Practicing Alternative Techniques to Heal From Depression: The PATH-D Study
Practicing Alternative Techniques to Heal From Depression: The PATH-D Study
This study is a randomized, controlled trial of Mindfulness-Based Cognitive Therapy (MBCT)
 versus Health-Enhancement Program (HEP) for patients with treatment-resistant major
 depressive disorder (MDD). Both arms of the study will continue to receive the standard
 medication management treatment as usual (TAU) throughout the study. MBCT is a new technique
 that has been found to be effective for prevention of relapse in individuals in complete
 recovery from depression. MBCT is a group-based, 8-week intervention that uses mindfulness
 meditation as its core therapeutic ingredient. It teaches people to have a different
 relationship to depressive thoughts and feelings. This study will use an active condition
 called the Health Enhancement Program (HEP) which was specifically developed to serve as a
 comparison condition for mindfulness interventions. HEP has been shown to decrease global
 stress levels and to increase perceived health. Stress has been considered a contributor to
 depression. One hundred and seventy four patients with MDD who have failed two or more
 adequate antidepressant trials will be identified and randomly assigned to one of two groups:
 MBCT+TAU or HEP+TAU. All patients who enroll in the study will undergo follow-up assessments
 at 3, 6, 9 and 12 months following the intervention. A supplemental portion of the study will
 enroll 88 patients to undergo functional magnetic resonance imagining (fMRI) scans
 immediately before and after treatment to better understand the neural pathways implicated in
 depression and those that may be affected through treatment.
Inclusion Criteria:

 DSM-IV TR Diagnosis of Major Depression receiving medication management.

 Adequate trial of 2 or more antidepressants (ATHF) for a minimum of 6 weeks (one of which
 at UCSF).

 Hamilton Depression Rating Scale 17 score ≥ 14

 Any Ethnicity

 English Speaking

 Male or Female

 No current psychotherapy (i.e. only medication management treatment) or plan to start new
 psychotherapy during MBCT or HEP

 Exclusion Criteria:

 Bipolar Disorder, Obsessive Compulsive Disorder, Schizophrenia, Schizoaffective Disorder,
 Antisocial and Borderline Personality Disorders, Current Eating Disorder, Pervasive
 Development Delay Major Depression with Psychotic Features

 Active Suicidality (per HAM-D17 > 1 on item 3)

 Meditation Practice once or more per week; yoga more than twice per week at study entry

 Substance Abuse Disorder within 6 months

 Cognitive Disorder with Mini Mental Status Exam score < 25

 Medical illness rated 4 on Cumulative Illness Rating Scale