1. Cognitive therapies for depression in adults: let’s just stick to the facts Ioana A. Cristea

2. REEACT NIHR Highlight tends to focus on potential reasons for “disappointing” performance of cCBT. Largest study of cCBT in a primary care setting: cCBT no better than regular GP care - lack of adherence to cCBT= important outcome - is it due to cCBT being provided with minimal support? PLAUSIBLE, but cannot be inferred from this trial - minimal support might be intrinsic to the study setting

3. CoBalT CBT + antidepressant medication (ADM) was an effective and cost-effective alternative compared to usual care (which almost invariably involved antidepressants alone) for patients with treatment resistant depression

4. Proving Efficacy 1.Showing superiority of one (new) treatment over another (placebo or active) 2.Showing equivalence or non- inferiority of a new intervention relative to an already existing efficacious treatment Österreichische Cochrane Zweigstelle (ÖCZ) ∙ www.cochrane.at Department für Evidenzbasierte Medizin und Klinische Epidemiologie, Donau-Universität Krems Gerald Gartlehner

5. Definitions  Superiority trial Objective: To determine a clinically relevant difference between two interventions  Equivalence trial Objective: To determine whether a (new) intervention is neither worse nor better than another (established) intervention  Non-inferiority trial Objective: To determine whether a (new) intervention is not inferior to another (established) intervention Österreichische Cochrane Zweigstelle (ÖCZ) ∙ www.cochrane.at Department für Evidenzbasierte Medizin und Klinische Epidemiologie, Donau-Universität Krems Gerald Gartlehner

6. MBCT  Superiority trial (PREVENT): -No differences between MBCT-TS (including support to taper or discontinue antidepressants) versus maintenance antidepressants (mADM) for time to relapse or recurrence of depression over 24 months.  Non-inferiority trial (MOMENT)  MBCT (with discontinuation of antidepressant medication) versus MBCT+ mADM exceeded the inferiority margin for depressive relapse and recurrence over 15 months.

7. PREVENT- No superiority of MBCT

8. MOMENT- No non-inferiority of MBCT

9. Conclusions cCBT and MBCT: -Both cases have long moved up from the category “promising” treatments BUT - Maybe the promise has been overblown