Emotions, Monoamines and Cognitions: Psychological and Biological Aspects of Depression Vulnerability

Depression is associated with much personal suffering and with high costs to society, and increases the risk of cardiac diseases. Although depression is treatable with medications and/or psychotherapy, not all patients respond and it takes 3-8 weeks before this becomes clear. The relapse rate after successful treatment is very high. The aim of the proposed studies is to identify biological and psychological vulnerability markers and to test novel treatments for prevention of relapses. Each project builds on existing research in innovative ways to examine new understandings of vulnerability to depression and new treatments based on this understanding.The objectives are: 1) to increase understanding of how antidepressants and cognitive therapy work; 2) to define vulnerability profiles and to investigate how different psychological and biological mechanisms lead up to these profiles; 3) to investigate the effect on vulnerability of two novel maintenance treatments. Project I will test the hypothesis that antidepressants have immediate cognitive effects which predict eventual treatment outcome; project I will also examine attentional difficulties in an at-risk group, and test an innovative treatment for these difficulties. Project II will examine the causal status of cognitive reactivity (CR), and its relationship with personality and serotonin transporter gene polymorphism. Project II will also test the hypothesis that suicidal depressed patients show a specific pattern of CR after recovery, which is determined by counterproductive cognitive regulation strategies. Project III is concerned with the relationship between depression, suicidality/impulsivity and heart rate variability (a risk factor of cardiac disease). This will be investigated in the context of a maintenance trial, in which recovered patients will be randomized to one of two novel treatments - a dietary intervention (omega-3 fatty acids supplementation) and a psychological intervention (mindfulness-based cognitive therapy). This will be the first placebo-controlled study investigating the effect of these interventions on vulnerability markers.