Major depressive disorder (MDD) is a prevalent psychiatric condition associated with significant disability, mortality and economic burden. Cognitive behavioral therapy (CBT) and psychodynamic psychotherapy (PDT) are found to be equally effective for patients with depression. However, many patients do not respond sufficiently to either treatment. To offer individualized treatment, we need to know if some patients benefit more from one of the two therapies. At present little is known about what patient characteristics (moderators) may be associated with differential outcomes of CBT and PDT, and through what therapeutic processes and mechanisms (mediators) improvements occur in each therapy mode. Presently only theoretical assumptions, sparsely supported by research findings, describe what potentially moderates and mediates the treatment effects of CBT and PDT. The overall aim of this study is to examine theoretically derived putative moderators and mediators in CBT and PDT and strengthen the evidence base about for whom and how these treatments works in a representative sample of patients with MDD. One hundred patients with a diagnosis of MDD will be randomized to either CBT or PDT. Patients will be treated over 28 weeks with either CBT (one weekly session over 16 weeks and three monthly booster sessions) or PDT (one weekly session over 28 weeks). The patients will be evaluated at baseline, during the course of therapy, at the end of therapy, and at follow-up investigations 1 and 3 years post treatment. A large range of patient and observer rated questionnaires (specific preselected putative moderators and mediators) are included. The clinical outcome of this study may better guide clinicians when deciding what kind of treatment any individual patient should be offered. Moreover, the study aims to further our knowledge of what mechanisms lead to symptom improvement and increased psychosocial functioning. ClinicalTrials.gov Identifier: NCT03022071.

中文翻译：

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抑郁症患者心理动力学和认知行为疗法中变化和异质性治疗作用的机制：一项随机对照试验

重度抑郁症（MDD）是一种精神疾病，与严重的残疾，死亡率和经济负担相关。认知行为疗法（CBT）和心理动力心理疗法（PDT）被发现对抑郁症患者同样有效。但是，许多患者对这两种治疗都没有足够的反应。为了提供个性化治疗，我们需要知道某些患者是否从两种疗法中受益更多。目前，关于哪种患者特征（主持人）可能与CBT和PDT的不同结果有关，以及通过哪种治疗方法和机制（介导者）在每种治疗模式中得到改善的了解很少。目前只有理论上的假设，很少得到研究结果的支持，描述什么可能缓和和介导CBT和PDT的治疗效果。这项研究的总体目标是检查CBT和PDT中从理论上推论得出的调节剂和介体，并在有代表性的MDD患者样本中加强有关这些疗法针对谁以及如何起作用的证据基础。一百名诊断为MDD的患者将被随机分为CBT或PDT。患者将在28周内接受CBT（16周内每周一次，每月3次强化治疗）或PDT（28周内每周一次）治疗。将在治疗过程中，治疗结束时以及治疗后1年和3年的随访研究中对患者进行基线评估。包括大量患者和观察者评级的问卷（特定的预选推定主持人和调解人）。这项研究的临床结果可以更好地指导临床医生，确定每个患者应接受哪种治疗。此外，该研究旨在进一步了解导致症状改善和社会心理功能增强的机制。ClinicalTrials.gov标识符：NCT03022071。