Improving Depression Treatment in Zimbabwe by Adding Antidepressants to the Friendship Bench Therapy

What this Trial Is About

Researchers are evaluating the effect of combining the Friendship Bench intervention with nurse-led antidepressant prescribing in adults with moderate to severe depression. This randomized controlled superiority trial aims to determine if adding antidepressants to the Friendship Bench therapy improves treatment response compared to the Friendship Bench alone. The study also explores barriers and enablers to nurse-led antidepressant prescription in primary care settings in Zimbabwe, addressing the high burden of depression and limited specialist care in low-income countries. Participants will be randomly assigned to one of two groups. The control group will receive six weekly sessions of the Friendship Bench Problem Solving Therapy delivered by lay health workers. The intervention group will receive the same Friendship Bench therapy plus antidepressants prescribed by nursesFluoxetine for most participants and Sertraline for breastfeeding women. Dosages may be adjusted based on symptom improvement during treatment visits and follow-up at three months. After three months, patients with insufficient improvement may have their antidepressant dose increased. Participants will be followed for three months to assess treatment response using the PHQ-9 depression scale. Additional follow-up at six months will be open-label. Researchers will conduct interviews and focus groups to understand factors affecting nurse-led antidepressant prescribing. Safety monitoring and adherence support are included. After the study, patients will be referred to specialist care for continued treatment. The trial aims to inform mental health care scale-up in Zimbabwe and contribute to international guidelines.

The Friendship Bench Plus Trial