Specialist treatment for persistent depression in secondary care: Sustained effects from a multicentre UK study at 24 and 36 months

Abstract

BackgroundDespite the known health costs of persistent depression, there is no established service framework for the treatment of this disorder and a lack of long-term outcome data to inform commissioning. To address this gap, we report the long-term clinical effectiveness of a randomised controlled trial (RCT) testing a specialist, collaborative model of care for people with persistent moderate to severe unipolar depression. MethodsA multicentre, pragmatic, single-blind, parallel-group randomised controlled trial comparing outcomes from a Specialist Depression Service (SDS) offering collaborative treatment with cognitive behavioural therapy (CBT) and pharmacotherapy for 12 months with treatment as usual (TAU) for persistent, moderate-severe depression in UK secondary care. Participants were initially assessed at baseline, 3, 6, 9, 12, and 18 months, with primary endpoints (17-item Hamilton Depression Rating Scale [HDRS17], and a Global Assessment of Functioning [GAF]) reported elsewhere (Morriss et al., 2016). Additional long-term, post-treatment, follow-up was made at 24 and 36 months with outcomes presented here. ClinicalTrials.gov (NCT01047124) and ISRCTN registration (ISRCTN 10963342). ResultsAt 24 months there remained a statistically significant between-group difference in HDRS17–2.69 (−5.14, −0.23) and a non-significant improvement in GAF 2.85 (−1.23, 6.94), both favouring the SDS. Simple statistics are presented at 36 months, due to attrition, showing higher continued response and remission vs TAU across all measures. LimitationsPotential bias through loss to follow-up, particularly beyond 24 months. ConclusionsCompared with standard secondary care, SDS management of persistent moderate-severe depression, produced long-term clinical benefits, sustained following treatment completion, suggesting a model for future specialist care.