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Staying Well After Depression: a randomised trial
ISRCTN ISRCTN97185214
DOI 10.1186/ISRCTN97185214
ClinicalTrials.gov identifier
EudraCT number
Public title Staying Well After Depression: a randomised trial
Scientific title Modifying risk and severity of relapse in patients with recurrent depression at high suicide risk: translational randomised controlled trial
Acronym SWAD
Serial number at source Protocol version 5 (6/5/09); 067797
Study hypothesis That treatment with mindfulness-based cognitive therapy for depression, a novel form of treatment combining mindfulness meditation and cognitive therapy for depression, delivered in addition to treatment as usual (TAU), will:
1. Reduce risk of relapse to major depression in recurrently depressed patients compared with TAU alone and cognitive psycho-education (CPE), a treatment of equal plausibility, and
2. Reduce incidence of suicidal symptoms in those with a history of suicidality compared with TAU alone
Lay summary http://www.staying-well.org/information-sheet
Ethics approval Oxfordshire Research Ethics Committee (REC) C approved on the 27th June 2008 (ref: 08/H606/56)
Study design Randomised controlled trial
Countries of recruitment United Kingdom
Disease/condition/study domain Recurrent depression
Participants - inclusion criteria 1. Aged 18 years or over, and not older than 70 years due to the fact that depression in old age has often been found to be related to different factors than depression in earlier stages of life. Male or female.
2. Meeting enhanced Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM-IV) criteria for a history of recurrent major depression, i.e. history of at least three episodes of depression, two of which must have occurred within the last five years, of which one must have occurred within the last two years. Although previous suicidality is recorded in detail (which allows stratification to be carried out on this basis) participants are not included/excluded from the study on the basis of their prior experience of suicidality.
3. Meeting the National Institute of Mental Health (NIMH) guidelines for recovery or remission at the time of baseline assessment. For the purposes of the trial participants are NOT deemed to be in recovery or remission (and hence are ineligible) if they report a week (or more) during the previous 8 weeks during which they experienced EITHER a core symptom of depression (depressed mood, anhedonia) or suicidal feelings AND at least one other symptom of depression, which together are not accounted for by bereavement or substances/general medical conditions, and which are accompanied by significant impairment in functioning.
4. Giving informed consent
5. Consent received from the participant's General Practitioner
Participants - exclusion criteria Participants are excluded from the study if one or more of the following apply:
1. They have a history of schizophrenia, schizoaffective disorder, bipolar I disorder, current and severe substance abuse, organic mental disorder, pervasive developmental delay, a primary diagnosis of obsessive-compulsive disorder or eating disorder, or are currently regularly self-harming
2. They are showing a positive and continuing response to CBT
3. They have current psychotherapy or counseling more frequently than once per month
4. They are unable to complete the baseline research assessment (e.g. due to difficulties with English, visual impairment, or cognitive difficulties)
Anticipated start date 01/10/2008
Anticipated end date 31/12/2011
Status of trial Completed
Patient information material Can be found at http://www.staying-well.org/information-sheet (Oxford) and http://stayingwell.bangor.ac.uk/participant_info.php.en?menu=1&catid=7164&subid=0 (Bangor)
Target number of participants 300 after allowing for attrition
Interventions Mindfulness-based cognitive therapy and cognitive psychoeducation as compared to ordinary care (treatment-as-usual).

Treatment duration: 8 weeks
Follow-up duration: 12 months
Primary outcome measure(s) Time to relapse or recurrence meeting DSM-IV criteria for major depression, assessed using the Structured Clinical Interview for DSM-IV (SCID). Occurrence of relapse/recurrence is assessed at all follow-up assessments, and ‘return to treatment’ will be treated as a relapse/recurrence if, in the judgment of a blind assessor, the participant has experienced exacerbation of symptoms that would have met the criteria for major depression in the absence of immediate treatment. In addition to diagnostic status, we assess severity of depression and hopelessness using a number of interview and self-report measures including the Hamilton Rating Scale for Depression, the Beck Depression Inventory and the Beck Hopelessness Scale, at all time points. These quantitative measures complement the dichotomised outcome of diagnosis.

Outcomes measured pre-treatment, post-treatment and at 3, 6, 9, and 12 months follow-up.
Secondary outcome measure(s) 1. Cognitive measures relevant to risk of relapse/recurrence (mindfulness, self-compassion, rumination, self discrepancy, autobiographical memory, and executive capacity) are assessed before and immediately after the treatment as well as at the end of the follow-up, and will be used in an explanatory analysis to examine factors that mediate and moderate efficacy
2. Severity of suicidal ideation/behaviour both within and between episodes of depression during the follow-up period

Outcomes measured pre-treatment, post-treatment and at 3, 6, 9, and 12 months follow-up.
Sources of funding The Wellcome Trust (UK) (grant ref: 067797)
Trial website http://www.staying-well.org/
Publications 2010 protocol in: http://www.ncbi.nlm.nih.gov/pubmed/20302615
2014 results in: http://www.ncbi.nlm.nih.gov/pubmed/24289891
Contact name Prof  Mark  Williams
  Address Department of Psychiatry
University of Oxford
Warneford Hospital
Warneford Lane
Headington
  City/town Oxford
  Zip/Postcode OX3 7JX
  Country United Kingdom
Sponsor University of Oxford (UK)
  Address Clinical Trials and Research Governance
Manor House
John Radcliffe Hospital
Headington
  City/town Oxford
  Zip/Postcode OX3 9DZ
  Country United Kingdom
  Sponsor website: http://www.ox.ac.uk/
Date applied 04/01/2010
Last edited 18/09/2014
Date ISRCTN assigned 05/01/2010
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