Adapting Augmented Depression Therapy (ADepT) for treatment of first onset depression in young adults

People usually experience their first episode of depression between the ages of 14 and 24 years (13-14). Current NHS service-provision for first onset depression in young adults is sub-optimal. With very few cases meeting severity thresholds to enter child and adolescent mental health services (CAMHS), a majority of people go untreated. With each successive episode of depression, the probability of a future episode is increased. At least 50% of people with depression who recover will have at least one subsequent episode and people with two or more episodes will have a 70-80% chance of recurrence. Individuals often do not access treatment until later in life, when a chronic, relapsing, treatment-resistant presentation is far more likely to have emerged. Effective treatment of first onset depression is needed to prevent this adverse developmental trajectory occurring. Current talking treatments are useful in repairing negative emotions but are less good at re-building positive emotions and wellbeing. Augmented Depression Therapy (ADepT) has equal focus on building positive emotions and reducing negative emotions (19-20), thus ADepT targets negative affect and positive affect dysfunction. Previous work has found that ADepT successfully reduces negative emotions and builds positive emotions in adults with recurrent depression, leading to marked reductions in the symptoms of depression as well as large increases in wellbeing. This project aims to preliminarily evaluate whether ADepT could be effective in targeting first onset depression in adolescents and young adults.
First, a systematic review of current treatments for first-episode depression in adolescents and young adults will be performed. How well these treatments target anhedonia and deficits in well-being relative to dysphoria and excesses in negative affect will be explored. In addition, the relevance of age-specific developmental variables that may moderate treatment effects, that could be useful to consider in treatment development, will be considered. Second, the intervention mapping framework will be used to adapt ADepT to be suitable for first onset depression in young adults. The IM process will begin with further stakeholder consultation, including interviews with young adults with lived experience of depression and therapists and service providers experienced in treating depression in a local service context. A stakeholder co-design team will be established to digest these findings and to revise the ADepT treatment protocols as necessary. Third, A two-wave multiple randomised baseline case series design will be utilized. Thirty young adults (aged 14-24) currently experiencing their first major depressive episode and with a PHQ-9 score >10 will be recruited (15 individuals per wave). The treatment protocol will be further refined between wave-one and wave-two. On completion, the proportion of individuals showing reliable and clinically significant change will be reported. Qualitative interviews with young adults and therapists will explore experiences of treatment, along with feasibility and acceptability (>70% participants complete minimum adequate dose of treatment and would recommend it to friends and family) and preliminary evidence of efficacy (>60% show significant improvement in intensive time series analyses)