Gedragsmatige activering bij ouderen met een depressie: een alternatieve effectieve behandeling?

Rationale: Behavioural activation (BA) has known a revival after the Jacobson study (1996). It showed that BA was equally effective as Cognitive Therapy (CT) to alleviate depression. Dimidjian (2006) replicated the findings in an RCT. A meta-analysis by Cuijpers et al. (2007) pointed in the same direction. In the elderly, psychotherapy research receives, relatively speaking, less attention, and there is also a lack of studies into psychological treatment of depression. In our experience, cognitive techniques are often not suitable for elderly patients with depression. Therefore, we wish to study the applicability of BA in elderly.
Objective: To evaluate the effectiveness of BA in reducing acute major and minor depression in elderly.
Study design: The present study will use a multiple baseline case series design. By applying multiple baseline periods over patients and comparing baseline, exploration and treatment phase a patient serves as its own control subject.
Study population: Elderly patients (60-99 yrs) with a primary diagnosis of acute major or minor depression referred to secondary mental health care (RIAGG Maastricht Elderly Care).
Intervention: BA belongs to the third-generation behavioural treatments. Based on individual case conceptualisation and functional analysis of withdrawal behaviour and ruminative thinking, an activation plan is made and implemented to activate the patient and increase reward. If indicated, skill training is offered to increase reward levels.
Primary outcome measure: GDS-15.
Secondary outcome measures: BDI-II, HRSD, BADS, post-treatment absence of major/minor depression, EuroQol, happiness question.
Ethical considerations: As BA is a component of Cognitive Behavioural Therapy (CBT), an evidence-based therapy for both adults and elderly, no adverse events are expected. If suicidal behaviour is encountered, appropriate measures will be taken.

Behavioural Activation is effective in reducing acute major and minor depression in elderly.

Weekly assessments by mail or internet
Primary outcome: GDS-15.



Face-to-face assessments at t-1 (start baseline phase, duration 6-10 weeks due to randomised variation in waiting list), t0 (start exploration phase, duration 5 weeks), t1 (start intervention phase, duration 12 weeks), t2 (mid-treatment), t3 (end-treatment) and t4 (3 months FU)
Secondary outcomes: BDI-II, BADS, HRSD, happiness, EuroQol



Pre- and post-treatment assessment
SCID-I
Checklist DSM-5 criteria major and minor depression
Patient acceptability of intervention and attrition
Medication use
Demographic variables at pre-treatment

Behavioural activation belongs to the third-generation behavioural treatments (Dimidjian & Davis 2009), and focuses at activating the patient to increase reward and at conceptualising ruminative thinking in its context and consequences. It is developed by Lewinsohn in the seventies, and showed a revival in the past 20 years when research trials and meta-analyses demonstrated its effectiveness as a stand-alone treatment method (Cuijpers et al. 2007, Dimidjian et al. 2006, Cuijpers et al. 2006). However, less evidence exists for the use of BA in elderly. We will use the book by Martell et al. (2010) as guideline in composing the BA treatment protocol for elderly, taking into account possible age-related sensory and memory problems.