Behavioral activation could be just as effective as more expensive treatment for depression

According to a new study, the most effective treatment for one of the most widespread mental health ailments could also be the cheapest.

Research published in the journal The Lancet compared the efficacy of two types of behavioral therapy used to treat depression: cognitive behavioral therapy (CBT), which is more expensive but currently considered the best depression treatment, and behavioral activation (BA), which is cheaper but not as comprehensively understood. CBT requires more training from its practitioners, while BA can be administered by less specialized healthcare providers.

They compared the outcomes of these methods when used to treat 440 British adults between 2012 and 2014 who had been diagnosed with major depressive disorder. About half were randomly assigned to each type of treatment, before they had outcomes measured based on check-ins at six months, one year and 18 months.

The biggest measure of the participants’ outcomes came after one year of the trial, when participants were asked to rate their own depressive symptoms. Researchers also tracked adverse events (self-harm or suicide attempts), and asked participants to rate their own status and quality of life at six months and 18 months, in addition to the one-year check-in. Plus, they were evaluated for major depressive and anxiety disorder based on the Diagnostic and Statistical Manual of Mental Disorders IV (DSM-4) at each of those times.

Based on these criteria, the researchers found the patients who received BA therapy saw their depression improve just as much as the patients receiving CBT, even when controlling for how severe their depression was in the first place or whether or not they were prescribed anti-depressant medication.

The patients who completed at least eight 60-minute CBT or BA sessions ended with similar PHQ-9 scores at the one-year treatment mark: 7.9 for CBT patients and 7.3 for BA patients. Between 61 and 70 percent of participants in both groups were considered recovered or responding to treatment at that time.

The subsequent analysis of the cost of both treatments showed that BA treatment was cheaper than CBT. BA could be administered more cheaply and with less training to more people with just as effective results as CBT.

As the study pointed out, depression is a mental health condition that affects many people globally, including detrimental economic and social effects. But there is a significant gap in the number of people who are diagnosed with the condition versus people who are able to receive effective treatment for it (the gap is as high as 80 to 90 percent in low-income countries, according to the study). Finding a less expensive and just-as-effective alternative to CBT could help those patients gain easier access to mental healthcare and treat their depression.

“Our results, therefore, offer hope to many societies, cultures and communities worldwide, rich and poor, struggling with the effect of depression on the health of their people and economies,” the authors wrote.