Dr Rebecca Segrave
Monash Alfred Psychiatry Research Centre (MAPrc), Monash University;
beyondblue Victorian Centre of Excellence
Project completion year
With a lifetime prevalence of between 15 and 21 per cent, major depressive disorder (MDD) is one of the most common of all mental illnesses. Between 20 and 30 per cent of individuals who experience MDD fail to respond to standard pharmacological and psychological treatment options and continue to experience substantial ongoing disability. Currently, there are very few options for individuals with treatment resistant depression (TRD) and there is a pressing need to develop novel and effective antidepressant treatment strategies.
Traditionally, therapeutic and research efforts for MDD have focused on the low, sad mood that depression causes. Recently, there has been a growing interest in the ways in which depression changes people’s cognition or ‘thinking skills’. There is now a wealth of scientific evidence documenting the ways in which the cognitive and emotional symptoms of depression interact with each other, and the importance of these relationships to the onset and maintenance of the illness. For example, people with depression remember many more negative memories, pay more attention to negative things that happen to them and around them and also have far greater difficulty suppressing negative thoughts compared to people without depression.
The current study will investigate a novel treatment approach that targets the cognitive symptoms of depression, the aim being to re-train the aforementioned cognitive and emotional interactions using a behavioural therapy called Cognitive Control Training (CCT).
CCT involves repeated practice of targeted cognitive activities that are specifically designed to activate areas of the brain that allow us to control and direct our attention. The study will look at whether CCT can re-train unhelpful cognitive and emotional interactions, and whether this provides an effective treatment for depression. It will focus specifically on TRD, including only individuals who have previously sought treatment for their depression but who have not gotten better. The study will also investigate whether the effectiveness of CCT can be enhanced using a form of mild brain stimulation called transcranial Direct Current Stimulation (tDCS). tDCS has been shown in other studies to be able to enhance cognitive processing and may be a useful augmenting agent for CCT.
The combined application of these techniques represents an innovative neuroscientifically-based approach to TRD treatment and could result in a significant therapeutic advance. The study will produce data that enhances our understanding of the neuropsychology of depression and the role of cognitive/emotional interactions in recovery from MDD. Importantly, both CCT and tDCS are inexpensive and portable. Following relatively brief formal training, and with appropriate supervision, they can be administered by non-medical personnel via highly structured standardised protocols. This means that they could be delivered in remote and rural areas and developing countries where novel mental health interventions are typically unavailable.