Summary of Guideline for the Treatment of Depression

2003 ◽  
Vol 11 (1) ◽  
pp. 34-38 ◽  
Author(s):  
Pete M. Ellis ◽  
Ian B. Hickie ◽  
Don A. R. Smith
Keyword(s):  
Depressive Disorders ◽  
Severe Depression ◽  
Subsequent Treatment ◽  
Recurrent Depression ◽  
Behaviour Therapy ◽  
Mild Depression ◽  
First Line ◽  
Atypical Depression ◽  
Treatment Of Depression ◽  
Cognitive Behaviour

Depression is common, serious and treatable. The Australian and New Zealand Clinical Practice Guideline for the Treatment of Depression by Specialist Services provides evidence-based treatment guidance across the spectrum of depressive disorders and delineates where specialist treatment and primary care management is indicated. The present summary version covers the key contents of the guideline. It includes assessment, treatment and general management issues by category type and severity of depressive disorder. Algorithms of first-line and subsequent treatment choices are provided for: (i) mild depression without complications; (ii) moderately severe depression (including with comorbid anxiety) and dysthymia; (iii) uncomplicated, melancholic or atypical depression; (iv) moderately severe depression with comorbid substance abuse; (v) moderate to severe depression with physical disorders; (vi) severe depression with melancholia; (vii) recurrent depression or failure to respond to a preferred first-line treatment; and (viii) psychotic depression, and severe depression with risk of suicide. Continuing and maintenance treatments for recurrent depression are discussed. Emerging evidence of the equal value of cognitive behaviour therapy (CBT) and interpersonal psychotherapy (IPT) to pharmacological treatments for some depression is discussed, and the need to ensure that they are provided by suitably trained practitioners. Indications for hospitalization and electroconvulsive therapy (ECT) are also provided.

A critical evaluation of the role of cognitive behaviour therapy in children and adolescents with depression

2009 ◽  
Vol 2 (2) ◽  
pp. 83-91 ◽  
Author(s):  
Maura Delaney
Keyword(s):  
Children And Adolescents ◽  
Cognitive Behaviour Therapy ◽  
Depressive Disorders ◽  
Critical Evaluation ◽  
Evidence Base ◽  
Current Evidence ◽  
Behaviour Therapy ◽  
Treatment Of Depression ◽  
Cognitive Behaviour ◽  
Current Evidence Base

AbstractDepressive disorders are relatively common in adolescents although less so in younger children. They accrue significant morbidity and frequent long-term sequelae as well as increased suicide risk in sufferers. Evidence-based treatment of depression in children and adolescents is the subject of intense investigation and debate. This article reviews the current evidence base for cognitive behaviour therapy in this group and makes recommendations for further areas of research.

scholarly journals AB0167 PECULIARITIES OF INTERACTION OF CHRONIC INFLAMMATION AND DEPRESSION IN RHEUMATOID ARTHRITIS

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 1110.1-1110
Author(s):  
A. Aleksandrov ◽  
N. Aleksandrova
Keyword(s):  
Rheumatoid Arthritis ◽  
Vitamin D ◽  
Inflammatory Cytokines ◽  
Depressive Disorders ◽  
Severe Depression ◽  
Mild Depression ◽  
Group Iii ◽  
Group I ◽  
Severity Of Depression ◽  
Pro Inflammatory Cytokines

Background:In patients with rheumatoid arthritis (RA), a high prevalence of depression and anxiety is observed, and the severity of these conditions depends on the degree of vitamin D deficiency. The role of the main mediator, with the help of which psychological and physical stress factors can contribute to the development of depression and systemic diseases, has been attributed to inflammation in recent years.Objectives:to assess the dependence of depressive disorders on vitamin D deficiency and the level of pro-inflammatory cytokines in patients with RA.Methods:88 women with a reliable diagnosis of RA (mean age 54.2 ± 12.0 years old, disease duration 9.0 [3.5; 16.0] years) were under observation. Beck’s depression inventory (BDI-II) was used to assess the presence of depressive symptoms. ELISA test was used to measure serum cytokines (IL-1, IL-6) and serum 25(OH)D levels.Results:The presence of depression was found in 66% of patients with RA. An insufficient level of 25(OH)D (<30 ng / ml) was determined in 89.8% of cases. In RA patients with no signs of depression, the level of 25(OH)D showed maximum values and significantly differed from that in the groups of patients with moderate (p = 0.028) and severe depression (p <0.001). A negative correlation (r = -0.38, n = 88, p <0.05) was established between the level of 25(OH)D and the severity of depression. A positive relationship was also found between 25(OH)D and ESR (r = 0.29, n = 73, p <0.05) and a negative relationship with the number of painful joints (r = -0.29, n = 76, p <0.05). Probably, vitamin D is indirectly involved in inflammatory processes in joints and in central sensitization, which provokes chronic pain and psychological disorders in patients with RA.The level of IL-6 in patients with RA with moderate and severe depression (n=18; 14.6 ± 6.7 pg/ml) significantly exceeded the parameters of patients with RA without depressive disorders (n=30; 9.8 ± 3.7; p = 0.003). There was also a tendency to increase IL-6 in the group of patients with moderate and severe depression compared with patients with mild depression (p = 0.06). IL-1β values significantly increased with the progression of depression (without depression – mild depression, p = 0.034; mild – moderate, p <0.001; moderate – severe depression, p = 0.044). A positive correlation of average severity was revealed between the degree of depression (according to BDI-II) and the dose of glucocorticoids (GC) at the time of the study (r = 0.33, p = 0.002). An increase in the GC dose in the short term can aggravate depressive disorders in RA patients (Table 1).Table 1.Indicators of levels of depression and IL-1β depending on the dose of GCGroup I (n=26), without GCGroup II (n=45),GC <10 mg / dayGroup III (n=17),GC ≥10 mg / dayDepression level according to BDI-II, points (Me [P25; P75])8,5[5;16]14[9;17]19[14;29] *III-IIL-1β level, pg / ml (M ± SD)4,57 ± 1,83*I-II6,04 ± 3,276,52 ± 5,16* - intergroup differences are reliable, p <0.05Patients who used GC in a daily dose of ≥10 mg / day (group III) had a higher degree of depression compared to patients with RA from group I (z = -2.98; p = 0.003). In patients with RA in the first group, the level of IL-1β was significantly higher (pI-II = 0.039) than in patients with GC prescription in minimal doses (up to 10 mg / day) (Table 1). Glucocorticoid hormones suppress pro-inflammatory cytokines. As a rule, this effect is not observed in patients with depression. This fact may indicate a violation of homeostatic mechanisms. IL-1β is thought to be the first step in the pro-inflammatory response to psychological stress and is capable of inducing a subsequent cascade of other inflammatory cytokine responses.Conclusion:Restoring the normal level of 25(OH)D in the blood serum of patients with RA can positively affect psychological indicators by reducing the severity of depression and manifestations of pain. The activation of pro-inflammatory cytokines during stress and depression suggests that suppression of the inflammatory response can also reduce the symptoms of depression in RA patients.Disclosure of Interests:None declared

A Controlled Comparison of Cognitive—Behaviour Therapy, Diazepam and Placebo in the Management of Generalized Anxiety

1989 ◽  
Vol 17 (1) ◽  
pp. 1-14 ◽  
Author(s):  
K. G. Power ◽  
D. W. A. Jerrom ◽  
R. J. Simpson ◽  
M. J. Mitchell ◽  
V. Swanson
Keyword(s):  
Cognitive Behaviour Therapy ◽  
Psychological Treatment ◽  
Subsequent Treatment ◽  
Self Report ◽  
Response To Treatment ◽  
Generalized Anxiety ◽  
Behaviour Therapy ◽  
Treatment Interventions ◽  
Group Response ◽  
Cognitive Behaviour

Generalized anxiety patients were randomly allocated to Cognitive-Behaviour Therapy, Diazepam or Placebo and managed in a primary care setting. Treatments were balanced for degree of psychologist/patient contact. A range of outcome measures, including patient self report, psychologist assessor and general practitioner ratings were used. Large variations within group response to treatment emerged. At the end of active treatment the superiority of Cognitive-Behaviour Therapy was suggested. Post-study psychotropic prescription and psychological treatment was assessed at a 12-month follow-up. The Cognitive-Behaviour group revealed the lowest incidence of subsequent treatment interventions.

scholarly journals Access, accountability, and the proliferation of psychological therapy: On the introduction of the IAPT initiative and the transformation of mental healthcare

2019 ◽  
Vol 49 (4) ◽  
pp. 627-650 ◽  
Author(s):  
Martyn Pickersgill
Keyword(s):  
Mental Health ◽  
Controlled Trial ◽  
Mental Healthcare ◽  
Public Mental Health ◽  
Psychological Therapy ◽  
Behaviour Therapy ◽  
Psychological Therapies ◽  
Treatment Of Depression ◽  
Cognitive Behaviour

Psychological therapy today plays a key role in UK public mental health. In large part, this has been through the development of the (specifically English) Improving Access to Psychological Therapies (IAPT) programme. Through IAPT, millions of citizens have encountered interventions such as cognitive behaviour therapy, largely for the treatment of depression and anxiety. This article interrogates how this national response to problems of mental ill-health – and the problematization itself – was developed, accounted for, and sustained. By imbricating economic expertise with accounts of mental ill-health and mechanisms of treatment, IAPT has revivified psychological framings of pathology and therapy. However, it has done so in ways that are more familiar within biomedical contexts (e.g. through recourse to randomized controlled trial studies). Today, the initiative is a principal player in relation to which other services are increasingly developed. Indeed, in many respects IAPT has transformed from content to context within UK public mental health (in a process of what I term ‘contextification’). By documenting these developments, this paper contributes to re-centring questions about the place and role of psychology in contemporary healthcare. Doing so helps to complicate assumptions about the dominance of linear forms of (de)biomedicalization in health-systems.

Diagnosis and Treatment of Depression in the Elderly

1989 ◽  
Vol 18 (3) ◽  
pp. 211-221 ◽  
Author(s):  
Kye Y. Kim ◽  
Linda A. Hershey
Keyword(s):  
Depressive Disorders ◽  
Severe Depression ◽  
The Elderly ◽  
Diagnostic Dilemma ◽  
Memory Problems ◽  
Alzheimer Type Dementia ◽  
Dementia Patients ◽  
Treatment Of Depression ◽  
Prevalence Of Depression ◽  
Early Dementia

Depression and suicide are significant problems in the elderly, both in terms of their severity and their prevalence. It is particularly difficult to distinguish depression from early dementia, since elderly depressed patients often deny mood disorder and focus on their memory problems. This differential diagnostic dilemma is further complicated by the fact that 20 percent of Alzheimer-type dementia patients have moderate to severe depression. An even higher prevalence of depression can be seen in elderly patients with stroke or Parkinson's disease. Most all of the depressive disorders of the elderly are amenable to one form or combination of therapies: pharmacologic, electro-convulsive, or psychotherapy. Tricyclic antidepressants are often associated with adverse drug reactions in the elderly, so alternatives such as MAO inhibitors, alprazolam, bupropion and psychostimulants are currently being explored in this patient population.

Sign in / Sign up

Export Citation Format

Share Document