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The East Midlands has higher rates of depression than the national average and a lower than average use of crisis resolution.
Chronic
Mood
Disorder
ÌÇÐÄÔ´´ aims
The purpose of this research is to determine whether a specialised depression service for people with chronic depression is clinically effective and financially viable compared to standard treatment. By giving patients a coordinated, tailor-made and evidence-based care plan through a psychiatrist and psychotherapist working collaboratively, the study aims to show the following outcomes:
- Improved care for patients with a clinical diagnosis of (unipolar) depressive disorder that has not been resolved within six months of being in secondary (ie. Consultant–led) care
- Those receiving specialised treatment are better able to manage their depression and possibly achieve remission
- Specialist mood disorder services are more cost effective than usual treatment
- Identification of obstacles and promoters to the implementation of a such a specialised service
Why is the project necessary?
By 2020 unipolar depression is projected to be the second leading cause of 'disability adjusted life years' in the world (World Bank, 1993). The East Midlands has higher rates of depression than the national average and a lower than average use of crisis resolution, home treatment and assertive outreach services. However, the region has the highest proportion of investment in mental health services provided by the NHS in England suggesting that resource use may be inefficient.
NICE Guidelines for depression recommend a combination of antidepressant medication and cognitive therapy for severe and chronic depression (NICE, 2004) and evidence suggests that a combination of individually tailored antidepressant treatment combined with cognitive therapy that follow algorithms of evidence based research appear to be the gold standard of treatment for depression (NICE 2004; Anderson et al., 2008).
There is no routinely collected data on adherence to NICE guidelines or of out-patient or community mental health team treatment for depression. The study is capturing this data through an audit tool. The persistent nature of depression and the consequent longitudinal pattern of reoccurrences mean that there is a high social and economic burden associated with the illness.
ÌÇÐÄÔ´´ process
The study is a randomised controlled trial which allows for a fair comparison of two treatment arms: Treatment as usual and a Specialised mood disorder team.
Eligible participants are randomly allocated to a treatment arm for 12 months with a follow up period of a further 12 months. Both groups are asked to meet with researchers every 6 months to assess their current mood and feelings as well as details about any medication and healthcare services used.