scholarly journals Conditional Beliefs of Primary-Care Patients with Treatment-Resistant Depression

2015 ◽  
Vol 44 (5) ◽  
pp. 513-526
Author(s):  
Alex Burrage ◽  
Samantha Green ◽  
Katrina Turner ◽  
Willem Kuyken ◽  
Chris Williams ◽  
...  
Keyword(s):  
Primary Care ◽  
Controlled Trial ◽  
Treatment Resistant Depression ◽  
Treatment Resistant ◽  
Behaviour Therapy ◽  
Framework Analysis ◽  
Client Group ◽  
Cognitive Behaviour ◽  
Resistant Depression ◽  
High Standards

Background:Cognitive behaviour therapy (CBT) for patients with treatment-resistant depression (TRD) aims to reframe underlying conditional beliefs that are thought to maintain depression.Aim:To systematically explore conditional beliefs expressed by primary-care based patients with TRD, defined as non-response to at least 6 weeks of antidepressants.Method:Conditional beliefs (stated in an “If. . .then. . .” format) were extracted from a random sample of 50 sets of therapist notes from the CoBalT trial, a large randomized controlled trial of CBT for TRD in primary care. The beliefs were separated into their two constituent parts; the demands (Ifs) and consequences (thens). An approach based on framework analysis provided a systematic way of organizing the data, and identifying key themes.Results:Four main themes emerged from the demand part of the conditional beliefs (Ifs): 1. High standards; 2. Putting others first/needing approval; 3. Coping; and 4. Hiding “true” self. Three main themes emerged from the consequence part of the conditional beliefs (thens): 1. Defectiveness; 2. Responses of others; 3. Control of emotions.Conclusions: Identifying common themes in the conditional beliefs of patients with TRD adds to our clinical understanding of this client group, providing useful information to facilitate the complex process of collaborative case conceptualization and working with conditional beliefs within CBT interventions.

scholarly journals Comparative efficacy and acceptability of seven augmentation agents for treatment-resistant depression: A multiple-treatments meta-analysis

2014 ◽  
Vol 20 (3) ◽  
pp. 6
Author(s):  
Hong-Bo Qi ◽  
Xing Wang ◽  
Shuai Huang
Keyword(s):  
Large Scale ◽  
Controlled Trial ◽  
Meta Analysis ◽  
Tricyclic Antidepressant ◽  
Treatment Resistant Depression ◽  
Treatment Resistant ◽  
Behaviour Therapy ◽  
Cognitive Behaviour ◽  
Resistant Depression ◽  
Multiple Treatments

<p><strong>Background. </strong>Treatment-resistant depression (TRD) is a therapeutic challenge for clinicians. Augmentation pharmacotherapy is effective for TRD, but it is still unclear which augmentation agent is most efficacious. </p><p><strong>Objective.</strong> To assess the effects of seven augmentation agents on TRD. </p><p><strong>Methods. </strong>We did a multiple-treatments meta-analysis, accounting for both direct and indirect comparisons. PubMed, the Center for Clinical and Translational Research, Web of Science, Embase, CBM-disc, the Chinese National Knowledge Infrastructure and relevant websites (up to August 2013) were searched for randomised controlled trials (RCTs) about augmentation agents. The following terms were used: ‘potentiation’, ‘augmentation’, and ‘adjunct’ paired with ‘depression’ and ‘resistant depression’. No language limitation was imposed.</p><p><span><strong>Results. </strong>We systematically reviewed 12 RCTs (1 936 participants), which included seven augmentation agents</span>: lithium, tricyclic antidepressant (TCA), atypical antipsychotics (AAPs), antiepileptic drugs (AEDs), buspirone, cognitive behaviour therapy (CBT) and tri-iodothyronine (T3). The results revealed that T3 was more efficacious than lithium, TCA, AAPs, AEDs, buspirone and CBT with odds ratios (ORs) of 1.58, 1.56, 1.51, 1.47, 1.77 and 1.25, respectively. ORs favoured CBT compared with lithium, TCA, AAPs, AEDs and buspirone. Buspirone was the least efficacious of all the other augmentation agents tested. AAPs were significantly more acceptable than lithium, and CBT more than buspirone. T3 was slightly more acceptable than lithium, and CBT more than AAPs.</p><p><strong>Conclusion. </strong>T3 as an augmentation agent should be a clinician’s first consideration instead of lithium in acute treatment for TRD. CBT might be a good augmentation agent in some communities. Buspirone should be a final option as an augmentation agent. Further research is needed, such as a well-designed, large-scale controlled trial, to support and draw definite conclusions.</p>

scholarly journals Mirtazapine added to SSRIs or SNRIs for treatment resistant depression in primary care: phase III randomised placebo controlled trial (MIR)

BMJ ◽  
2018 ◽  
pp. k4218 ◽  
Author(s):  
David S Kessler ◽  
Stephanie J MacNeill ◽  
Deborah Tallon ◽  
Glyn Lewis ◽  
Tim J Peters ◽  
...  
Keyword(s):  
Primary Care ◽  
Adverse Effects ◽  
Confidence Interval ◽  
Beck Depression Inventory ◽  
Reuptake Inhibitor ◽  
Controlled Trial ◽  
Phase Iii ◽  
Treatment Resistant Depression ◽  
Treatment Resistant ◽  
Resistant Depression

AbstractObjectiveTo investigate the effectiveness of combining mirtazapine with serotonin-noradrenaline reuptake inhibitor (SNRI) or selective serotonin reuptake inhibitor (SSRI) antidepressants for treatment resistant depression in primary care.DesignTwo parallel group multicentre phase III randomised placebo controlled trial.Setting106 general practices in four UK sites; Bristol, Exeter, Hull, and Keele/North Staffs, August 2013 to October 2015.Participants480 adults aged 18 or more years who scored 14 or more on the Beck depression inventory, second revision, fulfilled ICD-10 (international classification of diseases, 10th revision) criteria for depression, and had used an SSRI or SNRI for at least six weeks but were still depressed. 241 were randomised to mirtazapine and 239 to placebo, both given in addition to usual SSRI or SNRI treatment. Participants were stratified by centre and minimised by baseline Beck depression inventory score, sex, and current psychological therapy. They were followed up at 12, 24, and 52 weeks. 431 (89.8%) were included in the (primary) 12 week follow-up.Main outcome measuresDepressive symptoms at 12 weeks after randomisation, measured using the Beck depression inventory II score as a continuous variable. Secondary outcomes included measures of anxiety, quality of life, and adverse effects at 12, 24, and 52 weeks.ResultsBeck depression inventory II scores at 12 weeks were lower in the mirtazapine group after adjustment for baseline scores and minimisation or stratification variables, although the confidence interval included the null (mean (SD) scores at 12 weeks: 18.0 (12.3) in the mirtazapine group, 19.7 (12.4) in the placebo group; adjusted difference between means −1.83 (95% confidence interval −3.92 to 0.27); P=0.09). Adverse effects were more common in the mirtazapine group and were associated with the participants stopping the trial drug.ConclusionThis study did not find evidence of a clinically important benefit for mirtazapine in addition to an SSRI or SNRI over placebo in a treatment resistant group of primary care patients with depression. This remains an area of important unmet need where evidence of effective treatment options is limited.Trial registrationCurrent Controlled TrialsISRCTN06653773.

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