Grant: Project Grant

Major depressive disorder (MD) is recurrent, debilitating, and, to some extent, a chronic disorder, despite the many advances in treatment. Although both drug and psychological treatments are considered to be efficacious in the short-term treatment of MD, at least one third of patients do not respond to treatment. One strategy to improve treatment efficacy is to use of some form of antidepressant augmentation which refers to adding an additional medication or psychological procedure (i.e. such as adjunct "mindfulness" meditation) to augment the therapeutic efficacy of a traditional treatment. We are currently completing a pilot study where patients receive intranasal oxytocin as an adjunct to psychotherapy for MD. Oxytocin is a hormone found in the body and brain that is important in reproductive functions (for example, lactation), and has recently been shown to promote positive social behaviors, such as trust. Preliminary analyses of 16 patients indicate evidence of improved clinical outcomes in those receiving adjunct oxytocin administration. In this application, we are proposing to conduct a randomized clinical trial that attempts to augment the therapeutic effect of psychotherapy for MD using intranasal oxytocin. Building on our pilot study where we used a therapy focused on interpersonal relations, we intend to assess the efficacy of intranasal oxytocin augmentation in a larger sample using a different form of psychotherapy: cognitive-behavioral therapy (CBT). In addition to testing clinical outcomes, part of the project will focus on understanding how oxytocin improves psychotherapy outcomes (does it improve the relationship between the therapist and patient?), and whether some people may benefit from this dual treatment more than others (does oxytocin augmentation benefit patients with poor interpersonal functioning or adverse childhood experiences?). The novel study has the potential to improve the use of psychotherapy in treating patients with MD.