Three recent studies assess the benefits of various therapies for MDD.
1. Richards DA, Ekers D, McMillan D, et al. Cost and Outcome of Behavioural Activation versus Cognitive Behavioural Therapy for Depression (COBRA): a randomised, controlled, non-inferiority trial. Lancet. Published online July 22, 2016. DOI: http://dx.doi.org/10.1016/S0140-6736(16)31140-0.
2. Kellner CH, Husain MM, Knapp RG, et al. Right unilateral ultrabrief pulse ECT in geriatric depression: phase 1 of the PRIDE Study. Am J Psychiatry. Published online July 15, 2016. http://dx.doi.org/10.1176/appi.ajp.2016.15081101.
3. Quiroz JA, Tamburri P, Deptula D, et al. Efficacy and Safety of Basimglurant as Adjunctive Therapy for Major Depression: A Randomized Clinical Trial. JAMA Psychiatry. 2016;73:675-684. doi:10.1001/jamapsychiatry.2016.0838.
Three new treatments for MDD include a simple, inexpensive psychological therapy; individualized, ultrabrief ECT; and basimglurant as adjunctive therapy.[1-3] Scroll through this slideshow for the latest findings and take-home messages.
1.Behavioral Activation Is a Cost-Effective Alternative to Cognitive-Behavioral Therapy (CBT): This treatment requires less intensive and costly training than CBT. In a randomized, controlled trial, 221 patients were assigned to behavioral activation delivered by 10 junior mental health workers and 219 to CBT provided by 12 psychological therapists. At 12 months, from 61% to 70% of patients in both groups met criteria for recovery from depression.
Take-home message: Effective psychological therapy for depression can be delivered without the need for costly and intensive training.
2.ECT Is Highly Effective for Older Adults With MDD: A group of 240 depressed elderly patients were randomly assigned either to stop ECT and continue only with venlafaxine or to continue ECT. After a mean number of 7.3 ECT treatments, more than 60% of patients achieved remission and 70% had a response in the first phase of the study. Those who continued with ECT into a second phase were more than 6 times more likely to have no illness than those who had received medication alone.
Clinical implication: Continuing ECT after remission is likely to be beneficial in sustaining mood improvement for most patients.
3. Dysregulation of the Glutamatergic Neurotransmitter System May Play a Critical Role in Depression: Basimglurant is a selective metabotropic glutamate subtype 5 receptor–negative allosteric modulator used as adjunctive treatment to ongoing SSRI or SNRI therapy for MDD. A 6-week trial of 333 adults with MDD failed to show a statistically significant separation between 2 basimglurant doses and placebo in changes on a depression scale after 42 days. However, there was a trend for the 1.5-mg basimglurant dose to improve symptoms.