Optimizing treatment for depression in primary care using psychotherapy versus antidepressant medication in a low-resource setting: protocol for the OptimizeD randomized controlled trial.

Journal: BMC psychiatry
Published Date: Jul 30, 2025

Abstract

BACKGROUND: Psychotherapy and antidepressant medications are first-line treatments for depression, and they both have significant treatment effects on average. However, treatment response varies widely across patients, and neither approach is universally effective. Identifying the most effective treatment for each patient is critical everywhere, but particularly in low-resource settings where access to mental health care is limited. The Optimizing Depression (OptimizeD) trial aims to explore whether different patients respond differently to behavioral activation therapy versus antidepressant medication and if providing each patient with their optimal treatment improves outcomes in primary care.

Authors

  • Julia R Pozuelo
    Department of Global Health and Social Medicine, Harvard Medical School, Harvard University, Boston, Massachusetts.
  • Anuja Lahiri
  • Rahul S P Singh
  • Arvind Kushwah
  • Mimansa Khanduri
  • Akanksha Shukla
  • Azaz Khan
  • Sruthi G
  • Varun Shende
  • Yashika Parashar
  • Yashwant K Mehra
  • Anant Bhan
  • Ronald C Kessler
    Department of Health Care Policy, Harvard Medical School.
  • Daisy R Singla
    University of Toronto, Sinai Health System.
  • John A Naslund
    Department of Global Health and Social Medicine, Harvard Medical School, 641 Huntington Avenue, Boston, MA, 02115, USA.
  • Karmel W Choi
    Department of Psychiatry, Massachusetts General Hospital, Boston.
  • Pim Cuijpers
    Department of Clinical, Neuro, and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands; WHO Collaborating Center for Research and Dissemination of Psychological Interventions, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands; Babeș-Bolyai University, International Institute for Psychotherapy, Cluj-Napoca, Romania.
  • Robert DeRubeis
  • Mohammad M Herzallah
    Palestinian Neuroscience Initiative, Al-Quds University, Jerusalem, Palestine.
  • Chunling Lu
  • Jordan W Smoller
  • Tyler J VanderWeele
    Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.
  • Abhijit R Rozatkar
    All India Institute of Medical Sciences (AIIMS) Bhopal, Bhopal, India.
  • Tamonud Modak
    All India Institute of Medical Sciences (AIIMS) Bhopal, Bhopal, India.
  • Michelle Melwyn Joel
  • Debasis Biswas
  • Shubham Atal
  • Umay Kulsum
  • Steven D Hollon
    Vanderbilt University. Electronic address: steven.d.hollon@vanderbilt.edu.
  • Vikram Patel
    Division of Applied Regulatory Science, Office of Clinical Pharmacology, Center for Drugs Evaluation and Research, US Food and Drug Administration.

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