Depression Research Update August 2016
Three recent studies assess the benefits of various therapies for MDD.
References:
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.[1]
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.[2]
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.[3]
Bottom line: Basimglurant may be added to the list of emerging drugs, such as ketamine, that target the glutamatergic system for the treatment of mood disorders, including depression.