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Evidence at a glance on options for depression

A number of recent NIHR studies have provided useful new evidence on collaborative care and behavioural activation for depression. This Highlight considers some of the key points arising from the studies, but it is not a complete review of all the evidence in this area (see ‘About the research’ for more information).

What is collaborative care?

Collaborative care is a means of managing care for people with mental health conditions, involving co-ordination of medications, therapies and appointments by a dedicated case manager.

What is behavioural activation?

Behavioural activation is a therapy that encourages patients with depression to approach activities they may have been avoiding, through the development of goals and activity schedules. The rationale is that depression is linked to avoiding certain situations or activities, which in turn limits opportunities for positive experiences.

 At a glance

  • In a number of trials, collaborative care was associated with a greater improvement in symptoms of depression than usual care. The difference was often quite small, but similar to improvements seen with other types of treatment.
  • The largest and most recent trial of collaborative care in the UK echoes this finding, with patients experiencing a small but significant improvement in depression over usual care, and a greater chance of responding to treatment or recovering.
  • Patients in this trial were more satisfied with collaborative care than usual care.
  • Collaborative care is not expensive and appears cost-effective, based on the thresholds used by NICE.
  • Collaborative care is linked to small improvements in depression for a range of patient groups, including people with depression with or without an accompanying physical health condition, and older people with mild depression.
  • An ongoing study is exploring whether collaborative care is also effective for older people with more severe depression.
  • Behavioural activation is a simple psychological therapy that can be delivered by more junior staff than other commonly used talking therapies.
  • The largest trial to date of behavioural activation found it was no less effective than cognitive behavioural therapy (the most commonly used alternative) in treating depression.
  • Because less highly trained staff are able to deliver behavioural activation, it is cheaper than cognitive behavioural therapy and appears to be more cost-effective.

Questions for healthcare professionals

  • In your area, has collaborative care been used before? Has it proved worthwhile?
  • If it isn’t yet available, could collaborative care be appropriate and feasible for patients with depression in your area?
  • Are there particular patient groups who could benefit – such as older people, or those with comorbidities?
  • Is behavioural activation available in your area? Could it be offered to patients who might currently be receiving other therapies?
  • How could your service realise and use the cost savings that research suggests could be achieved through the wider use of behavioural activation?

Questions for patients

  • Which types of therapy are available in your area?
  • Do you know what behavioural activation is, and whether it might suit you?
  • Have you discussed the options for different treatments with your GP?

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