Cognitive behavioural therapy for the treatment of late life depression: study protocol of a multicentre, randomized, observer-blinded, controlled trial (CBTlate)

Forugh S Dafsari, Bettina Bewernick, Matthias Biewer, Hildegard Christ, Katharina Domschke, Lutz Froelich, Martin Hellmich, Melanie Luppa, Oliver Peters, Alfredo Ramirez, Steffi Riedel-Heller, Elisabeth Schramm, Magnus-Sebastian Vry, Michael Wagner, Martin Hautzinger, Frank Jessen, Forugh S Dafsari, Bettina Bewernick, Matthias Biewer, Hildegard Christ, Katharina Domschke, Lutz Froelich, Martin Hellmich, Melanie Luppa, Oliver Peters, Alfredo Ramirez, Steffi Riedel-Heller, Elisabeth Schramm, Magnus-Sebastian Vry, Michael Wagner, Martin Hautzinger, Frank Jessen

Abstract

Background: Late-life depression (LLD) is one of the most prevalent mental disorders in old age. It is associated with various adverse outcomes and frequent use of health care services thereby remaining a serious public health concern. Compared with depression in early adulthood, most treatment options of LLD are less effective. Psychotherapy may be particularly beneficial for LLD due to specific psychological conditions in old age and a low risk of side effects. Although cognitive behavioural therapy (CBT) is highly established and effective in depression in young and mid-life there is only a limited number of small studies on CBT in LLD. An LLD-specific CBT has not yet been compared to an active, but unspecific supportive psychological intervention in a multicentre trial.

Methods: Here we present the design of the CBTlate trial, which is a multicentre, randomized, observer-blinded, active-controlled, parallel group trial. CBTlate aims at including 248 patients with LLD of both genders at 7 sites in Germany. The purpose of the study is to test the hypothesis that a 15-session individually-delivered CBT specific for LLD is of superior efficacy in reducing symptoms of depression in comparison with a supportive unspecific intervention (SUI) of the same quantity. The intervention includes 8 weeks of individual treatment sessions twice per week and a follow-up period of 6 months after randomization. The primary end point is the severity of depression at the end of treatment measured by the self-rated 30-item Geriatric Depression Scale (GDS). Secondary endpoints include depressive symptoms at week 5 and at follow-up (6 months after randomization). Additional secondary endpoints include the change of depressive symptoms assessed with a clinician-rating-scale and a patient reported outcome instrument for major depressive disorder, anxiety symptoms, sleep, cognition, quality of life, and overall health status from baseline to end-of treatment and to end of follow-up. Add-on protocols include MRI and the collection of blood samples.

Discussion: This study is the first multicentre trial of a specific CBT intervention for LLD compared to an unspecific supportive psychological intervention administered in a specialist setting. It has important implications for developing and implementing efficient psychotherapeutic strategies for LLD and may be a significant step to broaden treatment options for people suffering from LLD.

Trial registration: ClinicalTrials.gov (NCT03735576, registered on 24 October 2018); DRKS (DRKS00013769, registered on 28 June 2018).

Keywords: Late-life depression; Major depression; Psychotherapy; Randomized controlled trial; Treatment.

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Trial Design. LLD-CBT: late-life depression cognitive behavioural therapy. SUI: supportive unspecific intervention

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