scholarly journals A Meta-Analyses of Cranial Electrotherapy Stimulation in the Treatment of Depression

2020 ◽  
Author(s):  
Larry Price ◽  
Josh Briley ◽  
Steve Haltiwanger ◽  
Rita Hitching
Keyword(s):  
Cranial Electrotherapy Stimulation ◽  
Treatment Of Depression ◽  
Meta Analyses

scholarly journals What we know, what we do not know, and where are we heading? Efficacy and acceptability of psychological interventions for depression

2015 ◽  
Vol 25 (4) ◽  
pp. 301-308 ◽  
Author(s):  
N. Solomonov ◽  
J. P. Barber
Keyword(s):  
Randomized Clinical Trials ◽  
Behavioural Therapy ◽  
Drop Out ◽  
Interpersonal Therapy ◽  
Problem Solving Therapy ◽  
Cognitive Behavioural ◽  
Treatment Of Depression ◽  
Personalised Treatment ◽  
Meta Analyses ◽  
And Control

In the past several decades, increasing evidence supports the efficacy of psychotherapies for depression. The vast majority of findings from meta-analyses, randomized clinical trials (RCTs) and naturalistic studies have demonstrated that well-established psychotherapies (behavioural activation, problem-solving therapy, psychodynamic therapy, cognitive-behavioural therapy, interpersonal therapy and emotion-focused therapy) are superior to no-treatment and control conditions, and are in most cases equally effective in treating depression. However, despite this abundant support for psychotherapies, studies have also consistently shown high drop-out rates, high percentages of non-respondent patients who experience treatment failures, and mixed findings regarding the enduring effects of psychotherapy. Thus, there is a need to develop more personalised treatment models tailored to patients’ needs. A new integrative sequential stepwise approach to the treatment of depression is suggested.

Depression, demoralization, and suicidality

2015 ◽  
Author(s):  
David W. Kissane ◽  
Matthew Doolittle
Keyword(s):  
Symptom Control ◽  
Combined Treatment ◽  
Mental Condition ◽  
Medical Treatments ◽  
Cognitive Behavioural ◽  
Treatment Of Depression ◽  
Screening For Distress ◽  
Behavioural Therapies ◽  
Meta Analyses ◽  
Anxiety Depression

The development of clinical depression is common during palliative care, adversely affects quality of life and adherence to medical treatments, yet regrettably can pass unrecognized. Screening for distress as the sixth vital sign is therefore highly recommended. Demoralization is another form of distress where the apparent pointlessness of continued life may lead to suicidal thinking. As the mental condition deteriorates, co-morbid states of anxiety, depression, and demoralization become more likely. Rates of suicide are increased with advanced cancer and poor symptom control. Fortunately, combined treatment with medication and counselling is effective in ameliorating depression, demoralization, and suicidality. Meta-analyses of psychotherapy trials confirm clear benefits, with behavioural activation, supportive, interpersonal, and cognitive behavioural therapies all making contributions. Group, couple, and family therapies optimize support for all involved. All members of the multidisciplinary team contribute to the active treatment of depression, demoralization, and the prevention of suicide.

On Chemical Imbalances, Antidepressants, and the Diagnosis of Depression

2009 ◽  
Vol 11 (3) ◽  
pp. 199-214 ◽  
Author(s):  
Allan M. Leventhal ◽  
David O. Antonuccio
Keyword(s):  
Disease Model ◽  
Medical Model ◽  
Antidepressant Drugs ◽  
Standard Of Care ◽  
Economic Interests ◽  
Negative Results ◽  
Receptor Sites ◽  
Treatment Of Depression ◽  
Meta Analyses ◽  
Chemical Imbalance

Over the past 30 years psychiatry has made a paradigm shift within a medical model from a psychological to a biological explanation for mental disorder. Depression is attributed to an imbalance of monoamines in the brain caused by depletion of neurotransmitters at receptor sites. The standard of care for treating depression is prescription of antidepressant medications alleged to correct this chemical imbalance. Research results testing the chemical imbalance theories for depression have been contradictory to the theories. Analyses of data from studies and meta-analyses of the efficacy of antidepressants indicate selective publication fostering an inflated impression of effectiveness and that antidepressants offer little more than placebos. Several sources of error, particularly breaking of the blind, may have determined outcome in studies showing drug/placebo differences. Despite negative results regarding the theory and pharmacotherapy for depression, the frequency of diagnoses of depression and prescription of antidepressant drugs have increased enormously. Economic interests more than science appear to be determining the treatment of depression. Prescription of antidepressant drugs as the standard of care for depression warrants reconsideration. A biopsychosocial model may be more useful than a disease model for conceptualizing and treating depression.

scholarly journals Pharmacological interventions for people with depression and chronic physical health problems: systematic review and meta-analyses of safety and efficacy

2011 ◽  
Vol 198 (3) ◽  
pp. 179-188 ◽  
Author(s):  
David Taylor ◽  
Nicholas Meader ◽  
Victoria Bird ◽  
Steve Pilling ◽  
Francis Creed ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Systematic Review ◽  
Physical Health ◽  
Selective Serotonin Reuptake Inhibitors ◽  
Health Problems ◽  
Treatment Of Depression ◽  
First Choice ◽  
Physical Health Problems ◽  
Meta Analyses

BackgroundAntidepressant drugs are widely used in the treatment of depression in people with chronic physical health problems.AimsTo examine evidence related to efficacy, tolerability and safety of antidepressants for people with depression and with chronic physical health problems.MethodMeta-analyses of randomised controlled efficacy trials of antidepressants in depression in chronic physical health conditions. Systematic review of safety studies.ResultsSixty-three studies met inclusion criteria (5794 participants). In placebo-controlled studies, antidepressants showed a significant advantage in respect to remission and/or response: selective serotonin reuptake inhibitors (SSRIs) risk ratio (RR) = 0.81 (95% CI 0.73–0.91) for remission, RR = 0.83 (95% CI 0.71–0.97) for response; tricyclics RR = 0.70 (95% CI 0.40–1.25 (not significant)) for remission, RR = 0.55 (95% 0.43–0.70) for response. Both groups of drugs were less well tolerated than placebo (leaving study early due to adverse effects) for SSRIs RR = 1.80 (95% CI 1.16–2.78), for tricyclics RR = 2.00 (95% CI 0.99–3.57). Only SSRIs were shown to improve quality of life. Direct comparisons of SSRIs and tricyclics revealed no advantage for either group for remission, response, effect size or tolerability. Effectiveness studies suggest a neutral or beneficial effect on mortality for antidepressants in participants with recent myocardial infarction.ConclusionsAntidepressants are efficacious and safe in the treatment of depression occurring in the context of chronic physical health problems. The SSRIs are probably the antidepressants of first choice given their demonstrable effect on quality of life and their apparent safety in cardiovascular disease.

Clinical use of nutraceuticals in the adjunctive treatment of depression in mood disorders

2017 ◽  
Vol 25 (4) ◽  
pp. 369-372 ◽  
Author(s):  
Jerome Sarris
Keyword(s):  
Bipolar Depression ◽  
Unipolar Depression ◽  
Adjunctive Treatment ◽  
Current Evidence ◽  
Omega 3 ◽  
Treatment Of Depression ◽  
Study Results ◽  
Adenosyl Methionine ◽  
Meta Analyses ◽  
Cost Factors

Objectives: The aim of this paper is to detail a summary of the current evidence in this area, to better inform clinical practice. Our recent systematic reviews and meta-analyses of nutrient pharmacotherapies in the treatment unipolar depression revealed primarily positive results for replicated studies testing S-adenosyl methionine (SAMe), methylfolate, omega-3 (EPA or ethyl-EPA), and Vitamin D; with supportive isolated studies found for creatine and an amino acid combination. Mixed results were found for zinc, folic acid, Vitamin C, and tryptophan; and non-significant study results for inositol. In bipolar depression, omega-3 and N-acetyl cysteine (NAC) were found to have supportive evidence, with an isolated study using a chelated mineral formula also displaying efficacy. No major adverse effects were noted in the studies (aside from occasional minor digestive disturbances with omega-3 and NAC). Conclusions: Several clinical considerations are needed when psychiatrists are considering prescribing nutrients, including knowledge of drug interactions, supplement safety and quality issues, individual psychological and biochemical individualities, in addition to cost factors.

scholarly journals Effects of Discontinuation of Drugs Used for Augmentation Therapy on Treatment Outcomes in Depression: A Systematic Review and Meta-analysis

2020 ◽  
Author(s):  
Hideo Kato ◽  
Teruki Koizumi ◽  
Hiroyoshi Takeuchi ◽  
Hideaki Tani ◽  
Masaru Mimura ◽  
...  
Keyword(s):  
Treatment Outcomes ◽  
Meta Analysis ◽  
Statistical Significance ◽  
Augmentation Therapy ◽  
Double Blind ◽  
Randomized Controlled ◽  
Treatment Of Depression ◽  
Meta Analyses ◽  
Stabilization Period ◽  
Frequent Relapse

Abstract Introduction There has been no consensus on whether and how long add-on drugs for augmentation therapy should be continued in the treatment of depression. Methods Double-blind randomized controlled trials that examined the effects of discontinuation of drugs used for augmentation on treatment outcomes in patients with depression were identified. Meta-analyses were performed to compare rates of study withdrawal due to any reason, study-defined relapse, and adverse events between patients who continued augmentation therapy and those who discontinued it. Results Seven studies were included (n=841 for continuing augmentation therapy; n=831 for discontinuing augmentation therapy). The rate of study withdrawal due to any reason was not significantly different between the 2 groups (risk ratio [RR]=0.86, 95% confidence interval [CI]=0.69–1.08, p=0.20). Study withdrawal due to relapse was less frequent in the continuation group than in the discontinuation group (RR=0.61, 95% CI=0.40–0.92, p=0.02); however, this statistical significance disappeared when one study using esketamine as augmentation was excluded. Analysis of the data from 5 studies that included a stabilization period before randomization found less frequent relapse in the continuation group than in the discontinuation group (RR=0.47, 95% CI=0.36–0.60, p<0.01). This finding was repeated when the esketamine study was excluded. Discussion No firm conclusions could be drawn in light of the small number of studies included. Currently available evidence suggests that add-on drugs, other than esketamine, used for augmentation therapy for depression may be discontinued. This may not be the case for patients who are maintained with augmentation therapy after remission.

scholarly journals The “NICE Guideline” on the treatment of depression

2006 ◽  
Vol 15 (1) ◽  
pp. 11-15 ◽  
Author(s):  
David Goldberg
Keyword(s):  
Randomised Controlled Trials ◽  
Clinical Excellence ◽  
Stepped Care ◽  
Controlled Trials ◽  
Nice Guideline ◽  
Hierarchy Of Evidence ◽  
Treatment Of Depression ◽  
Randomised Controlled ◽  
The Uk ◽  
Meta Analyses

AbstractThe National Institute of Clinical Excellence (NICE) in the UK is responsible for producing evidence based guidelines for the treatment of most common illnesses, both physical and psychological. NICE uses a hierarchy of evidence, ranging from data from meta-analyses of randomised controlled trials (RCT's) at the apex, to the opinions of acknowledged experts at the bottom. The task of preparing guideline for depression involved us in performing clean meta-analyses of around 8,000 published RCTs of the treatment of this disorder. Where drug treatments were concerned we used three indicators of efficacy, as well as considering toxicity, tolerability and cost. We also distinguished between studies carried out in primary care, and studies in patients treated by the mental health services. We found it helpful to arrange our report in terms of a “stepped care” model, addressing the indications for patients being referred on for more specialised, and expensive, treatments. In the full guideline we included our doubts that depression was a homogenous clinical entity, and our awareness of the limitations of relying on randomised controlled trials (RCT's) as the only source of evidence. This Editorial summarises the content of the guideline on the treatment of depression and discusses how it was received and also what it did not say.

Psychological treatment of depression: Results of a series of meta-analyses

2011 ◽  
Vol 65 (6) ◽  
pp. 354-364 ◽  
Author(s):  
Pim Cuijpers ◽  
Gerhard Andersson ◽  
Tara Donker ◽  
Annemieke van Straten
Keyword(s):  
Psychological Treatment ◽  
Treatment Of Depression ◽  
Meta Analyses
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