ADepT, a Novel Type of Talk Therapy Targeting Anhedonia

 

CMS in Medium 07-18-2023

A new trial shows how Augmented Depression Therapy benefits depressed patients


Depression and Anhedonia

Anhedonia, the diminished capacity to experience pleasure, is a symptom associated with a myriad of disease processes. It is a prevalent feature of depression.

Approximately 95% of depressed individuals report some loss of interest or pleasure and more than one third show severe anhedonic symptoms.

Functional neuroimaging studies have revealed that anhedonia is characterized by decreased responsiveness of mesocorticolimbic reward processing brain circuitry

Imbalances in neurotransmitters, or chemical messengers secreted by nerves, have also been investigated in relation to anhedonia.

Dopamine is a neurotransmitter involved in reward pathways. Reduced dopamine expression in the ventral striatum has been found to correlate with increased severity of anhedonia.

Even people with anhedonia may have a reduced capacity to experience pleasure, they can keep the ability to experience pain, general stimulation, and negative emotions like sadness.

A gap to be bridged

Current depression psychotherapies may fail to target these features adequately, contributing to sub-optimal outcomes.

Current psychological treatments are effective at reducing negativity (thinking and feeling sad and anxious) but are less successful at building positivity (thinking and feeling happy or experiencing wellbeing).

Researchers from the University of Exeter (UoE) developed Augmented Depression Therapy (ADepT).

This novel type of talk therapy aimed to address the inadequate targeting of anhedonia symptoms and wellbeing deficits in current depression psychotherapies.

ADepT pays equal attention to building the positives as reducing the negatives, giving clients new skills to ‘act opposite’ to old ways of thinking

They encouraged clients to take a new perspective on their difficulties, aiming to learn to live well alongside depressed mood.

The primary goals are to help clients to:Identify what is important to them in key life areas
Take steps towards living a life that is consistent with these values
Take opportunities and manage challenges while they do so that they can experience wellbeing and pleasure

The trial

The researchers conducted a pilot trial to establish the clinical and economic proof of concept for ADepT and examine the feasibility of a future definitive trial comparing ADepT to Cognitive-Behavioral Therapy (CBT).

The trial recruited adults diagnosed with a current major depressive episode, who exhibited anhedonic features and were high-scored on the Patient Health Questionnaire in Devon, UK.

They were randomly assigned to receive either 20 sessions of Cognitive-Behavioral Therapy (CBT) or ADepT using an algorithm to balance depression severity and antidepressant use between the groups.

The treatment was provided in an outpatient university-based specialist mood disorder clinic.

Assessments were conducted at intake and at six, twelve, and eighteen months, with researcher-blinded evaluations.

The co-primary outcomes measured were:Depression (PHQ-9) and
Wellbeing (Warwick Edinburgh Mental Wellbeing Scale) at six months.

Results from a trial of 82 adults showed the treatment led to “greater gains in quality of life”.

Researchers from the University of Exeter (UoE) said the “talking therapy” could be a “significant advance” on current treatments. They said the new treatment increased the emphasis on building wellbeing.

Prof Barney Dunn, from UoE, said about 80% of clients no longer met diagnostic criteria for depression after ADepT, compared to around 56% of clients in CBT Medscape Medical News

They found ADepT showed to be a promising therapy, probably better than CBT, at building wellbeing and reducing depression at the end of treatment and over the longer term.

Both therapies cost roughly the same, but greater gains in quality of life were shown in ADepT

By building positive mood, ADepT is expected to help people stay well for longer in the future.

EClinicalMedicine. Published online July 13, 2023. Full text