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Open Access Study protocol

Magnetic resonance imaging of a randomized controlled trial investigating predictors of recovery following psychological treatment in adolescents with moderate to severe unipolar depression: study protocol for Magnetic Resonance-Improving Mood with Psychoanalytic and Cognitive Therapies (MR-IMPACT)

Cindy C Hagan1*, Julia ME Graham1, Barry Widmer2, Rosemary J Holt2, Cinly Ooi1, Adrienne O van Nieuwenhuizen1, Peter Fonagy3, Shirley Reynolds4, Mary Target3, Raphael Kelvin58, Paul O Wilkinson28, Edward T Bullmore1689, Belinda R Lennox7, Barbara J Sahakian16, Ian Goodyer28 and John Suckling168

Author Affiliations

1 Department of Psychiatry, University of Cambridge, Herchel Smith Building for Brain and Mind Sciences, Robinson Way, Cambridge CB2 0SZ, UK

2 Department of Psychiatry, University of Cambridge, Douglas House, 18b Trumpington Road, Cambridge CB2 8AH, UK

3 Psychoanalysis Unit, Research Department of Clinical, Educational and Health Psychology, University College London, Gower Street, London WC1E 6BT, UK

4 Department of Psychological Sciences, Norwich Medical School, University of East Anglia, Norwich NR4 7QH, UK

5 Brookside Family Consultation Clinic, 18d Trumpington Road, Cambridge CB2 8AH, UK

6 MRC/Wellcome Trust Behavioural and Clinical Neurosciences Institute, University of Cambridge, Herchel Smith Building for Brain and Mind Sciences, Robinson Way, Cambridge CB2 0SZ, UK

7 Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford OX3 7JX, UK

8 Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK

9 GlaxoSmithKline, Clinical Unit Cambridge, Cambridge, UK

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BMC Psychiatry 2013, 13:247  doi:10.1186/1471-244X-13-247

Published: 5 October 2013

Abstract

Background

Major depressive disorders (MDD) are a debilitating and pervasive group of mental illnesses afflicting many millions of people resulting in the loss of 110 million working days and more than 2,500 suicides per annum. Adolescent MDD patients attending NHS clinics show high rates of recurrence into adult life. A meta-analysis of recent research shows that psychological treatments are not as efficacious as previously thought. Modest treatment outcomes of approximately 65% of cases responding suggest that aetiological and clinical heterogeneity may hamper the better use of existing therapies and discovery of more effective treatments. Information with respect to optimal treatment choice for individuals is lacking, with no validated biomarkers to aid therapeutic decision-making.

Methods/Design

Magnetic resonance-Improving Mood with Psychoanalytic and Cognitive Therapies, the MR-IMPACT study, plans to identify brain regions implicated in the pathophysiology of depressions and examine whether there are specific behavioural or neural markers predicting remission and/or subsequent relapse in a subsample of depressed adolescents recruited to the IMPACT randomised controlled trial (Registration # ISRCTN83033550).

Discussion

MR-IMPACT is an investigative biomarker component of the IMPACT pragmatic effectiveness trial. The aim of this investigation is to identify neural markers and regional indicators of the pathophysiology of and treatment response for MDD in adolescents. We anticipate that these data may enable more targeted treatment delivery by identifying those patients who may be optimal candidates for therapeutic response.

Trial registration

Adjunctive study to IMPACT trial (Current Controlled Trials: ISRCTN83033550).