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About the research on options for depression

What is the research that this Highlight is based on?

This Highlight is based on findings from the following NIHR-funded studies:

We selected these studies because they are recent, high quality and directly relevant to the topic of this Highlight. There is another study underway which is also highly relevant to the issues discussed here, and which will publish in 2017:

The following NIHR study is also of relevance to the topic:

Integrated primary care for patients with mental and physical multimorbidity: cluster randomised controlled trial of collaborative care for patients with depression comorbid with diabetes or cardiovascular disease (Greater Manchester CLAHRC)

There are other NIHR studies that may have some relevance to the topic – you can find out more at nihr.ac.uk or netscc.nihr.ac.uk.

The Cochrane Common Mental Disorders Review Group carries out a range of systematic reviews on depression and other conditions, see http://cmd.cochrane.org/

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How strong is the research evidence in this area?

This Highlight does not aim to bring together all the evidence in this area, but discusses a small number of key studies which have published recently. Overall, the evidence presented here is of good quality. It includes two systematic reviews, which bring together all the research in a particular area and analyse the findings together. Both of these reviews looked at randomised controlled trials, which are the most reliable form of evidence. In addition to these reviews, the Highlight includes findings from three randomised controlled trials. These were all large, well-designed studies which followed up participants over two years. One is the first large trial to look at the effectiveness of collaborative care in the UK; another is the largest trial to date of behavioural activation. Together this research represents the most recent, best evidence for these interventions in the UK context.

How does this fit with current guidance?

NICE currently recommends that collaborative care can be offered to patients with both mild or moderate depression and a physical health condition, but it isn’t recommended as standard management for patients with depression alone. The evidence presented here indicates that collaborative care seems to be effective for patients with depression, regardless of the presence of a physical comorbidity. However, the improvement in depression symptoms was only slightly greater than that for usual care. Although collaborative care costs more than usual care, evidence suggests that it is cost-effective in that these extra costs will yield a greater improvement in people’s health. NICE and commissioning bodies will be responsible for deciding whether this is worthwhile.

NICE currently recommends behavioural activation as an option for the treatment of depression, but notes that the evidence base is less strong than for cognitive behavioural therapy. The evidence presented here goes some way to filling that gap, and also demonstrates that the therapy is cost-effective. NICE is currently reviewing the guidance on depression.

 

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