The efficacy and cost-effectiveness of outpatient-based, specialist depression services (SDS) versus treatment as usual (TAU) on depression symptoms and function was tested.

The study, co authored by Tim Dalgleish and reported in Lancet Psychiatry was a multicentre, single-blind, patient-level, parallel, randomised controlled trial (RCT), in three mental health outpatient settings in England. Eligible participants were older than 18 years, had unipolar depression and had not responded to 6 months or more of treatment. Patients were randomly offered either SDS (collaborative care approach between psychiatrists and cognitive behavioural therapists for 12 months, followed by graduated transfer of care up to 15 months) or the TAU group. They were followed up at 6, 12 and 18 months.

The changes from baseline to 6 months did not significantly differ between treatments at 6 and 12 months. The mean change in HDRS score from baseline to 18 months was significantly improved in the SDS group compared with the TAU group but the GAF scores showed no significant differences between the groups.

Compared with usual specialist mental health secondary care, SDS might improve depression symptoms for patients with persistent moderate to severe depression, but functional outcomes and economic benefits are equivocal.

http://www.thelancet.com/pdfs/journals/lanpsy/PIIS2215-0366(16)30143-2.pdf