focus group" to discuss personal experiences with study treatments.

Eligibility

Minimum age: 18 Years. Maximum age: 79 Years. Gender(s): Both.

Criteria:

Inclusion Criteria:

- Self-identifies as Hispanic

- Meets Diagnostic and Statistical Manual, 4th edition criteria for major depressive

disorder (MDD)

- Score of 16 or higher on Hamilton Depression Scale (HAM-D17) at study entry

- Willing to abstain from other psychotropic medications not included in the Texas

Medication Algorithm (TMA) for depression, as clinically indicated, for the duration of the study. Zolpidem for insomnia will be allowed.

- Fluency in English or Spanish

Exclusion Criteria:

- Acute suicidality

- History of schizophrenia, bipolar affective disorder, schizoaffective disorder,

depression with psychotic features, or organic brain syndromes

- Alcohol or other substance abuse or dependence (except nicotine) within 6 months

prior to study entry

- Clinically unstable medical disease, including narrow-angle glaucoma or increased

intra-ocular pressure

- Systemic blood pressure of 140/90 mm Hg or less

- Liver function test values two times above the normal level

- Pregnant or breastfeeding

- Sexually active women not using an effective method of birth control

- Current or past history of seizure disorder (except febrile seizure in childhood)

- Receiving effective medication for MDD

- Unable to tolerate or unwilling to accept drug-free period of varying length: 1 week

for benzodiazepines taken as needed; 2 weeks for buspirone, lithium, anticonvulsants, stimulants, barbiturates, opiates, and regular-use benzodiazepines (except clonazepam); and 5 weeks for clonazepam

- Received electroconvulsive therapy (ECT) within 3 months prior to study entry

- Parkinson's disease, dementia of any type, or cognitive impairment

Locations and Contacts

New York State Psychiatric Institute, 1051 Riverside Drive, New York, New York 10032, United States
Additional Information

Related info

Starting date: February 2008
Last updated: September 2, 2014

Page last updated: August 23, 2015

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