Effective Treatment For Depression Research Articles

Long-term remission and relapse of anxiety and depression in older adults after Cognitive Behavioural Therapy (CBT): A 10-year follow-up of a randomised controlled trial

BackgroundThis study examined the long-term durability of cognitive behaviour therapy (CBT) for older adults with comorbid anxiety and depression 10 years after treatment, in comparison to an active control group. MethodParticipants from a randomised controlled trial for older adults with comorbid anxiety and depression (Wuthrich et al., 2016) were re-contacted. Participants had received either group CBT or an active control treatment (Discussion Group). The final sample (N = 54; Aged 70–84, Mage = 76.07, SD = 3.83; 59 % of the eligible original sample) completed a diagnostic interview, cognitive assessment and self-report measures of symptoms and quality of life. ResultsCBT was associated with significantly improved long-term (10-year) efficacy for reducing anxiety and depression in older adults compared to the Discussion group. Effects included higher rates of remission (58 % remission of all diagnoses vs 27 %, 88 % of all depressive diagnoses vs 54 %, 63 % of all anxiety diagnoses vs 35 %, 67 % of primary diagnosis vs 42 %), lower rates of relapse (25–31 % vs 50–78 %) and lower rates of chronic treatment-resistance (8 % primary disorder vs 39 %, 21 % any disorder vs 58 %). Participants who showed an acute treatment response at post-treatment were 7–9 times more likely to be in remission after 10 years than those with residual symptoms. LimitationsResults may not generalise to those who do not complete CBT, and the time trajectory of symptom change is unclear. ConclusionsLong-term improvements in symptoms are specific to CBT. Results provide compelling evidence for CBT as an effective and durable treatment for late-life anxiety and depression.

Effectiveness of an add-on brief group behavioral activation treatment for depression in psychiatric care: a randomized clinical trial.

Behavioral activation (BA) is an effective treatment for depression. We investigated the effectiveness of add-on group-format BA and peer support (PS) with treatment as usual (TAU) in a registered randomized clinical trial in psychiatric outpatient settings (ISRCTN10647845). Adult outpatients (N = 140) with major depressive disorder (MDD) and Patient Health Questionnaire (PHQ-9) score ≥10 were randomized into a) group BA, consisting of eight 90-minute weekly group sessions plus TAU; b) group PS, including eight 90-minute weekly group sessions plus TAU; or c) TAU alone. The primary outcome was a within-individual change in PHQ-9 score between baseline and 8 weeks. Secondary outcomes were 1) response, 2) remission, and 3) functional impairment at 8 weeks, plus 4) change in PHQ-9 at 6 months. Of the randomized patients, 100 (71.4%) completed treatments, including 29/45 (64.4%) patients in the BA group, 39/49 (79.6%) in the PS group, and 32/46 (69.6%) in the TAU group. By 8 weeks, PHQ-9 scores declined most in the TAU group [BA -0.28 (95% CI -2.48, 1.92), PS -0.58 (-2.09, 0.94) vs. TAU -3.32 (-5.21, -1.44); group-difference test, p = 0.034]. The secondary outcomes in the BA or PS arms did not significantly differ from those in TAU. Videotaped sessions revealed marked variation in briefly trained therapists' adherence to the treatment manual. In this randomized trial, the effectiveness of treatments with the added BA and PS groups did not exceed that of TAU alone. The preconditions in which brief BA or PS group interventions benefit outpatients with depression in psychiatric settings warrant critical investigation.

Prevalence of Diagnosed and Undiagnosed Depression Among US Adults with Human Immunodeficiency Virus: Data from the Medical Monitoring Project.

People with human immunodeficiency virus (PWH) are disproportionately affected by depression, but the recent national estimates for US PWH encompassing both current symptoms and clinical diagnoses to assess missed diagnoses and lack of symptom remission are lacking. We used data from CDC's Medical Monitoring Project (MMP) to report nationally representative estimates of diagnosed and undiagnosed depression among US adult PWH. During June 2021 to May 2022, MMP collected interview data on symptoms consistent with major or other depression and depression diagnoses from medical records of 3928 PWH. We report weighted percentages and prevalence ratios (PRs) to quantify differences between groups on key social and health factors. Overall, 34% of PWH experienced any depression (diagnosis or Patient Health Questionnaire-8); of these, 26% had symptoms but no diagnosis (undiagnosed depression), 19% had both diagnosis and symptoms, and 55% had a diagnosis without symptoms. Among those with depression, persons with a disability (PR: 1.52) and food insecurity (PR: 1.67) were more likely to be undiagnosed. Unemployed persons (PR: 1.62), those experiencing a disability (PR: 2.78), food insecurity (PR: 1.46), or discrimination in human immunodeficiency virus (HIV) care (PR: 1.71) were more likely to have diagnosed depression with symptoms. Those with symptoms (undiagnosed or diagnosed) were less likely to be antiretroviral therapy (ART) dose adherent (PR: 0.88; PR: 0.73) or have sustained viral suppression (PR: 0.62; PR: 0.91) and were more likely to have unmet needs for mental health services (PR: 2.38, PR: 2.03). One-third of PWH experienced depression, of whom nearly half were undiagnosed or still experiencing clinically relevant symptoms. Expanding screening and effective treatment for depression could improve quality of life and HIV outcomes.

Efficacy and Safety of Adding Lurasidone to Ongoing Therapy With Lithium or Valproate for the Treatment of an Acute Bipolar Depressive Episode: A Post Hoc Analysis of 2 Placebo-Controlled Trials.

The aim of this study was to compare the efficacy and safety profile of lurasidone combined with either lithium or valproate, in the short-term treatment of patients with bipolar depression. Data were pooled from two 6-week, double-blind, placebo-controlled trials of patients with bipolar depression on stable doses of lithium or valproate randomized to lurasidone (20-120 mg/d) or placebo. Efficacy measures included the Montgomery-Åsberg Depression Rating Scale, Clinical Global Impressions Bipolar Scale, and the Quick Inventory of Depressive Symptomatology via self-assessment and were analyzed using a mixed model for repeated measures approach. Notably larger week 6 effect sizes were observed when lurasidone was added to lithium, compared with when lurasidone was added to valproate, on 2 of the 3 depression outcome measures, Montgomery-Åsberg Depression Rating Scale total score (d = 0.45 vs 0.22) and Quick Inventory of Depressive Symptomatology via self-assessment (d = 0.63 vs 0.29); the efficacy advantage was smaller on the Clinical Global Impressions Bipolar Scale depression score (d = 0.34 vs 0.29). Similar adverse event profiles were observed for lurasidone treatment in combination with either lithium or valproate. The most frequently reported events (≥5%) in both groups were nausea, parkinsonism, somnolence, akathisia, and insomnia. Minimal changes in weight, lipids, and measures of glycemic control were observed during treatment with lurasidone combined with either lithium or valproate. Lurasidone added to either lithium or valproate was found to be an effective treatment for bipolar depression, with a larger antidepressant effect observed when lurasidone was combined with lithium. There were no clinically meaningful differences in the safety or tolerability of lurasidone when used adjunctively with lithium or valproate.

The Frequency of Depression Among Patients with Chronic Kidney Disease on Hemodialysis

Objective: To find out the frequency of depression among patients with chronic kidney disease (CKD) on hemodialysis and to know fresh local descriptive statistics and updated analysis of depression in our local population in patients presenting with chronic kidney disease on hemodialysis.
 Methodology: In this study, a total of 126 chronic kidney disease patients on hemodialysis presented to Nephrology department, Nephrology Department District Headquarter Teaching Hospital, Kohat were observed from December 10, 2021, to June 9, 2022. Written informed consent was taken and all patients underwent detailed interviews using Beck Depression Inventory (BDI) score in a calm environment in nephrology OPD.
 Results: In this study mean patient age was 52 years with SD ± 8.214. Sixty-two percent of patients were male and rest were female. More than 53(42%) patients had depression while 73(58%) didn’t have depression. 
 Conclusion: Our study concludes that the frequency of depression was 42% in chronic kidney disease patients on hemodialysis. Effective screening and treatment of depression in chronic kidney disease patients are crucial for improving their clinical outcomes and enhancing their overall quality of life.
 Key words: chronic kidney disease, depression, hemodialysis.

Is behavioural activation an effective treatment for depression in children and adolescents? An updated systematic review and meta-analysis.

Behavioural Activation (BA)-a brief therapy based on the scheduling of enjoyable, purposeful and rewarding activities-is an effective and cost-effective treatment for depression in adults that shows promise for children and adolescents. We provide an update on a previous systematic review of evidence on BA-delivered in-person, telephone, or online-for depression and comorbid anxiety in children and adolescents.We conducted systematic literature searches in 6 databases up to February 2024. We included all study designs evaluating BA with participants up to 18years old with diagnosable depression, as established by a validated screening tool or diagnostic manual. We used the Moncrieff Scale and the Cochrane Risk of Bias tool to assess study quality. We summarised the findings of all study types with a narrative synthesis and of randomised controlled trials (RCTs) with a meta-analysis.Overall, 24 studies (6 RCTs, 18 pre-post evaluations, n = 2,758) met our inclusion criteria. A meta-analysis of 4 RCTs (n = 156) showed that BA has a small effect of 0.24 (Hedge's adjusted g) in reducing depression symptoms compared to a waiting-list control, usual care and other therapies. Online and telephone-facilitated BA was shown to be feasible in 3 studies and effective in 1. Outcomes on comorbid anxiety were mixed. No economic evaluations met our inclusion criteria.BA shows sufficient promise as an intervention for reducing depression symptoms in children and adolescents to justify the need for further RCTs, providing that five conditions are met: studies are powered to detect a minimal clinically important difference; BA materials are fit-for-purpose to produce clinically meaningful change; follow-ups are longer than 6months; primary outcomes are child-reported; and intervention costs, resource use and adverse events are reported.

Treatment of comorbid depression after acute coronary syndrome: Meta-analysis of randomized controlled trials

Depression post-acute coronary syndrome (ACS) increases cardiac risk; however, the efficacy of antidepressant therapies for its treatment has not been sufficiently demonstrated. Our aim is to meta-analyze controlled trials with homogeneous samples that allow us to explain the inconsistency of the results obtained so far. After reviewing 1525 articles, two independent reviewers identified 7 studies that met very restrictive criteria to ensure homogeneity of the samples. The results indicated that patients treated with interventions of proven efficacy for the depression, reduce their levels of depressive disorder significantly more than subjects without this treatment and that there are significant differences in the number of patients who reduce depressive symptoms in a clinically relevant way. In addition, fewer adverse cardiovascular events were observed during treatment, although this difference was minimally significant and was not maintained after the follow-up. These results suggest that the inconsistency of the currently available data could be due to methodological difficulties evidencing the need for further research to clarify the effect of depression treatment on post-ACS prognosis.

IJCM_423A: Mental Health Literacy for Depression and Schizophrenia among Undergraduate students

Background: Mental Health Literacy (MHL) arose as a facet of Health Literacy after it was understood that the concept of health went beyond the physiological or the physical aspect. Despite improvements in various health indicators in the last couple of decades, India still significantly contributes to the global burden of disease and mental illnesses. Objective This study aimed to examine the level of Mental Health Literacy in terms of diagnosis, treatment, prognosis and help-seeking behavior for Depression and Schizophrenia among Indian Undergraduate students and to compare the levels of Mental Health Literacy among males and females Methodology: The study used a cross-sectional design with snowball sampling across various educational institutions the participants 324 in number were undergraduate students aged between 18 and 23. All consenting participants were recruited for the study and Google forms consisting of case vignettes and questions that followed them were distributed using snowball sampling. Results Participants were able to diagnose depression but were poor at diagnosing Schizophrenia. Psychological therapy was rated as the most effective treatment for depression and psychological and drug therapy were rated as the most effective treatments for Schizophrenia. Higher prognosis ratings were given to Depression as compared to Schizophrenia. Females were more optimistic about the prognosis of both disorders as compared to males. Conclusion: Overall, participants demonstrated better Mental Health Literacy for depression as compared to schizophrenia, possibly due to the availability of internet resources.

Is pramipexole an effective adjunctive treatment for treatment-resistant depression?

Is pramipexole an effective adjunctive treatment for treatment-resistant depression?

Traditional Chinese exercises on depression: A network meta-analysis.

Exercise is an important factor for the treatment and rehabilitation of depression. Traditional Chinese exercise is considered as an effective treatment for depression. In recent years, many studies have shown that Chinese exercise therapy may be safe in the treatment of depression. To evaluate the therapeutic effect of traditional Chinese exercise on depression using network meta-analysis. PubMed, Cochrane Library, Web of Science, China National Knowledge Infrastructure, VIP shop Database, China Biomedical Literature Database, and Wan Fang Data Knowledge Service Platform were included in randomized controlled studies on traditional Chinese exercises for the treatment of depression from the establishment of the library to July 2023. The literature was extracted and assessed for risk of bias using the Cochrane Risk of Bias Assessment and statistically analyzed using Review Manager 5.4 and Stata 14.2. A total of 25 studies involving 3 exercises with a total of 1605 cases were included. The results of the network meta-analysis showed that each exercise significantly reduced the 24-item Hamilton Depression Scale (HAMD-24), Hamilton Anxiety Scale, Beck Depression Inventory, and Self-rating Depression Scale scores. However, conventional treatments have the advantage of improving the sleep quality of patients with depression. The 3 exercises included in this study were effective for depression. Baduanjin and Tai Chi were better at improving the outcomes related to depression and anxiety. The effect of sleep quality intervention was slightly worse. Larger, high-quality randomized controlled trials are needed to compare interventions across exercises in a more granular manner.

Patient and provider perspectives on the phenomenon and effective treatment of treatment-resistant depression: A grounded theory

BackgroundTreatment-Resistant Depression (TRD) is a poorly understood but prevalent clinical phenomenon that lacks a widely accepted definition, explanatory model, or set of practice recommendations. It involves a chronic form of unipolar Major Depressive Disorder (MDD) that fails to respond to at least two first-line clinical treatments. TRD affects as many as 70 % of patients who fail to respond to their first trial of antidepressant medication and 60 % of patients who fail to respond to their first phase of psychotherapy. PurposeThis qualitative study aims to develop a model for understanding the phenomenon of unipolar TRD and the practices involved in its effective treatment. MethodsThis study involved a grounded theory analysis of interviews with four adult-American patients with unipolar TRD and five American providers who routinely treat such patients. ResultsA model of unipolar TRD was developed, explaining common etiological and maintaining factors of unipolar TRD and offering recommendations for guiding effective treatment. LimitationsThis study had a small sample size (N = 9) with limited sociodemographic diversity (all Americans; only two females; one racial/ethnic minority; no sexual minorities), which may limit its generalizability. ConclusionsNevertheless, its emergent theory underscores the importance of TRD patients cultivating positive views of medication and psychotherapy while collaborating with their providers to obtain psychoeducation, build mindfulness/coping skills, enhance social support, and re-engage with pleasurable activities. It recommends that mental health providers focus on processing TRD patients’ subjective experiences, validating patients’ frustrations, and monitoring and calibrating patients’ expectations.

Efficacy and safety of esketamine for perioperative depression in patients undergoing elective surgery: A meta-analysis of randomized controlled trials

BackgroundDepression is a prevalent mood disorder during the perioperative period, with both preoperative concurrent depression and new-onset postoperative depression impacting postoperative recovery. Recent studies have indicated that the dissociative anesthetic esketamine may alleviate perioperative depressive symptoms. ObjectiveThis meta-analysis aimed to assess the efficacy and safety of esketamine in treating perioperative depression. MethodsWe selected randomized controlled trials comparing esketamine to placebo in terms of postoperative depressive symptoms. The primary outcome was postoperative depression scores, with secondary outcomes including the prevalence of postoperative depression, pain scores using the Visual Analogue Scale or Numeric Rating Scale, and incidences of adverse reactions such as nausea/vomiting, dizziness, dreams/nightmares, hallucinations. ResultsWe enrolled a total of 17 studies involving 2462 patients. The esketamine group demonstrated a significant reduction in postoperative depression scores within one week after surgery (SMD −0.47, 95% CI (−0.66, −0.27), P < 0.001) and over the long term (SMD −0.44, 95% CI (−0.79, −0.09), P = 0.01). Furthermore, esketamine significantly decreased the prevalence of postoperative depression both within one week (RR 0.46, 95% CI (0.33, 0.63), P < 0.001) and over the long term (RR 0.50, 95% CI (0.36, 0.70), P < 0.001). Additionally, esketamine effectively relieved pain on the first postoperative day compared to control. However, it also increased the risks of dizziness and hallucinations for a short time. ConclusionThis meta-analysis suggests that the intraoperative or postoperative application of esketamine could be a potentially effective treatment for perioperative depression, although the increased risk of adverse reactions should be considered.

Clinical efficacy of adjunctive esketamine anesthesia in electroconvulsive therapy for major depressive disorders: A pragmatic, randomized, controlled trial

Electroconvulsive therapy (ECT) is an effective treatment for depression, and esketamine has been shown to have antidepressant effects. However, it is currently unclear whether adjunctive esketamine can enhance the clinical efficacy of ECT in real-world clinical practice. In this pragmatic clinical trial, patients with major depression were randomly assigned into two groups: patients received 0.25 mg/kg esketamine plus propofol (esketamine group) or the same volume of saline (control group) plus propofol. Results indicated that there was no difference in response and remission rates between the two groups. However, patients receiving esketamine had a higher remission rate of SI and lower psychotic scores. Patients receiving esketamine also required a lower electric dose, but the seizure duration and cognitive function were comparable between the two groups. Diastolic blood pressure increased after esketamine injection, but there was no increased risk of hypertension. Furthermore, incidence of delirium and confusion were comparable between the groups. Conclusively, adjunctive esketamine anesthesia does not provide any advantage in improving the response and remission rates of ECT. However, it can improve remission of SI and alleviate accompanying psychotic symptoms in depressive patients. With adjunctive usage, the adverse cardiovascular and neuropsychiatric events associated with esketamine appear to be tolerable.

What is the most effective and safest treatment of depression after CABG?

What is the most effective and safest treatment of depression after CABG?

국내 우울증 치료에서 REBT와 MBCT기반치료의 현황 고찰

This study focuses on understanding the role and detailed treatment process of RBET (rational emotive behavior therapy), a second-generation theory in cognitive behavior therapy, and MBCT (mindfulness-based cognitive therapy), a third-generation theory in cognitive behavior theory. The research method compared and analyzed the two theories and domestic papers related to depression. The result of the study shows that RBET plays a fundamental role in treating depression by philosophically changing and modifying key beliefs that cause depression. The effectiveness of RBET has already been verified in many previous studies. The result of the study also shows that MBCT is used as maintenance therapy in cases where depression has improved. The process of MBCT is as follows: to notice signs of worsening or recurrence of symptoms; to get past negative emotions by focusing on the present; to learn to relate to the senses, emotions, and thoughts arising from within; and to switch to the “being mode” from cognitive defusion and the “doing mode”. In summary, RBET is effective as a quick and early treatment technique, and MBCT is effective as a maintenance treatment technique to prevent recurrence once depression has improved. This study is meaningful in maximizing the effectiveness of depression treatment by comparing the differences and commonalities between REBT and MBCT theories and clarifying the cooperative relationship.

Effect of exercise for depression: systematic review and network meta-analysis of randomised controlled trials

ObjectiveTo identify the optimal dose and modality of exercise for treating major depressive disorder, compared with psychotherapy, antidepressants, and control conditions.DesignSystematic review and network meta-analysis.MethodsScreening, data extraction, coding, and risk...

Nrf2 activation rescues stress-induced depression-like behaviour and inflammatory responses in male but not female rats

BackgroundMajor depressive disorder (MDD) is a recurring affective disorder that is two times more prevalent in females than males. Evidence supports immune system dysfunction as a major contributing factor to MDD, notably in a sexually dimorphic manner. Nuclear factor erythroid 2-related factor 2 (Nrf2), a regulator of antioxidant signalling during inflammation, is dysregulated in many chronic inflammatory disorders; however, its role in depression and the associated sex differences have yet to be explored. Here, we investigated the sex-specific antidepressant and cognitive effects of the potent Nrf2 activator dimethyl fumarate (DMF), as well as the associated gene expression profiles.MethodsMale and female rats were treated with vehicle or DMF (25 mg/kg) whilst subjected to 8 weeks of chronic unpredictable stress. The effect of DMF treatment on stress-induced depression- and anxiety-like behaviours, as well as deficits in recognition and spatial learning and memory were then assessed. Sex differences in hippocampal (HIP) gene expression responses were also evaluated.ResultsDMF treatment during stress exposure had antidepressant effects in male but not female rats, with no anxiolytic effects in either sex. Recognition learning and memory and spatial learning and memory were impaired in chronically stressed males and females, respectively, and DMF treatment rescued these deficits. Further, chronic stress elicited sex-specific alterations in HIP gene expression, many of which were normalized in animals treated with DMF. Of note, most of the differentially expressed genes in males normalized by DMF were related to antioxidant, inflammatory or immune responses.ConclusionsCollectively, these findings may support a greater role of immune processes in males than females in a rodent model of depression. This suggests that pharmacotherapies that target Nrf2 have the potential to be an effective sex-specific treatment for depression.

Expert Opinion on the Prescription Practice of Selective Serotonin Reuptake Inhibitors for Major Depressive Disorder in Indian Settings

Objective: To gather expert opinions and insights on the prevalence of anxiety and depression, along with prescription trends for different therapeutic options based on escitalopram, in Indian outpatient settings. Methodology: The questionnaire-based survey, comprising 28 questions, collected perspectives of experts across India regarding the prescription practice of selective serotonin reuptake inhibitors (SSRIs) with a special focus on escitalopram for treating major depressive disorder. Additionally, information on the symptoms of major depressive disorder and the age range of those affected by the disorder was also collected. Results: About 53% of the 331 participants reported that behavioral symptoms were the most frequent among depressed patients. Among the various classes of antidepressants, about 86% of the participants indicated SSRIs as their preferred choice for treating depression. In comparison to vilazodone, paroxetine, and sertraline medications, approximately 87% of the respondents favored escitalopram as the ideal option for treating depression. According to 64% of the respondents, the use of escitalopram has led to improvements in 50-75% of patients. Around 74% of the respondents reported a significant correlation between early responders to antidepressant therapies and achieving full remission. About 49% stated that it may take 8 weeks for depressive patients undergoing escitalopram therapy to experience remission. Adverse effects and poor response were highlighted as the reasons for depressive patients transitioning from other SSRI medications to escitalopram by approximately 43% of the respondents. Conclusion: The survey emphasizes the significance of the 8-week regimen of escitalopram in achieving full remission in patients with depression. The majority of respondents underscored the superiority of escitalopram among SSRIs when compared to other options like vilazodone, paroxetine, and sertraline, reaffirming its role as a preferred choice for effective depression treatment.

Analysis of the Effect of Different Physical Exercise Protocols on Depression in Adults: Systematic Review and Meta-analysis of Randomized Controlled Trials.

Physical exercise (PE) is an effective treatment for depression, alone or as an adjunct. There is a lack of indicators regarding the frequency, intensity, duration, and type of physical exercise (PE). This study aims to synthesize and analyze the dose-effect of different PE protocols in adult subjects in the treatment of depression, based on the analysis of randomized controlled trials (RCTs). The search was conducted using Web of Science, PubMed, and Cochrane Library electronic databases. Studies with an exercise-based intervention published by December 31, 2021 were identified. RCTs and meta-analyses involving adults with depression were also included; 10 studies were selected, including a total of 956 subjects. Systematic review and meta-analysis. Level 1. Effect sizes were summarized using standardized mean differences (95% confidence interval) by effected randomized models. The results reinforce that exercise appears to be beneficial in improving depression among adults aged 18 to 65 years. Interventions lasting above 150 minutes per week of moderate intensity and group interventions seem to have a more significant effect on reducing depression. Studies have revealed that aerobic exercise, compared with resistance or flexibility, has a more positive effect on depression. PE can be a way to reduce depression and can be used as a possible adjunctive tool for pharmacological and/or alternative treatments. Considering the findings of this study, it is important that health professionals (eg, exercise physiologists, physicians, nurses, psychologists) promote the practice of PE as a complementary alternative and act early to prevent the worsening of depression. CRD42020188909.

Cost-effectiveness of behavioral activation compared to treatment as usual for depressed older adults in primary care: A cluster randomized controlled trial

IntroductionDepression in older adults is associated with decreased quality of life and increased utilization of healthcare services. Behavioral activation (BA) is an effective treatment for late-life depression, but the cost-effectiveness compared to treatment as usual (TAU) is unknown. MethodsAn economic evaluation was performed alongside a cluster randomized controlled multicenter trial including 161 older adults (≥65 years) with moderate to severe depressive symptoms (PHQ-9 ≥ 10). Outcome measures were depression (response on the QIDS-SR), quality-adjusted life-years (QALYs) and societal costs. Missing data were imputed using multiple imputation. Cost and effect differences were estimated using bivariate linear regression models, and statistical uncertainty was estimated with bootstrapping. Cost-effectiveness acceptability curves showed the probability of cost-effectiveness at different ceiling ratios. ResultsSocietal costs were statistically non-significantly lower in BA compared to TAU (mean difference (MD) -€485, 95 % CI -3861 to 2792). There were no significant differences in response on the QIDS-SR (MD 0.085, 95 % CI -0.015 to 0.19), and QALYs (MD 0.026, 95 % CI -0.0037 to 0.055). On average, BA was dominant over TAU (i.e., more effective and less expensive), although the probability of dominance was only 0.60 from the societal perspective and 0.85 from the health care perspective for both QIDS-SR response and QALYs. DiscussionAlthough the results suggest that BA is dominant over TAU, there was considerable uncertainty surrounding the cost-effectiveness estimates which precludes firm conclusions.