Behavioural activation v. antidepressant medication for treating depression in Iran: randomised trial
Open accessAbstract
Background: Behavioural activation might be a viable alternative to antidepressant medication for major depressive disorder. Aims: To compare the effectiveness of behavioural activation and treatment as usual (TAU, antidepressant medication) for major depressive disorder in routine clinical practice in Iran. Method: Patients with major depressive disorder (n = 100) were randomised to 16 sessions of behavioural activation (n = 50) or antidepressant medication (n = 50) (IRCT138807192573N1). The main outcome was depression, measured with the Beck Depression inventory (BDI) and the Hamilton Rating Scale for Depression (HRSD), assessed at 0, 4, 13 and 49 weeks. Results: Symptom reduction was greater in the behavioural activation group than in the TAU group on both the BDI and the HRSD at 13 and 49 weeks in multilevel analysis. Baseline depression severity was a moderator, with relatively better effects for behavioural activation in individuals who were more severely depressed. Also, there was better retention in the behavioural activation than in the TAU group. Conclusions: Behavioural activation is a viable and effective treatment for people with major depressive disorder, especially for those who are more severely depressed, and it can successfully be disseminated into routine practice settings in a non-Western country such as Iran.
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A single additional face-to-face study together with a new meta-analysis including many older, small studies elevate behavioural activation (BA) to first-line treatment.
“a single additional faceto-face study together with a new meta-analysis including many older, small studies elevate behavioural activation (BA) to first-line treatment.70,71”
From Canadian Network for Mood and Anxiety Treatments (CANMAT) 2016 Clinical Guidelines for the Management of Adults with Major Depressive Disorder (2016) · cites this paper as [71]
A subsequent meta-analysis (26 RCTs, N=1524) that incorporated older studies, the Internet/smartphone studies, and 1 recent face-to-face trial reported a large effect size of BA compared to control conditions.
“A subsequent meta-analysis (26 RCTs, N ¼ 1524) that incorporated older studies, the Internet/smartphone studies, and 1 recent face-to-face trial reported a large effect size of BA compared to control conditions.130,131”
From Canadian Network for Mood and Anxiety Treatments (CANMAT) 2016 Clinical Guidelines for the Management of Adults with Major Depressive Disorder (2016) · cites this paper as [131]
One additional study and three studies also included in the BA vs. control comparison were included in the BA vs. Medication meta-analysis (BA condition n = 130; anti-depressant medication n = 153).
“One additional study [89] and three studies also included in the BA vs. control comparison [68], [72], [82], [89] were included in the BA vs. Medication meta-analysis (BA condition n = 130; anti-depressant medication n = 153).”
From Behavioural Activation for Depression; An Update of Meta-Analysis of Effectiveness and Sub Group Analysis (2014) · cites this paper as [89]
Two studies used SSRI medication and complex BA with the other two using tri-cyclic medication and simple BA.
“Two studies used SSRI medication ad complex BA [82], [89] with the other two using tri-cyclic medication ad simple BA.”
From Behavioural Activation for Depression; An Update of Meta-Analysis of Effectiveness and Sub Group Analysis (2014) · cites this paper as [89]
Two studies used SSRI with two studies tricyclic antidepressant medication with no apparent association between drug type and effect size.
“Two studies used SSRI [82], [89] with two studies tricyclic antidepressant medication [68], [72] with no apparent association between drug type and effect size (see table 2).”
From Behavioural Activation for Depression; An Update of Meta-Analysis of Effectiveness and Sub Group Analysis (2014) · cites this paper as [89]
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References 28 · Cited by 79
Research works printed but not linked: 3
- [5]5. Schatzberg AF. Treatment of severe depression with the selective serotonin reuptake inhibitors. Depress Anxiety 1996; 4: 182-9.
- [6]6. American Psychiatric Association. Practice guidelines for the treatment of patients with major depressive disorder (revision). Am J Psychiatry 2000; 157: 1-45.
- [11]11. Beck AT, Rush AJ, Shaw BF, Emery G. Cognitive Therapy of Depression. Guilford Press, 1979.
- Authors
- Moradveisi, L., Huibers, M. J. H., Renner, F., Arasteh, M., & Arntz, A.
- Affiliations
- Kurdistan University of Medical Sciences (IR)
- Vrije Universiteit Amsterdam (NL)
- Maastricht University (NL)
- Corresponding author
- Arntz, Arnoud
- Venue
- British Journal of Psychiatry
- Publisher
- Royal College of Psychiatrists
- Published
- 2013-03
- Volume
- 202
- Issue
- 3
- Pages
- 204-211
- ISSN
- 0007-1250 (ISSN-L)
- 1472-1465
- OpenAlex
- W2113302965
- Semantic Scholar
- 5099197a5fa1841e1414b047d125e6e7e2d7f868
- Cited by
- 79
- References
- 28
- Citations by year
- 2026: 1 · 2025: 2 · 2024: 2 · 2023: 5 · 2022: 2 · 2021: 4 · 2020: 20 · 2019: 3 · 2018: 3 · 2017: 6 · 2016: 12 · 2015: 8 · 2014: 6 · 2013: 5
- FWCI
- 13.97
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- The British Journal of Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- VU Research Portal (publishedVersion)
- Research Publications (Maastricht University) (submittedVersion, other-oa)
- Data Archiving and Networked Services (DANS) (submittedVersion)
- Funders
- Universiteit Maastricht
- Kurdistan University Of Medical Sciences
- Topics
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Health Sciences › Medicine › Pharmacology › Treatment of Major Depression
- Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
- Keywords
- behavioral activation, major depressive disorder, antidepressants, depression treatment, usual care, depression severity, treatment retention, routine clinical practice, non-Western countries, Iran
- MeSH terms
- Adaptation, Psychological, Adolescent, Adult, Aged, Antidepressive Agents, Behavior Therapy, Major Depressive Disorder, Female, Humans, Iran, Male, Middle Aged, Patient Dropouts, Psychiatric Status Rating Scales, Recurrence, Severity of Illness Index, Outcome Assessment, Health Care, Sertraline, Multilevel Analysis, Young Adult, Intention to Treat Analysis
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