The IMPACT Trial: A pilot study of group cognitive behavioural therapy to prevent recurrence of late life depressive illness
Nicola Alder, Ed Juszczak and Rosamund Weatherall with groups in three regions headed by Robin Jacoby (Oxford), Robert Howard (London) and Helen Matthews (Southampton)
Depression is a common disorder in old age and carries a rather poor prognosis. Over one million elderly people in the United Kingdom suffer from a depressive illness. Among the more serious cases i.e. those treated by specialist psychiatric services, only about 25 % remain well; the rest either suffering recurrent or persistent illness.
Continuation of medication after an episode of depression has been shown to improve the prognosis. The aim of the proposed study is to determine whether it might be possible further to improve the prognosis by addition of a group psychological treatment, Cognitive Behavioural Therapy (CBT), which has been shown to work in this way with younger adults.
The pilot study is a single-blind randomised controlled study. Patients suffering from a depressive illness will be recruited whilst unwell. Once they have remitted or recovered they will be randomly assigned to two groups: 1. The active treatment group who will receive CBT and continue their medication; 2. The control group who will continue with their antidepressant medication. At the end of the study the two groups will be assessed with respect to relapse or recurrence rate, which will be the primary outcome measure.
This is a small study of between 75-100 patients, because we have to find out whether the treatment is feasible and acceptable and shows an effect before a highly costly, fully statistically powered study, involving hundreds or possibly thousands of patients can be undertaken. If the treatment is shown to be effective it should have a major impact on old age depression by preventing relapse and recurrence of illness, and thereby a huge burden of suffering in a large proportion of the population.
Recruitment began in October 2003.
