TAPERS

Treating Anxiety to PrevEnt Relapse in pSychosis: a feasibility trial

Background

The main aim of the TAPERS study is to establish whether adding antidepressant medication to treatment as usual in early psychosis is feasible and acceptable to patients. In the longer term (i.e. in a later, larger trial if this proves feasible) we will also look at whether this decreased relapse rates.

To achieve this aim, we need to understand whether adding an antidepressant in this way is acceptable to patients, and can be delivered within the context of NHS care (a feasibility trial). By the end of the feasibility trial we will be in a position to decide whether it is appropriate to proceed to a larger, full-scale evaluation of add-on antidepressant treatment in early psychosis.

This work will investigate a new way of decreasing relapse in psychosis, with potential major health benefits and cost savings to the NHS.

Psychosis and antidepressants

Psychosis is characterised by abnormal thoughts and perceptions. Psychotic illnesses, such as schizophrenia, typically begin in the early 20s and patients frequently relapse, despite the best available treatment, with significant consequences for sufferers, carers and the NHS. Anxiety and depressive symptoms often occur in psychotic illnesses and may precede relapses.

Antidepressant medications are effective in decreasing anxiety, and are well tolerated in psychosis. We therefore want to assess whether giving an antidepressant in early psychosis (in addition to usual treatment) is effective at decreasing relapse rates. The current study will pave the way to a full trial of this approach.

Study aims

Our eventual aim is to discover whether antidepressant medication in early psychosis decreases rates of psychotic relapse. In order to plan for a large scale evaluation of this approach, we need to determine whether the addition of antidepressants is:

1. acceptable to patients;
2. feasible;
3. associated with a decrease in key relevant symptoms such as anxiety.

Stakeholder and public involvement

We will involve service users, carers and health professionals from trial design through to dissemination. During the development of the proposal we have presented the background and plan of research to the Service User and Carer Research Panel (SUCRP), formulated as a key part of the National Centre for Mental Health (NCMH). We have incorporated the views of the panel in the current research plan and welcome the constructive feedback provided. The SUCRP will review all patient information produced for the study.

We have agreed a plan to embed service user and carer involvement throughout the trial by appointing an experienced service user representative from SUCRP alongside a service user from local psychosis services to our TAPERS advisory group. This will be mutually beneficial in providing the project with consultation from someone of similar age and experience to trial participants as well as a mentorship and development opportunity for a younger service user representative.

Dissemination strategy

We will utilise the public engagement and education expertise and resource of the NCMH to disseminate the findings of the research. This will include an event to communicate the main trial results to project participants and their relatives / carers, patients and representatives from Welsh mental health services, health and social care professionals as well as third sector representatives including Hafal.

We will also report the results of the research in national and international research journals and conferences, as well as via social media and will develop a Cardiff University blog/vlog at the end of the trial.

EudraCT registration number: 2019-001408-39

Results

Results due to be published March 2023.