Neoplasms

Skin and Connective Tissue Diseases

All Conditions

Behaviors and Mental Disorders

Breast Neoplasms

Depression

Depressive Disorder

Depressive Disorder, Major

Behavioral Symptoms

Mood Disorders

Mental Disorders

Psychotic Disorders

Interpersonal Psychotherapy is a brief, manualized therapy that has shown efficacy in treating major depression in several controlled trials including a large trial for depressed HIV-infected individuals and other randomized trials in depressed individuals with other comorbid medical illnesses. Research shows that Interpersonal Psychotherapy improves social skills and functioning. Interpersonal Psychotherapy has shown remarkable flexibility and efficacy across age ranges, cultures, formats, and modes of delivery. We recently obtained promising pilot data in a small open trial on the acceptability and efficacy of individual IPT for depressed breast cancer patients of diverse ethnic background, socioeconomic status, and cancer progression stage.

Problem-Solving Therapy is a brief, manualized form of cognitive-behavioral therapy (CBT) that has been adapted to treat depression in cancer patients, and has shown highly promising results.

Brief Supportive Psychotherapy, a relatively unstructured psychotherapy commonly used in clinical practice, focuses on the patient's affect. It builds a strong therapeutic alliance through careful, empathic listening and validating and encouraging toleration of the patient's emotions. It has shown promising results in depressed individuals with cancer and other medical illnesses.

Interpersonal Psychotherapy will consist of twelve 50-minute sessions delivered within a period of 16 weeks. IPT is divided into three phases.

Interpersonal Psychotherapy

Problem-Solving Therapy will also consist of 12 50-minute sessions. The goals of the PST are: 1) to assist patients to identify and link life situations related to the depression; 2) to increase the effectiveness of the patient's problem-solving attempts at coping with current problems based on an intervention carried out in a concrete, structured and, unambiguous manner.

Problem-Solving Therapy

The treatment approach will follow the standard supportive therapy approaches used in depression and medical illness, as noted below.

Brief Supportive Psychotherapy has a biopsychosocial perspective, recognizing contributions of genetic predisposition and neuroendocrine factors (Novalis et al., 1993, p. 257-277). Its goals are to maximize patient function during crisis, to support the patient's judgment with the therapist's reasoning skills, and to engender hope for recovery. Primary techniques and practices include reality testing; being relatively accepting of existing defenses but attempting to restructure them when appropriate; and, using self-esteem enhancing measures.

Brief Supportive Psychotherapy

John C. Markowitz, M.D.

The investigators propose a randomized clinical trial to compare the efficacy of Interpersonal Psychotherapy (IPT), Problem-Solving Therapy (PST), and Brief Supportive Psychotherapy (BSP), in improving depressive symptoms, psychosocial functioning, and quality of life among patients with breast cancer and major depressive disorder (MDD).

Depressive symptoms and disorders are common in cancer patients: up to 58% have depressive symptoms, and 38% meet Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV) criteria for major depressive disorder (MDD). Depression worsens over the course of cancer treatment, persists long after cancer therapy, recurs with recurrence of cancer, and negatively affects patients' adherence to cancer treatment, survival, symptom management, psychosocial functioning, and quality of life. As surviving cancer becomes increasingly common, there is an urgent need to establish an empirical basis for the provision of evidence-based treatments to depressed cancer patients.We propose a randomized clinical trial to compare the efficacy of Interpersonal Psychotherapy (IPT), Problem-Solving Therapy (PST), and Brief Supportive Psychotherapy (BSP), in improving depressive symptoms, psychosocial functioning, and quality of life among patients with breast cancer and major depressive disorder. The study is based on several complementary observations from recent studies. First, 30-60% of cancer patients experience clinically significant depressive symptoms. Second, depression is associated with poorer cancer outcomes. Third, over the course of the illness, depression recurs or persists for a significant number of cancer patients. Fourth, several recent reviews have indicated that, despite decades of research and hundreds of studies, the available evidence is insufficient to empirically guide the treatment of major depressive disorder in cancer patients. This has led the national institute of health, the Institute of Medicine, and other experts to call for well-designed, controlled trials of the treatment of depression in cancer patients.

Interpersonal Psychotherapy is a brief, manualized therapy that has shown efficacy in treating major depression in several controlled trials including a large trial for depressed HIV-infected individuals and other randomized trials in depressed individuals with other comorbid medical illnesses. Research shows that Interpersonal Psychotherapy improves social skills and functioning. Interpersonal Psychotherapy has shown remarkable flexibility and efficacy across age ranges, cultures, formats, and modes of delivery. We recently obtained promising pilot data in a small open trial on the acceptability and efficacy of individual Interpersonal Psychotherapy for depressed breast cancer patients of diverse ethnic background, socioeconomic status, and cancer progression stage. Problem-Solving Therapy is a brief, manualized form of cognitive-behavioral therapy (CBT) that has been adapted to treat depression in cancer patients, and has shown highly promising results. Brief Supportive Psychotherapy, a relatively unstructured psychotherapy commonly used in clinical practice, focuses on the patient's affect. It builds a strong therapeutic alliance through careful, empathic listening and validating and encouraging toleration of the patient's emotions. It has shown promising results in depressed individuals with cancer and other medical illnesses.

Interpersonal Therapy for Depression in Breast Cancer

Change in HAMD-17 following acute treatment is the primary outcome measure

New York State Psychiatric Institute

Symptoms and General Pathology

Urinary Tract, Sexual Organs, and Pregnancy Conditions

Gland and Hormone Related Diseases

Syndrome

Polycystic Ovary Syndrome

Cysts

Ovarian Cysts

Ovarian Diseases

Adnexal Diseases

Genital Diseases, Female

Genital Diseases

Urogenital Diseases

Female Urogenital Diseases

Pregnancy Complications

Female Urogenital Diseases and Pregnancy Complications

Gonadal Disorders

Endocrine System Diseases

Participate in IPT 6-week intervention group.

Lauren Gulley, PhD

The main purpose of this study is to find out whether taking part in a group-based interpersonal psychotherapy (IPT) program designed to improve mood and lessen stress in girls with PCOS will improve depression, unhealthy eating behaviors, weight, and insulin resistance.

Interpersonal Psychotherapy in Adolescents With Polycystic Ovary Syndrome

Depression symptoms will be assessed by the Center for Epidemiologic Studies-Depression Scale. Scores range from 1 to 4. The scoring of positive items is reversed. Possible range of scores is zero to 60, with the higher scores indicating the presence of more symptomatology.

Disordered eating will be assessed by the Emotional Eating Scale Adapted for Children. The scale has been adapted for children and assesses eating in response to negative affect, such as feeling sad or irritated. The scale ranges from "I have no desire to eat" to "I have a very strong desire to eat" and averages how many days a week the participant eats based on that feeling.

Loss-of-control eating will be assessed via the 19-item Loss-of-Control Eating Disorder Questionnaire (LOC-ED-Q), which shows sound psychometric properties in adolescents using Yes/No.

Reward based eating will be assessed by the Reward Based Eating Drive Scale. This is a self-report questionnaire which assesses reward-based eating that shows sound psychometric properties. The total score is summed at the end; a higher total is indicative of reward-based eating.

Fasting BMI (kg/m2) will be derived from measured height in triplicate by stadiometer and measured fasting weight by calibrated digital scale. BMI z-score and BMI %ile will be computed to determine eligibility (BMI ≥75th percentile).

Blood will be sampled via a venipuncture procedure following a 10-hour overnight fast to measure fasting insulin. Insulin resistance will be estimated from fasting insulin and glucose with the homeostatic model assessment of insulin resistance (HOMA-IR).

Blood will be sampled via a venipuncture procedure following a 10-hour overnight fast to measure dyslipidemia. Insulin resistance will be estimated from fasting insulin and glucose with the homeostatic model assessment of insulin resistance (HOMA-IR).

American Psychological Association (APA)

University of Colorado, Denver

Breast Diseases

Skin Diseases

All Drugs and Chemicals

Psychotropic Drugs

Anti-Dyskinesia Agents

Vasoconstrictor Agents

Escitalopram

Citalopram

Antidepressive Agents

Selective Serotonin Reuptake Inhibitors

Dexetimide

Venlafaxine Hydrochloride

Serotonin

Neurotransmitter Agents

Norepinephrine

Serotonin and Noradrenaline Reuptake Inhibitors

Interpersonal psychotherapy is a time-limited, affect-focused treatment of repeatedly demonstrated efficacy for major depression in the general population. It was also helpful to patients with comorbid depression and breast cancer in our prior randomized controlled trial. IPT focuses on the connection between upsetting life circumstances (e.g., diagnosis of breast cancer) and their effect on mood, and vice versa. We have considerable experience, enhanced by the Covid-19 lockdown, in delivering IPT as a HIPAA-secure tele-therapy.

Both venlafaxine and escitalopram are FDA-approved treatments with demonstrated efficacy in treating major depression in the general population. Although little formal research has been done in treating patients with depression and breast cancer, these two are the favored treatments among serotonin reuptake inhibitors due to minimal interference with oncotherapy. The choice between prescribing these two study medications will depend upon prior treatment history. Venlafaxine XR will be serially titrated under expert psychopharmacologist tele-guidance from 75 mg to 300 mg daily, depending on clinical response and tolerance. Escitalopram will similarly be dosed between 5 mg and 30 mg daily.

Time-limited, affect-focused, empirically supported psychotherapy

Venlafaxine HCl ER

John C Markowitz, MD

David J Hellerstein, MD

John C Markowitz, M.D.

Cancer and depression commonly occur together, and each worsens the other. We conducted a large psychotherapy study treating depression in breast cancer patients, showing that psychotherapy lowers symptoms. Surprisingly, no studies have compared depression-focused psychotherapy to antidepressant medication for patients with breast cancer and depression. We applied to the National Cancer Institute for a large, cross-national grant. Reviewers asked us to first demonstrate that patients would accept either psychotherapy or medication as treatment.

Thanks to funding from the Columbia Herbert Irving Cancer Center, we will test this study approach. We will randomly assign 20 patients with both non-metastatic breast cancer and major depression to 12 weeks of tele-therapy (by Zoom) with either interpersonal psychotherapy or a serotonin reuptake inhibitor. We expect patients in both treatments to report improvement in depression symptoms. We will also measure C-reactive protein, a blood test of inflammation elevated in both cancer and depression, which may predict medication response.

Screening. All patients with non-metastatic, Stage I-III breast cancer who are undergoing care at HICCC will be offered the PHQ-9, a brief, reliable, widely used depression screener. This provides an opportunity to assess depression prevalence in the HICCC population. Patients who screen positive for likely major depression (PHQ-9 score ≥10; sensitivity 88%, specificity 88%)26 will be offered further evaluation and an explanation of the study. Independent evaluators trained to reliability will assess patient eligibility. Inclusion criteria: 1) Age ≥18 and \<80; 2) diagnosis of diagnosis of Stage I-III breast cancer (\<10 years from diagnosis), based on patient report and HICCC chart; 3) MDD episode without psychotic features on Structured Clinical Interview for DSM-5 (SCID-528); 4) 24-item Ham-D27 score ≥18; 5) written informed consent. Men and women are eligible. Exclusion criteria: 1) Psychosis (by SCID-5 interview); 2) current moderate/severe substance use disorder (mild substance disorder is not an exclusion) (by SCID-5); 3) acute suicidal risk (Ham-D suicide item score \>2); 4) history of non-response to (\>6 week) trials of venlafaxine (≥225 mg/d) and escitalopram (≥20 mg/d); 5) history of non-response to IPT (\>4 sessions); 6) receiving current medication or psychotherapy treatment for depression; 7) acute medical instability (too physically debilitated to participate in trial) or delirium; 8) inability to complete self-administered questionnaires in English; 9) current enrollment in a therapeutic oncology trial; 10) known metastases. Eligible patients who consent will be randomly assigned in 1:1 ratio to 12 weeks of IPT or SRI (venlafaxine XR or escitalopram, based on treatment history).

Study-eligible patients will be interviewed by a research assistant using an open-ended inventory of patient willingness and disinclination to participate in the study based on factors including treatment preference, tele-therapy preference, cell phone and computer broadband access, socioeconomic status and family burden, work conflicts, interpersonal support, and outside depression treatment. We will tabulate the number of patients already receiving antidepressant treatments, whose non-participation would not reflect on treatment acceptability or study participation.

Treatments. As both treatments were initially intended to be delivered as tele-therapy in the multi-site SWOG grant proposal, they are well adapted to the Covid-19 era.9 All treatment sessions and all assessments (unless patient is visiting the HICCC in person and prefers this) will be conducted via HIPAA-secure Zoom. Tele-therapy has become standard treatment during the pandemic9 and may ease access for already burdened BC patients. Tele-therapy may improve current undertreatment of MDD among patients with BC.

IPT is a well-defined, manualized, repeatedly proven treatment for depression.14,29 Dr. Markowitz, a leading IPT researcher with multiple NIH grant experience, including with tele-therapy,9,30 will supervise already trained IPT therapists based on recorded HIPAA-secure Zoom sessions. IPT defines depression as a treatable medical illness that is not the patient's fault, and which often arises in the context of distressing life events - such as the diagnosis of breast cancer, and the effect of cancer and its treatment on body image. In 12 50-minute weekly sessions, IPT helps patients understand and accept their feelings in an environmental context and to use their emotions to handle the crisis and build protective social support.

Pharmacotherapy. Dr. Hellerstein, a clinical trials veteran, will provide expert supervision, supplementing a manualized medication approach.31 In our experience, venlafaxine (VLX) and escitalopram (ESC) are the two antidepressants best tolerated and least likely to interfere with oncotherapy for patients with MDD and breast cancer. Having minimal CYP2D6 inhibition and hence interfering less with tamoxifen and aromatase inhibitor metabolism, VLX makes sense as first choice; ESC mildly inhibits 2D6. Tele-sessions lasting 20-30 minutes will occur weekly for two weeks, then biweekly through week 12. Clinicians will raise doses as tolerated to ensure efficacy, assessing side effects by checklist, to a maximum of velafaxine XR 300 mg or escitalopram 30 mg daily. Pharmacotherapists will not conduct psychotherapy.

Assessments will be conducted at baseline, midpoint, and end of treatment (weeks 0, 6, and 12) by raters reliably trained on instruments and blinded to treatment assignment. Self-reports will be conducted online using REDCap. Treatment sessions will be recorded for therapist adherence rating using the established CSPRS-6 scale.32 In addition to the rating instruments, the PI and co-PI will tele-interview all patients post-treatment to determine their level of and reasons for treatment satisfaction and dissatisfaction, and will debrief all study clinicians to determine their views of patient treatment acceptability, comfort, and satisfaction.

The study will employ standard observer and self-report assessments. The PROMIS-2936 assesses not only psychiatric and medical symptom domains but quality of life and meaning and purpose, factors that might potentially distinguish treatment effects. We have previously used such scales to evaluate treatment trials, and similarly expect high levels in this study: clinician treatment fidelity (\>95%), patient treatment preference, and patient satisfaction (\>80% scores). We have allocated in the study budget $50 compensation for patients who complete their week 12 evaluations.

Data analysis. 1. Descriptive statistics such as means with standard deviation, proportions, and counts will be reported to characterize BC patients that will be screened. 2. Point prevalence of depression at HICCC for patients with Stage I-III BC will be calculated. 3. Qualitative analysis will be used to report reasons eligible patients would participate in or decline the study. Zero-Inflated Poisson regression will be used to model both study participants and eligible BC patients who decline the study. 4. Paired t-test or Fisher's exact test will be used to compare outcome changes between baseline and end of study. Proportion responding (≥50% Ham-D-24 decrease from pre-treatment Ham-D-24) and remission rate (Ham-D-24 ≤7) will be the outcomes of interests.

Pilot randomized 12-week clinical trial of tele-interpersonal psychotherapy vs. tele-serotonin reuptake inhibitor (escitalopram or venlafaxine) for patients with major depressive disorder and breast cancer to test the acceptability of randomization and treatment.

Independent evaluators will be blinded to treatment and therapist. Patients will be alerted not to mention the type of treatment they are receiving or the name of their therapist to independent evaluators.

Feasibility Trial of Tele-IPT and Tele-Pharmacotherapy for Patients With Depression and Non-Metastatic Breast Cancer

Pilot Randomized Feasibility Trial of Tele-Interpersonal Psychotherapy and Tele-Pharmacotherapy for Depression in Patients With Non-Metastatic Breast Cancer

Observer-rated canonical measure of depression; 24-item version; higher scores= greater severity

Serum measure of inflammation; higher values= greater inflammation

Self-reported PTSD symptom questionnaire; higher scores= greater severity

PROMIS is a set of person-centered measures that evaluates and monitors physical, mental, and social health. We will use self-report measures of pain; physical and social functioning; associated symptoms; higher scores= greater severity

Brief 9-item self-report screen of depressive symptoms; higher scores= greater severity

Questionnaire measuring perceived social support; higher scores= greater support

Established self-report scale measuring social functioning; higher scores= poorer functioning

Study title	NCT ID	Conditions	Interventions	Eligibility	Organization
Interpersonal Therapy for Depression in Breast Cancer	NCT01191580	Major Depressio...	Interpersonal P... Problem-Solving... Brief Supportiv...	18 Years - 90 Years	New York State Psychiatric Institute
Interpersonal Psychotherapy in Adolescents With Polycystic Ovary Syndrome	NCT06056453	Interpersonal P... Polycystic Ovar...	Interpersonal P...	12 Years - 17 Years	University of Colorado, Denver
Interpersonal Therapy for Depression in Breast Cancer	NCT01191580	Major Depressio...	Interpersonal P... Problem-Solving... Brief Supportiv...	18 Years - 90 Years	New York State Psychiatric Institute
Feasibility Trial of Tele-IPT and Tele-Pharmacotherapy for Patients With Depression and Non-Metastatic Breast Cancer	NCT04973930	Major Depressiv... Breast Cancer Venlafaxine	Interpersonal P... Venlafaxine HCl...	18 Years - 80 Years	New York State Psychiatric Institute
Feasibility Trial of Tele-IPT and Tele-Pharmacotherapy for Patients With Depression and Non-Metastatic Breast Cancer	NCT04973930	Major Depressiv... Breast Cancer Venlafaxine	Interpersonal P... Venlafaxine HCl...	18 Years - 80 Years	New York State Psychiatric Institute

Spots Global Cancer Trial Database for interpersonal psychotherapy