The DARE study of relapse prevention in depression: design for a phase 1/2 translational randomised controlled trial involving mindfulness-based cognitive therapy and supported self monitoring

<p>Abstract</p> <p>Background</p> <p>Depression is a common condition that typically has a relapsing course. Effective interventions targeting relapse have the potential to dramatically reduce the point prevalence of the condition. Mindfulness-based cognitive therapy (MBCT) is a group-based intervention that has shown efficacy in reducing depressive relapse. While trials of MBCT to date have met the core requirements of phase 1 translational research, there is a need now to move to phase 2 translational research - the application of MBCT within real-world settings with a view to informing policy and clinical practice. The aim of this trial is to examine the clinical impact and health economics of MBCT under real-world conditions and where efforts have been made to assess for and prevent resentful demoralization among the control group. Secondary aims of the project involve extending the phase 1 agenda to an examination of the effects of co-morbidity and mechanisms of action.</p> <p>Methods/Design</p> <p>This study is designed as a prospective, multi-site, single-blind, randomised controlled trial using a group comparison design between involving the intervention, MBCT, and a self-monitoring comparison condition, Depression Relapse Active Monitoring (DRAM). Follow-up is over 2 years. The design of the study indicates recruitment from primary and secondary care of 204 participants who have a history of 3 or more episodes of Major Depression but who are currently well. Measures assessing depressive relapse/recurrence, time to first clinical intervention, treatment expectancy and a range of secondary outcomes and process variables are included. A health economics evaluation will be undertaken to assess the incremental cost of MBCT.</p> <p>Discussion</p> <p>The results of this trial, including an examination of clinical, functional and health economic outcomes, will be used to assess the role that this treatment approach may have in recommendations for treatment of depression in Australia and elsewhere. If the findings are positive, we expect that this research will consolidate the evidence base to guide the decision to fund MBCT and to seek to promote its availability to those who have experienced at least 3 episodes of depression.</p> <p>Trial Registration</p> <p>Australian New Zealand Clinical Trials Registry: <a href="http://www.anzctr.org.au/ACTRN12607000166471.aspx">ACTRN12607000166471</a></p

Methanogens: Syntrophic Metabolism

Syntrophy is a mutualistic interaction in which two metabolically different types of microorganisms are linked by the need to keep metabolites exchanged between the two partners at low concentrations to make the overall metabolism of both organisms feasible. In most cases, the cooperation is based on the transfer of hydrogen, formate, or acetate from fermentative bacteria to methanogens to make the degradation of electron-rich substrates thermodynamically favorable. Syntrophic metabolism proceeds at very low Gibbs’ free energy changes, close to the minimum free energy change needed to conserve energy biologically, which is the energy needed to transport one proton across the cytoplasmic membrane. Pathways for syntrophic degradation of fatty acids predict the net synthesis of about one-third of an ATP per round of catabolism. Syntrophic metabolism entails critical oxidation-reduction reactions in which H2 or formate production would be thermodynamically unfavorable unless energy is invested. Molecular insights into the membrane processes involved in ion translocation and reverse electron transport revealed that syntrophs harbor multiple systems for reverse electron transfer. While much evidence supports the interspecies transfer of H2 and formate, other mechanisms of interspecies electron transfer exist including cysteine cycling and possibly direct interspecies electron transfer as electric current via conductive pili or (semi)conductive minerals