The Efficacy of Cognitive Therapy in Depression: A Treatment Trial Using Cognitive Therapy and Pharmacotherapy, each Alone and in Combination

1981 ◽  
Vol 139 (3) ◽  
pp. 181-189 ◽  
Author(s):  
I. M. Blackburn ◽  
S. Bishop ◽  
A. I. M. Glen ◽  
L. J. Whalley ◽  
J. E. Christie
Keyword(s):  
General Practice ◽  
Drug Treatment ◽  
Cognitive Therapy ◽  
Cognitive Theory ◽  
Antidepressant Drug ◽  
Antidepressant Drugs ◽  
Extensive Study ◽  
Response To Treatment ◽  
Treatment Trial ◽  
Independent Observer

SummaryWe report an extensive study which compares cognitive therapy, antidepressant drugs and a combination of these two, in depressed patients seen either in general practice or an out-patient department. One-hundred and forty patients were screened for primary major depression and 64 patients completed the trial. All were rated on seven measures of mood, including independent observer-rated and self-rated depression and scales of anxiety and irritability. Patients were randomly assigned to cognitive therapy, antidepressants or a combination of the two. The antidepressant drug group did less well in both hospital and general practice and combination treatment was superior to drug treatment in both hospital and general practice. In general practice, cognitive therapy was superior to drug treatment. The presence of endogenous features did not affect response to treatment. The results are discussed in terms of Beck's cognitive theory of depression and factors of presumed causal importance of depression in general practice.

scholarly journals Trends in treatment for patients with depression in general practice in Norway, 2009–2015: nationwide registry-based cohort study (The Norwegian GP-DEP Study)

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Sabine Ruths ◽  
Inger Haukenes ◽  
Øystein Hetlevik ◽  
Tone Smith-Sivertsen ◽  
Stefan Hjørleifsson ◽  
...  
Keyword(s):  
Mental Health ◽  
Health Care ◽  
General Practice ◽  
Cohort Study ◽  
Drug Treatment ◽  
Time Trends ◽  
Older Patients ◽  
Antidepressant Drug ◽  
Depression Care ◽  
Patient Gender

Abstract Background Depression is highly prevalent, but knowledge is scarce as to whether increased public awareness and strengthened government focus on mental health have changed how general practitioners (GPs) help their depressed patients. This study aimed to examine national time trends in GP depression care and whether trends varied regarding patient gender, age, and comorbidity. Methods Nationwide registry-based cohort study, Norway. The study population comprised all residents aged 20 years or older with new depression diagnoses recorded in general practice, 2009–2015. We linked reimbursement claims data from all consultations in general practice for depression with information on demographics and antidepressant medication. The outcome was type(s) of GP depression care during 12 months from the date of diagnosis: (long) consultation, talking therapy, antidepressant drug treatment, sickness absence certification, and referral to secondary mental health care. Covariates were patient gender, age, and comorbidity. The data are presented as frequencies and tested with generalized linear models. Results We included 365,947 new depression diagnoses. Mean patient age was 44 years (SD = 16), 61.9 % were women, 41.2 % had comorbidity. From 2009 to 2015, proportions of patients receiving talking therapy (42.3–63.4 %), long consultations (56.4–71.8 %), and referral to secondary care (16.6–21.6 %) increased, while those receiving drug treatment (31.3–25.9 %) and sick-listing (58.1–50 %) decreased. The trends were different for gender (women had a greater increase in talking therapy and a smaller decrease in sick-listing, compared to men), age (working-aged patients had a smaller increase in talking therapy, a greater increase in long consultations, and a smaller decrease in antidepressant drug use, compared to older patients) and comorbidity (patients with mental comorbidity had a smaller increase in talking therapy and a greater increase in long consultations, compared to those with no comorbidity and somatic comorbidity). Conclusions The observed time trends in GP depression care towards increased provision of psychological treatment and less drug treatment and sick-listing were in the desired direction according to Norwegian health care policy. However, the large and persistent differences in treatment rates between working-aged and older patients needs further investigation.

scholarly journals GPs’ drug treatment for depression by patients’ educational level: registry-based study

BJGP Open ◽  
2021 ◽  
pp. BJGPO-2020-0122
Author(s):  
Anneli Borge Hansen ◽  
Valborg Baste ◽  
Oystein Hetlevik ◽  
Inger Haukenes ◽  
Tone Smith-Sivertsen ◽  
...  
Keyword(s):  
General Practice ◽  
Drug Treatment ◽  
Antidepressant Treatment ◽  
Antidepressant Drugs ◽  
Prescription Database ◽  
Highly Educated ◽  
Cox Proportional Hazard ◽  
Norwegian Prescription Database ◽  
To Receive

BackgroundAntidepressant drugs are often prescribed in general practice. Evidence is conflicting on how patient education influences antidepressant treatment.AimTo investigate the association between educational attainment and drug treatment in adult patients with a new depression diagnosis, and to what extent sex and age influence the association.Design & settingA nationwide registry-based cohort study was undertaken in Norway from 2014–2016.MethodThe study comprised all residents of Norway born before 1996 and alive in 2015. Information was obtained on all new depression diagnoses in general practice in 2015 (primary care database) and data on all dispensed depression medication (Norwegian Prescription Database [NorPD]) 12 months after the date of diagnosis. Independent variables were education, sex, and age. Associations with drug treatment were estimated using a Cox proportional hazard model and performed separately for sex.ResultsOut of 49 967 patients with new depression (61.6% women), 15 678 were dispensed drugs (30.4% women, 33.0% men). Highly educated women were less likely to receive medication (hazard ratio [HR] = 0.93; 95% confidence interval [CI] = 0.88 to 0.98) than women with low education. No such differences appeared among men. Women aged 20–29 years were more likely to be treated with drugs than those aged 30–59 years, and women aged ≥70 years were more likely to receive drugs (HR = 1.65; 95% CI = 1.54 to 1.77) than those aged 20–29 years. The pattern was similar but less pronounced for men.ConclusionEducational differences in antidepressant therapy among women may reflect different treatment approaches that clinicians should be aware of to avoid unintended variation. Reasons for this variation and consequences for quality of treatment should be explored.

scholarly journals The effects of drugs on human models of emotional processing: an account of antidepressant drug treatment

2015 ◽  
Vol 17 (4) ◽  
pp. 477-487 ◽  
Keyword(s):  
Drug Treatment ◽  
Emotional Processing ◽  
Antidepressant Drug ◽  
Antidepressant Drugs ◽  
Emotional Information ◽  
Subjective Change ◽  
Novel Treatments ◽  
Human Models ◽  
Drug Treatments ◽  
Antidepressant Drug Treatment

Human models of emotional processing suggest that the direct effect of successful antidepressant drug treatment may be to modify biases in the processing of emotional information. Negative biases in emotional processing are documented in depression, and single or short-term dosing with conventional antidepressant drugs reverses these biases in depressed patients prior to any subjective change in mood. Antidepressant drug treatments also modulate emotional processing in healthy volunteers, which allows the consideration of the psychological effects of these drugs without the confound of changes in mood. As such, human models of emotional processing may prove to be useful for testing the efficacy of novel treatments and for matching treatments to individual patients or subgroups of patients.

Changes in Cognition with Pharmacotherapy and Cognitive Therapy

1983 ◽  
Vol 143 (6) ◽  
pp. 609-617 ◽  
Author(s):  
I. M. Blackburn ◽  
S. Bishop
Keyword(s):  
General Practice ◽  
Cognitive Therapy ◽  
Treatment Effect ◽  
Combined Treatment ◽  
Cognitive Variables ◽  
Treatment Trial ◽  
The World ◽  
The Future ◽  
Hospital Outpatients

SummaryA treatment trial comparing cognitive therapy and pharmacotherapy, alone and in combination, in depressed out-patients, indicated that outcome on cognitive variables was similar to outcome on mood and severity measures, pharmacotherapy being less effective than cognitive therapy or the combined treatment in a hospital and a general practice sample. While combined treatment was superior to cognitive therapy in the hospital outpatients, the two treatments were equivalent in the general practice. Significant effects were obtained on measures of views of self, the world and the future, whose validity was demonstrated. The pattern of change through treatment showed the same order of progress for responders, while non-responders to cognitive therapy tended to do worst. The specificity of treatment effect is discussed.

scholarly journals General practitioners’ drug treatment for depression by patients’ educational level: registry-based study

BJGP Open ◽  
2020 ◽  
pp. BJGPO.2020.0122
Author(s):  
Anneli Borge Hansen ◽  
Valborg Baste ◽  
Oystein Hetlevik ◽  
Inger Haukenes ◽  
Tone Smith-Sivertsen ◽  
...  
Keyword(s):  
General Practice ◽  
Drug Treatment ◽  
Antidepressant Treatment ◽  
Antidepressant Drugs ◽  
Prescription Database ◽  
Highly Educated ◽  
Cox Proportional Hazard ◽  
Gender And Age ◽  
Norwegian Prescription Database ◽  
To Receive

Background: Antidepressant drugs are often prescribed in general practice. Evidence is conflicting on how patient education influences antidepressant treatment. Aim: To investigate the association between educational attainment and drug treatment in adult patients with a new depression diagnosis, and how gender and age influence the association. Design and setting: Nationwide registry-based cohort study, Norway, 2014-2016. Method: The study comprised all residents of Norway born before 1996 and alive in 2015. We obtained information on all new depression diagnoses in general practice in 2015 (Primary Care Database) and data on all dispensed depression medication (Norwegian Prescription Database) 12-months after the date of diagnosis. Independent variables were education, gender, and age. Associations with drug treatment were estimated using a Cox proportional hazard model, for genders separately. Results: Out of 49,967 patients with new depression (61.6% women), 15,678 were dispensed drugs (30.4% women, 33.0% men). Highly educated women were less likely to receive medication (Hazard Ratio (HR) =0.93, 95% CI (0.88 – 0.98)) than women with low education. No such differences appeared among men. Women aged 20-29 were more likely to be treated with drugs than those aged 30-59, and women aged 70+ were more likely to receive drugs (HR=1.65, (1.54 – 1.77)) than those aged 20-29. The pattern was similar but less pronounced for men. Conclusion: Educational differences in antidepressant therapy among women may reflect different treatment approaches that clinicians should be aware of to avoid unintended variation. Reasons for this variation and consequences for quality of treatment should be

La valutazione dei costi del trattamento farmacologico nella depressione. Una revisione critica della letteratura

1995 ◽  
Vol 4 (1) ◽  
pp. 51-66 ◽  
Author(s):  
Cesario Bellantuono ◽  
Matteo Balestrieri
Keyword(s):  
Drug Treatment ◽  
Comparative Studies ◽  
Antidepressant Drug ◽  
Antidepressant Drugs ◽  
Indirect Costs ◽  
Drop Out ◽  
Work Loss ◽  
Correct Evaluation ◽  
Antidepressant Treatments ◽  
Antidepressant Drug Treatment

SummaryAims -. To review the factors which are relevant for a correct evaluation of the costs of antidepressant drug treatment and to report the results of the studies on the efficacy, tollerability and costs of the most utilized antidepressants (tricyclics and SSRI). Methods - We reviewed the international literature concerning both with comparative studies on efficacy, tollerability and safety of tricyclics and SSRI and with studies of pharmacoeconomics that have focused on the costs of depression and of different antidepressant treatments. Results - Depression involves high costs, especially if indirect costs are considered. Comparative studies indicate a substantial equivalence of efficacy between tricyclics and SSRI, but a better tolerability of the latters. The few studies of pharmacoeconomics that have evaluated different antidepressant drugs indicate that a treatment with SSRI involves lower costs as compared with tricyclics. These results are due to the higher indirect costs (compliance, drop-out for side-effects, work loss, etc.) of tricyclics. Conclusions - A correct economic evaluation of an antidepressant drug treatment should consider both direct and indirect costs. Available studies indicate that SSRI involves lower costs as compared with tricyclics; however in order to confirm these results more studies of pharmacoeconomics are needed with experimental designes (longitudinal studies) taking into account the outcome of patients treated in routine clinical practice.

Evaluation of Myocardial Cell Damage by In-111-Monoclonal Antimyosin Antibodies in Patients Under Chronic Tricyclic Antidepressant Drug Treatment

Circulation ◽  
1995 ◽  
Vol 91 (6) ◽  
pp. 1619-1623 ◽  
Author(s):  
Vicens Martí ◽  
Manel Ballester ◽  
Claudi Udina ◽  
Ignasi Carrió ◽  
Enric Alvarez ◽  
...  
Keyword(s):  
Drug Treatment ◽  
Cell Damage ◽  
Antidepressant Drug ◽  
Myocardial Cell ◽  
Tricyclic Antidepressant ◽  
Antidepressant Drug Treatment ◽  
Myocardial Cell Damage

scholarly journals EPID-36. ANTIDEPRESSANT DRUG USE IN GLIOBLASTOMA PATIENTS: AN EPIDEMIOLOGICAL VIEW

2020 ◽  
Vol 22 (Supplement_2) ◽  
pp. ii86-ii86
Author(s):  
Dorothee Gramatzki ◽  
James Rogers ◽  
Marian Neidert ◽  
Caroline Hertler ◽  
Emilie Le Rhun ◽  
...  
Keyword(s):  
Overall Survival ◽  
Multivariate Analysis ◽  
Drug Use ◽  
Survival Data ◽  
Selective Serotonin Reuptake Inhibitors ◽  
Methylation Status ◽  
Antidepressant Drug ◽  
Antidepressant Drugs ◽  
Population Level ◽  
Disease Course

Abstract PURPOSE Antidepressant drugs have shown anti-tumor activity in preclinical glioblastoma studies. Antidepressant drug use, as well as its association with survival, in glioblastoma patients has not been well characterized on a population level. METHODS Patient characteristics, including the frequency of antidepressant drug use, were assessed in a glioblastoma cohort diagnosed in a 10-year time-frame between 2005 and 2014 in the Canton of Zurich, Switzerland. Cox proportional hazards regression models were applied for multivariate analysis. Kaplan-Meier survival curves were used to estimate overall survival data and the log-rank test was performed for comparisons. RESULTS Four hundred four patients with isocitrate dehydrogenase (IDH) wildtype glioblastoma were included in this study. Sixty-five patients (16.1%) took antidepressant drugs at some point during the disease course. Patients were most commonly prescribed selective serotonin reuptake inhibitors at any time (N=46, 70.8%). Nineteen patients (29.2%) were on antidepressant drugs at the time of their tumor diagnosis. No differences were observed in overall survival between those patients who had taken antidepressants at some point in their disease course and those who had not (p=0.356). These data were confirmed in a multivariate analysis including age, Karnofsky performance status, gender, extent of resection, O6-methylguanine DNA methyltransferase (MGMT) promoter methylation status, and first-line treatment as cofounders (p=0.315). Also, there was no association of use of drugs modulating voltage-dependent potassium channels (citalopram; escitalopram) with survival (p=0.639). CONCLUSIONS This signal-seeking study does not support the hypothesis that antidepressants have antitumor efficacy in glioblastoma on a population level.

scholarly journals Outcomes associated with modern treatment paradigms in connective tissue disease (CTD)-associated pulmonary arterial hypertension (PAH): a meta-analysis of randomized controlled trials (RCTs)

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
V McLaughlin ◽  
C Zhao ◽  
J.G Coghlan ◽  
L.S Chung ◽  
S.C Mathai ◽  
...  
Keyword(s):  
Drug Treatment ◽  
Treatment Effect ◽  
Meta Analysis ◽  
Response To Treatment ◽  
Funding Source ◽  
Class Iii ◽  
Inclusion Criteria ◽  
Private Company ◽  
Mortality Event

Abstract Background CTD-PAH has historically represented a PAH subtype with poor prognosis. New therapies, as well as combination therapy approaches targeting multiple pathways have been approved for PAH based on RCTs. CTD-PAH patients comprise a subgroup of the RCT populations and efficacy analyses are based on subgroup analyses which can be less reliable than the overall analysis. We conducted a meta-analysis of RCTs of approved PAH therapies to evaluate outcomes of patients with CTD-PAH. Purpose To use meta-analysis to determine response to treatment in patients with CTD-PAH. Methods The PubMed and EMBASE databases were searched for English-only articles published between January 1, 2000 and November 25, 2019. Inclusion criteria were multicenter RCTs that enrolled adults with WHO group 1 pulmonary hypertension (PAH); enrollment in 2000 or later; long-term clinical morbidity and/or mortality event or 6-minute walk distance (6MWD) as an efficacy endpoint reported for ≥30 patients with CTD-PAH; and evaluation of a US Food and Drug Administration-approved PAH therapy. The primary outcomes were treatment effect as measured by the study time to first morbidity or morality event and change in 6MWD from baseline to between 3–6 months, per the data provided in each article. Results from individual studies were combined using a random-effects model for overall study population (PAH patients) and the subgroup of CTD-PAH patients. Results Ten RCTs (N=4329 PAH patients; n=1263 (29%) with CTD-PAH) met inclusion criteria and were included in the meta-analysis. At baseline, PAH patients had a mean age of 50 years, approximately 78% were female, and approximately 58% had functional class III or IV disease. These characteristics were balanced between treatment and control groups. Baseline 6MWD was 356 m for the overall population and 337 m for patients with CTD-PAH. Five RCTs (N=3172; n=941 with CTD-PAH [30%]) reported hazard ratios (HRs) for time to a morbidity or mortality event by drug treatment and PAH etiology: overall population HR=0.63 (95% confidence interval [CI], 0.56–0.72; P<0.001); CTD-PAH population HR=0.64 (95% CI, 0.51–0.80; P<0.001) (Figure). Nine RCTs reported mean change with drug treatment from baseline to 3 to 6 months in 6MWD for PAH and CTD patients: 33.9 m (95% CI, 21.9–45.9; P<0.001) in the overall population; 20.2 m (95% CI, 10.8–29.7; P<0.001) in CTD-PAH patients. Conclusions The improvement in 6MWD in patients with CTD-PAH is smaller than in those with other types of PAH, perhaps reflecting comorbidities and CTD-induced mobility constraints, independent of their cardiopulmonary capacity. Data from long term clinical morbidity/mortality endpoint studies in this large group of patients with CTD-PAH demonstrate that these patients derive significant benefit from currently available PAH therapies which, in many patients, comprised the addition of a drug targeting a second or third pathway involved in the pathophysiology of PAH. Treatment effect on morbidity/mortality Funding Acknowledgement Type of funding source: Private company. Main funding source(s): Actelion Pharmaceuticals US, Inc.

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