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Shinozuka K, Tabaac BJ, Arenas A, Beutler BD, Cherian K, Evans VD, Fasano C, Muir OS. Psychedelic Therapy: A Primer for Primary Care Clinicians-N,N-Dimethyltryptamine and Ayahuasca. Am J Ther 2024; 31:e112-e120. [PMID: 38518268 DOI: 10.1097/mjt.0000000000001725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/24/2024]
Abstract
BACKGROUND N,N-dimethyltryptamine (DMT) is a naturally occurring serotonergic psychedelic found in natural plants around the globe. As the main psychoactive component in ayahuasca, which also contains monoamine oxidase inhibitors, DMT has been consumed as plant-based brew by indigenous peoples for centuries. Further research is required to delineate the therapeutic utility of DMT. AREAS OF UNCERTAINTY Although previous research has shown that DMT is synthesized endogenously, it may not be produced at physiologically relevant concentrations. Additionally, the phenomenological similarities between the DMT-induced state and near-death experiences led to the popular hypothesis that endogenous DMT is released during the dying process. However, this hypothesis continues to be debated. Generally, DMT and ayahuasca seem to be physiologically and psychiatrically safe, although ayahuasca is known to cause transient vomiting. THERAPEUTIC ADVANCES A double-blind, randomized controlled trial showed that, within 1 week, ayahuasca causes remission in 36% of patients with treatment-resistant depression. According to top-line results from a recent phase IIa trial, 57% of patients with major depressive disorder experienced remission 12 weeks after receiving a single intravenous dose of DMT. LIMITATIONS There has only been a single published double-blind randomized controlled trial on ayahuasca and 2 on DMT. All clinical trials have had small sample sizes (≤34 participants). DMT requires further research to understand its therapeutic and clinical potential as a psychedelic. CONCLUSIONS Preliminary evidence indicates that ayahuasca and DMT may be more effective than existing antidepressants for treating major depressive disorder and treatment-resistant depression.
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Affiliation(s)
- Kenneth Shinozuka
- Centre for Eudaimonia and Human Flourishing, University of Oxford, Oxford, United Kingdom
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
| | - Burton J Tabaac
- University of Nevada, Reno School of Medicine, Reno, NV
- Department of Neurology, Carson Tahoe Health, Carson City, NV
| | - Alejandro Arenas
- Department of Anesthesiology, University of Washington School of Medicine, Seattle, WA
| | - Bryce D Beutler
- University of Southern California, Keck School of Medicine, Los Angeles, CA
| | - Kirsten Cherian
- Department of Psychiatry & Behavioral Sciences, Stanford University, Palo Alto, CA
| | - Viviana D Evans
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY
| | | | - Owen S Muir
- Fermata Health, Brooklyn, New York, NY; and
- Acacia Clinics, Sunnyvale, CA
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Tan GCY, Wang Z, Tan ESE, Ong RJM, Ooi PE, Lee D, Rane N, Tey SYX, Chua SY, Goh N, Lam GW, Chakraborty A, Yew AKL, Ong SK, Kee JL, Lim XY, Hashim N, Lu SH, Meany M, Tolomeo S, Lee CA, Tan HM, Keppo J. Transdiagnostic clustering of self-schema from self-referential judgements identifies subtypes of healthy personality and depression. Front Neuroinform 2024; 17:1244347. [PMID: 38274390 PMCID: PMC10808829 DOI: 10.3389/fninf.2023.1244347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 11/06/2023] [Indexed: 01/27/2024] Open
Abstract
Introduction The heterogeneity of depressive and anxiety disorders complicates clinical management as it may account for differences in trajectory and treatment response. Self-schemas, which can be determined by Self-Referential Judgements (SRJs), are heterogeneous yet stable. SRJs have been used to characterize personality in the general population and shown to be prognostic in depressive and anxiety disorders. Methods In this study, we used SRJs from a Self-Referential Encoding Task (SRET) to identify clusters from a clinical sample of 119 patients recruited from the Institute of Mental Health presenting with depressive or anxiety symptoms and a non-clinical sample of 115 healthy adults. The generated clusters were examined in terms of most endorsed words, cross-sample correspondence, association with depressive symptoms and the Depressive Experiences Questionnaire and diagnostic category. Results We identify a 5-cluster solution in each sample and a 7-cluster solution in the combined sample. When perturbed, metrics such as optimum cluster number, criterion value, likelihood, DBI and CHI remained stable and cluster centers appeared stable when using BIC or ICL as criteria. Top endorsed words in clusters were meaningful across theoretical frameworks from personality, psychodynamic concepts of relatedness and self-definition, and valence in self-referential processing. The clinical clusters were labeled "Neurotic" (C1), "Extraverted" (C2), "Anxious to please" (C3), "Self-critical" (C4), "Conscientious" (C5). The non-clinical clusters were labeled "Self-confident" (N1), "Low endorsement" (N2), "Non-neurotic" (N3), "Neurotic" (N4), "High endorsement" (N5). The combined clusters were labeled "Self-confident" (NC1), "Externalising" (NC2), "Neurotic" (NC3), "Secure" (NC4), "Low endorsement" (NC5), "High endorsement" (NC6), "Self-critical" (NC7). Cluster differences were observed in endorsement of positive and negative words, latency biases, recall biases, depressive symptoms, frequency of depressive disorders and self-criticism. Discussion Overall, clusters endorsing more negative words tended to endorse fewer positive words, showed more negative biases in reaction time and negative recall bias, reported more severe depressive symptoms and a higher frequency of depressive disorders and more self-criticism in the clinical population. SRJ-based clustering represents a novel transdiagnostic framework for subgrouping patients with depressive and anxiety symptoms that may support the future translation of the science of self-referential processing, personality and psychodynamic concepts of self-definition to clinical applications.
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Affiliation(s)
| | | | | | - Rachel Jing Min Ong
- Faculty of Social Sciences, National University of Singapore, Singapore, Singapore
| | - Pei En Ooi
- School of Biological Sciences, National Technological University, Singapore, Singapore
| | - Danan Lee
- Yale-NUS College, Singapore, Singapore
| | - Nikita Rane
- Institute of Mental Health, Singapore, Singapore
| | | | - Si Ying Chua
- Institute of Mental Health, Singapore, Singapore
| | | | | | - Atlanta Chakraborty
- Institute of Operations Research and Analytics, National University of Singapore, Singapore, Singapore
| | - Anthony Khye Loong Yew
- Institute of Operations Research and Analytics, National University of Singapore, Singapore, Singapore
| | | | | | - Xin Ying Lim
- Faculty of Social Sciences, National University of Singapore, Singapore, Singapore
| | - Nawal Hashim
- Institute of Mental Health, Singapore, Singapore
| | | | - Michael Meany
- Singapore Institute for Clinical Sciences, A*STAR, Singapore, Singapore
| | - Serenella Tolomeo
- Institute of High Performance Computing (IHPC), Agency for Science, Technology and Research (A*STAR), Singapore, Singapore
| | | | - Hong Ming Tan
- Institute of Operations Research and Analytics, National University of Singapore, Singapore, Singapore
| | - Jussi Keppo
- Institute of Operations Research and Analytics, National University of Singapore, Singapore, Singapore
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Heinzel S, Schwefel M, Sanchez A, Heinen D, Fehm L, Henze R, Terán C, Kallies G, Rapp MA, Fydrich T, Ströhle A, Heissel A. Physical exercise training as preceding treatment to cognitive behavioral therapy in mild to moderate major depressive disorder: A randomized controlled trial. J Affect Disord 2022; 319:90-98. [PMID: 36113693 DOI: 10.1016/j.jad.2022.09.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 07/28/2022] [Accepted: 09/11/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Many patients with major depressive disorder (MDD) remain untreated or do not respond to cognitive behavioral therapy (CBT). Physical exercise shows antidepressive effects and may serve as an effective augmentation treatment. However, research on combining exercise with CBT is sparse in MDD and underlying mechanisms of exercise are not well understood to date. METHODS 120 outpatients with MDD were randomized to either a high intensity exercise group (HEX), a low intensity exercise group (LEX), or a waiting list control group (WL). After 12 weeks of exercise training or waiting period, all patients received a manualized CBT. RESULTS Seventy-five patients with MDD completed both the exercise program/ waiting period and the CBT. While physical fitness improved in HEX after the exercise program, it did not change in LEX and WL. Depressive symptoms improved in all three groups from baseline to post-CBT and the group by time interaction was not significant. Regression analyses revealed that the amount of fitness improvement during exercise predicted the subsequent CBT response. LIMITATIONS The dropout rate was relatively high, preparatory CBT sessions during exercise / waiting period may have influenced depressive symptoms, and no patients with severe MDD were included. CONCLUSIONS High intense physical exercise did not lead to a general enhancement of CBT outcome, but higher increases in physical fitness seem to improve symptom change during CBT. Our results suggest that the implementation of more individually tailored exercise programs could be a promising approach for future research and clinical practice.
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Affiliation(s)
- Stephan Heinzel
- Clinical Psychology and Psychotherapy, Department of Education and Psychology, Freie Universität Berlin, Berlin, Germany.
| | - Melanie Schwefel
- Clinical Psychology and Psychotherapy, Department of Education and Psychology, Freie Universität Berlin, Berlin, Germany
| | - Alba Sanchez
- Social and Preventive Medicine, University of Potsdam, Potsdam, Germany
| | - Darlene Heinen
- Social and Preventive Medicine, University of Potsdam, Potsdam, Germany
| | - Lydia Fehm
- Department of Psychology, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Romy Henze
- Department of Psychology, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Christina Terán
- Social and Preventive Medicine, University of Potsdam, Potsdam, Germany
| | - Gunnar Kallies
- Department of Psychiatry and Psychotherapy, Campus Charité Mitte, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Michael A Rapp
- Social and Preventive Medicine, University of Potsdam, Potsdam, Germany
| | - Thomas Fydrich
- Department of Psychology, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Andreas Ströhle
- Department of Psychiatry and Psychotherapy, Campus Charité Mitte, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Andreas Heissel
- Social and Preventive Medicine, University of Potsdam, Potsdam, Germany
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Gao L, Zheng WY, Yang WL, Zhang XR. Drug-drug salt forms of vortioxetine with mefenamic acid and tolfenamic acid. J Mol Struct 2022. [DOI: 10.1016/j.molstruc.2022.133725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Tarutani S, Omori M, Ido Y, Yano M, Komatsu T, Okamura T. Effects of 4G-beta-D-Galactosylsucrose in patients with depression: A randomized, double-blinded, placebo-controlled, parallel-group comparative study. J Psychiatr Res 2022; 148:110-120. [PMID: 35123322 DOI: 10.1016/j.jpsychires.2022.01.059] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 12/24/2021] [Accepted: 01/26/2022] [Indexed: 12/20/2022]
Abstract
Advances in genetic research on microbiome have led to several trials on the effectiveness of synbiotics or probiotics in patients with depression; however, none have evaluated the efficacy of prebiotics. 4G-beta-D-Galactosylsucrose (Lactosucrose, LS) is selectively assimilated by Bifidobacterium as a prebiotic and improves microbiome diversity. However, as it is not clear if LS consumption can improve symptoms of depression, we investigated whether LS intake can improve depressive symptoms, quality of life (QOL), and self-efficacy by conducting a single cite, double-blinded, randomized controlled trial in 20 outpatients with depressive episodes (F32, ICD-10) for 24 weeks. Participants (age range, 36-72 years) were randomized to the LS (n = 9) or placebo groups (n = 11). Primary outcome was improvement in total Montgomery Asberg Depression Rating Scale (MADRS) score, and the secondary outcomes were MADRS subscores, global self-efficacy scale (GSES) score, World Health Organization QOL (WHO/QOL-26) score, and 16S rRNA analysis of the fecal microbiome. LS consumption did not significantly improve total MADRS scores (-2 (-16 to 16) vs 0 (-6 to 10), p = 0.552), but GSES tended to improve in the LS group (2.00 ± 4.24 vs -1.36 ± 4.15, p = 0.091) with a large effect size (Cohen's d = 0.802). Sequencing of 16S rRNA revealed individual-level differences in microbiome diversity changes due to the intervention. Thus, we show that LS intake can improve self-efficacy, but not depressive symptoms, even in a small sample. Additional studies that also regulate diet and ensure adherence may help determine a correlation between depression and the gut microbiome.
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Affiliation(s)
- Seiichiro Tarutani
- Department of Psychiatry, Shin-Abuyama Hospital, Osaka Institute of Clinical Psychiatry, 4-10-1, Nasahara, Takatsuki, Osaka, 569-1041, Japan.
| | - Maiko Omori
- Faculty of Human Life and Science, Doshisha Women's College, Teramachi Nishiiru, Imadegawa-dori, Kamigyo-ku, Kyoto, 602-0893, Japan; Department of Food Science and Nutrition, Faculty of Agriculture, Kinki University, 3327-204 Nakamachi, Nara, Nara, 631-8505, Japan.
| | - Yumiko Ido
- Faculty of Health and Nutrition Baika Women's University, 2-19-5, Shukunosho, Ibaraki, Osaka, 567-0051, Japan; Department of Food and Nutrition, Faculty of Home Economies, Kyoto Women's University, 35 Kitahiyoshi-cho, Imakumano, Higashiyama-ku, Kyoto, 605-8501, Japan.
| | - Megumu Yano
- Research Institute for Nutrition Sciences, Mukogawa Women's University, 6-46, Ikebiraki, Nishinomiya, Hyogo, 663-8558, Japan.
| | - Tatsushi Komatsu
- Faculty of Human Life and Science, Doshisha Women's College, Teramachi Nishiiru, Imadegawa-dori, Kamigyo-ku, Kyoto, 602-0893, Japan.
| | - Takehiko Okamura
- Department of Psychiatry, Shin-Abuyama Hospital, Osaka Institute of Clinical Psychiatry, 4-10-1, Nasahara, Takatsuki, Osaka, 569-1041, Japan.
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Dalhuisen I, Smit F, Spijker J, van Oostrom I, van Exel E, van Mierlo H, de Waardt D, Arns M, Tendolkar I, van Eijndhoven P. rTMS combined with CBT as a next step in antidepressant non-responders: a study protocol for a randomized comparison with current antidepressant treatment approaches. BMC Psychiatry 2022; 22:88. [PMID: 35123427 PMCID: PMC8818163 DOI: 10.1186/s12888-022-03732-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 01/26/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Major depressive disorder (MDD) is one of the most common psychiatric disorders, however, current treatment options are insufficiently effective for about 35% of patients, resulting in treatment-resistant depression (TRD). Repetitive transcranial magnetic stimulation (rTMS) is a form of non-invasive neuromodulation that is effective in treating TRD. Not much is known about the comparative efficacy of rTMS and other treatments and their timing within the treatment algorithm, making it difficult for the treating physician to establish when rTMS is best offered as a treatment option. This study aims to investigate the (cost-)effectiveness of rTMS (in combination with cognitive behavioral therapy (CBT) and continued antidepressant medication), compared to the next step in the treatment algorithm. This will be done in a sample of patients with treatment resistant non-psychotic unipolar depression. METHODS In this pragmatic multicenter randomized controlled trial 132 patients with MDD are randomized to either rTMS or the next pharmacological step within the current treatment protocol (a switch to a tricyclic antidepressant or augmentation with lithium or a second-generation antipsychotic). Both groups also receive CBT. The trial consists of 8 weeks of unblinded treatment followed by follow-up of the cohort at four and 6 months. A subgroup of patients (n = 92) will have an extended follow-up at nine and 12 months to assess effect decay or retention. We expect that rTMS is more (cost-)effective than medication in reducing depressive symptoms in patients with TRD. We will also explore the effects of both treatments on symptoms associated with depression, e.g. anhedonia and rumination, as well as the effect of expectations regarding the treatments on its effectiveness. DISCUSSION The present trial aims to inform clinical decision making about whether rTMS should be considered as a treatment option in patients with TRD. The results may improve treatment outcomes in patients with TRD and may facilitate adoption of rTMS in the treatment algorithm for depression and its implementation in clinical practice. TRIAL REGISTRATION This trial is registered within the Netherlands Trial Register (code: NL7628 , date: March 29th 2019).
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Affiliation(s)
- Iris Dalhuisen
- Department of Psychiatry, Radboud University Medical Center, Nijmegen, The Netherlands. .,Donders Institute for Brain Cognition and Behavior, Centre for Medical Neuroscience, Nijmegen, The Netherlands.
| | - Filip Smit
- grid.509540.d0000 0004 6880 3010Department of Clinical Psychology and Department of Epidemiology and Biostatistics, Amsterdam University Medical Centers, location VUmc, Amsterdam, The Netherlands ,grid.416017.50000 0001 0835 8259Department of Mental Health and Prevention, Trimbos Institute - Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands
| | - Jan Spijker
- grid.491369.00000 0004 0466 1666Depression Expertise Centre, Pro Persona Mental Health Care, Nijmegen, The Netherlands ,grid.5590.90000000122931605Behavioral Science Institute, Radboud University, Nijmegen, The Netherlands
| | | | - Eric van Exel
- grid.420193.d0000 0004 0546 0540Department of Psychiatry, GGZ inGeest Specialized Mental Health Care, Amsterdam, Netherlands
| | - Hans van Mierlo
- grid.415960.f0000 0004 0622 1269Department of Psychiatry & Psychology, St. Antonius Hospital, Utrecht/Nieuwegein, The Netherlands
| | - Dieuwertje de Waardt
- grid.416373.40000 0004 0472 8381Department of Psychiatry, ETZ Hospital (Elisabeth-TweeSteden Ziekenhuis), Tilburg, The Netherlands
| | - Martijn Arns
- grid.476937.8Research Institute Brainclinics, Nijmegen, The Netherlands ,grid.5012.60000 0001 0481 6099Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, the Netherlands
| | - Indira Tendolkar
- grid.10417.330000 0004 0444 9382Department of Psychiatry, Radboud University Medical Center, Nijmegen, The Netherlands ,grid.5590.90000000122931605Donders Institute for Brain Cognition and Behavior, Centre for Medical Neuroscience, Nijmegen, The Netherlands
| | - Philip van Eijndhoven
- grid.10417.330000 0004 0444 9382Department of Psychiatry, Radboud University Medical Center, Nijmegen, The Netherlands ,grid.5590.90000000122931605Donders Institute for Brain Cognition and Behavior, Centre for Medical Neuroscience, Nijmegen, The Netherlands
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Olarte SW, Teo DCL, Alfonso CA. Intermittent Treatment with the Psychodynamic Psychiatrist: A Patient-Centered Approach. Psychodyn Psychiatry 2021; 48:314-336. [PMID: 32996848 DOI: 10.1521/pdps.2020.48.3.314] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
This study examines the experiences of patients in treatment with psychodynamic psychiatrists on an intermittent basis following an initial brief period of intensive psychotherapy and stabilization. Patients with non-psychotic disorders who received intermittent treatment answered a web-based questionnaire describing the usefulness of various supportive, cognitive-behavioral, and psychodynamic interventions. Forty-eight out of 58 patients invited to participate completed the survey (83% response rate). The majority (75%) of respondents welcomed the intermittent treatment frame. Therapeutic factors deemed to be most helpful included supportive interventions such as ability to relate to the clinician, ability of clinician to listen empathically, and feeling supported by a non-judgemental therapist when talking about private matters. The majority of respondents also endorsed as highly beneficial various cognitive-behavioral interventions such as understanding how thinking patterns impact behavior and feelings and discussing alternative coping skills. Also highly rated were psychodynamic interventions, including understanding how the present is modeled from past experiences and expression and regulation of affect. In the open-ended qualitative feedback, therapeutic factors including collaboration, forming an alliance, and empathic attunement emerged as important. Our preliminary findings suggest that the intermittent psychodynamic treatment frame is well received by patients. Patients welcome integration of different psychotherapeutic approaches to individualize treatment. The common factors in psychotherapy are important patient-reported therapeutic factors in the intermittent treatment approach.
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Affiliation(s)
| | - David C L Teo
- Consultant Psychiatrist, Changi General Hospital, Singapore
| | - César A Alfonso
- Associate Professor of Psychiatry, Columbia University Medical Center; Adjunct Professor, University of Indonesia; Visiting Professor, National University of Malaysia
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Davis AK, Barrett FS, May DG, Cosimano MP, Sepeda ND, Johnson MW, Finan PH, Griffiths RR. Effects of Psilocybin-Assisted Therapy on Major Depressive Disorder: A Randomized Clinical Trial. JAMA Psychiatry 2021; 78:481-489. [PMID: 33146667 PMCID: PMC7643046 DOI: 10.1001/jamapsychiatry.2020.3285] [Citation(s) in RCA: 509] [Impact Index Per Article: 169.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
IMPORTANCE Major depressive disorder (MDD) is a substantial public health burden, but current treatments have limited effectiveness and adherence. Recent evidence suggests that 1 or 2 administrations of psilocybin with psychological support produces antidepressant effects in patients with cancer and in those with treatment-resistant depression. OBJECTIVE To investigate the effect of psilocybin therapy in patients with MDD. DESIGN, SETTING, AND PARTICIPANTS This randomized, waiting list-controlled clinical trial was conducted at the Center for Psychedelic and Consciousness Research at Johns Hopkins Bayview Medical Center in Baltimore, Maryland. Adults aged 21 to 75 years with an MDD diagnosis, not currently using antidepressant medications, and without histories of psychotic disorder, serious suicide attempt, or hospitalization were eligible to participate. Enrollment occurred between August 2017 and April 2019, and the 4-week primary outcome assessments were completed in July 2019. A total of 27 participants were randomized to an immediate treatment condition group (n = 15) or delayed treatment condition group (waiting list control condition; n = 12). Data analysis was conducted from July 1, 2019, to July 31, 2020, and included participants who completed the intervention (evaluable population). INTERVENTIONS Two psilocybin sessions (session 1: 20 mg/70 kg; session 2: 30 mg/70 kg) were given (administered in opaque gelatin capsules with approximately 100 mL of water) in the context of supportive psychotherapy (approximately 11 hours). Participants were randomized to begin treatment immediately or after an 8-week delay. MAIN OUTCOMES AND MEASURES The primary outcome, depression severity was assessed with the GRID-Hamilton Depression Rating Scale (GRID-HAMD) scores at baseline (score of ≥17 required for enrollment) and weeks 5 and 8 after enrollment for the delayed treatment group, which corresponded to weeks 1 and 4 after the intervention for the immediate treatment group. Secondary outcomes included the Quick Inventory of Depressive Symptomatology-Self Rated (QIDS-SR). RESULTS Of the randomized participants, 24 of 27 (89%) completed the intervention and the week 1 and week 4 postsession assessments. This population had a mean (SD) age of 39.8 (12.2) years, was composed of 16 women (67%), and had a mean (SD) baseline GRID-HAMD score of 22.8 (3.9). The mean (SD) GRID-HAMD scores at weeks 1 and 4 (8.0 [7.1] and 8.5 [5.7]) in the immediate treatment group were statistically significantly lower than the scores at the comparable time points of weeks 5 and 8 (23.8 [5.4] and 23.5 [6.0]) in the delayed treatment group. The effect sizes were large at week 5 (Cohen d = 2.5; 95% CI, 1.4-3.5; P < .001) and week 8 (Cohen d = 2.6; 95% CI, 1.5-3.7; P < .001). The QIDS-SR documented a rapid decrease in mean (SD) depression score from baseline to day 1 after session 1 (16.7 [3.5] vs 6.3 [4.4]; Cohen d = 2.6; 95% CI, 1.8-3.5; P < .001), which remained statistically significantly reduced through the week 4 follow-up (6.0 [5.7]; Cohen d = 2.3; 95% CI, 1.5-3.0; P < .001). In the overall sample, 17 participants (71%) at week 1 and 17 (71%) at week 4 had a clinically significant response to the intervention (≥50% reduction in GRID-HAMD score), and 14 participants (58%) at week 1 and 13 participants (54%) at week 4 were in remission (≤7 GRID-HAMD score). CONCLUSIONS AND RELEVANCE Findings suggest that psilocybin with therapy is efficacious in treating MDD, thus extending the results of previous studies of this intervention in patients with cancer and depression and of a nonrandomized study in patients with treatment-resistant depression. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT03181529.
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Affiliation(s)
- Alan K. Davis
- Center for Psychedelic and Consciousness Research, Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland,College of Social Work, The Ohio State University, Columbus
| | - Frederick S. Barrett
- Center for Psychedelic and Consciousness Research, Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Darrick G. May
- Center for Psychedelic and Consciousness Research, Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Mary P. Cosimano
- Center for Psychedelic and Consciousness Research, Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Nathan D. Sepeda
- Center for Psychedelic and Consciousness Research, Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Matthew W. Johnson
- Center for Psychedelic and Consciousness Research, Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Patrick H. Finan
- Center for Psychedelic and Consciousness Research, Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Roland R. Griffiths
- Center for Psychedelic and Consciousness Research, Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland,Department of Neuroscience, Johns Hopkins School of Medicine, Baltimore, Maryland
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Steffen PR, Bartlett D, Channell RM, Jackman K, Cressman M, Bills J, Pescatello M. Integrating Breathing Techniques Into Psychotherapy to Improve HRV: Which Approach Is Best? Front Psychol 2021; 12:624254. [PMID: 33658964 PMCID: PMC7917055 DOI: 10.3389/fpsyg.2021.624254] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 01/14/2021] [Indexed: 01/04/2023] Open
Abstract
Introduction Approaches to improve heart rate variability and reduce stress such as breathing retraining are more frequently being integrated into psychotherapy but little research on their effectiveness has been done to date. Specifically, no studies to date have directly compared using a breathing pacer at 6 breaths per minute with compassion focused soothing rhythm breathing. Current Study In this randomized controlled experiment, 6 breaths per minute breathing using a pacer was compared with compassion focused soothing rhythm breathing, with a nature video being used as a control group condition. Methods Heart rate variability (HRV) measures were assessed via electrocardiogram (ECG) and respiration belt, and an automated blood pressure machine was used to measure systolic diastolic blood pressure, and heart rate (HR). A total of 96 participants were randomized into the three conditions. Following a 5-min baseline, participants engaged in either 6 breath per minute breathing, soothing rhythm breathing, or watched a nature video for 10 min. To induce a stressful state, participants then wrote for 5 min about a time they felt intensely self-critical. Participants then wrote for 5 min about a time they felt self-compassionate, and the experiment ended with a 10-min recovery period. Results Conditions did not significantly differ at baseline. Overall, HRV, as measured by standard deviation of NN intervals (SDNN), low frequency HRV (LF HRV), and LF/HF ratio, increased during the intervention period, decreased during self-critical writing, and then returned to baseline levels during the recovery period. High frequency HRV (HF HRV) was not impacted by any of the interventions. The participants in the 6 breath per minute pacer condition were unable to consistently breathe at that rate and averaged about 12 breaths per minute. Time by Condition analyses revealed that both the 6 breaths per minute pacer and soothing breathing rhythm conditions lead to significantly higher SDNN than the nature video condition during breathing practice but there were no significant differences between conditions in response to the self-critical and self-compassionate writing or recovery periods. The 6 breath per minute pacer condition demonstrated a higher LF HRV and LF/HF ratio than the soothing rhythm breathing condition, and both intervention conditions had a higher LF HRV and LF/HF ratio than the nature video. Conclusions Although the 6 breath per minute pacer condition participants were not able to breath consistently at the low pace, both the participants attempting to breathe at 6 breaths per minute as well as those in the soothing rhythm breathing condition effectively increased HR variability as measured by SDNN, and attempting to breathe at 6 breaths per minute led to the highest LF HRV and LF/HF ratio. Both breathing approaches impacted HRV more than watching a relaxing nature video and can potentially be used as key adjuncts in psychotherapy to aid in regulating physiological functioning, although it appears that consistent breathing practice would be needed.
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Affiliation(s)
- Patrick R Steffen
- Department of Psychology, Brigham Young University, Provo, UT, United States
| | - Derek Bartlett
- Department of Psychology, Brigham Young University, Provo, UT, United States
| | | | - Katelyn Jackman
- Department of Psychology, Brigham Young University, Provo, UT, United States
| | - Mikel Cressman
- Department of Psychology, Brigham Young University, Provo, UT, United States
| | - John Bills
- Department of Psychology, Brigham Young University, Provo, UT, United States
| | - Meredith Pescatello
- Department of Psychology, Brigham Young University, Provo, UT, United States
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10
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Fabbri C, Kasper S, Zohar J, Souery D, Montgomery S, Albani D, Forloni G, Ferentinos P, Rujescu D, Mendlewicz J, Serretti A, Lewis CM. Cost-effectiveness of genetic and clinical predictors for choosing combined psychotherapy and pharmacotherapy in major depression. J Affect Disord 2021; 279:722-729. [PMID: 33217644 DOI: 10.1016/j.jad.2020.10.049] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 09/09/2020] [Accepted: 10/25/2020] [Indexed: 01/02/2023]
Abstract
BACKGROUND Predictors of treatment outcome in major depressive disorder (MDD) could contribute to evidence-based therapeutic choices. Combined pharmacotherapy and psychotherapy show increased efficacy but higher cost compared with antidepressant pharmacotherapy; baseline predictors of pharmacotherapy resistance could be used to identify patients more likely to benefit from combined treatment. METHODS We performed a proof-of-principle study of the cost-effectiveness of using previously identified pharmacogenetic and clinical risk factors (PGx-CL-R) of antidepressant resistance or clinical risk factors alone (CL-R) to guide the prescription of combined pharmacotherapy and psychotherapy vs pharmacotherapy. The cost-effectiveness of these two strategies was compared with standard care (ST, pharmacotherapy to all subjects) using a three-year Markov model. Model parameters were literature-based estimates of response to pharmacotherapy and combined treatment, costs (UK National Health System) and benefits (quality-adjusted life years [QALYs], one QALY=one year lived in perfect health). RESULTS CL-R was more cost-effective than PGx-CL-R: the cost of one-QALY improvement was £2341 for CL-R and £3937 for PGx-CL-R compared to ST. PGx-CL-R had similar or better cost-effectiveness compared to CL-R when 1) the cost of genotyping was £100 per subject or less or 2) the PGx-CL-R test had sensitivity ≥ 0.90 and specificity ≥ 0.85. The cost of one-QALY improvement for CL-R was £3664 and of £4110 in two independent samples. LIMITATIONS lack of validation in large samples from the general population. CONCLUSIONS Using clinical risk factors to predict pharmacotherapy resistance and guide the prescription of pharmacotherapy combined with psychotherapy could be a cost-effective strategy.
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Affiliation(s)
- Chiara Fabbri
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, United Kingdom.
| | - Siegfried Kasper
- Department of Psychiatry and Psychotherapy, Medical University Vienna, Austria
| | - Joseph Zohar
- Department of Psychiatry, Sheba Medical Center, Tel Hashomer, and Sackler School of Medicine, Tel Aviv University, Israel
| | - Daniel Souery
- Laboratoire de Psychologie Medicale, Universitè Libre de Bruxelles and Psy Pluriel, Centre Européen de Psychologie Medicale, Brussels
| | | | - Diego Albani
- Laboratory of Biology of Neurodegenerative Disorders, Neuroscience Department, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Gianluigi Forloni
- Laboratory of Biology of Neurodegenerative Disorders, Neuroscience Department, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | | | - Dan Rujescu
- University Clinic for Psychiatry, Psychotherapy and Psychosomatic, Martin-Luther-University Halle-Wittenberg, Germany
| | | | - Alessandro Serretti
- Department of Biomedical and NeuroMotor Sciences, University of Bologna, Italy
| | - Cathryn M Lewis
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, United Kingdom
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11
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Malhi GS, Bell E, Bassett D, Boyce P, Bryant R, Hazell P, Hopwood M, Lyndon B, Mulder R, Porter R, Singh AB, Murray G. The 2020 Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for mood disorders. Aust N Z J Psychiatry 2021; 55:7-117. [PMID: 33353391 DOI: 10.1177/0004867420979353] [Citation(s) in RCA: 225] [Impact Index Per Article: 75.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
OBJECTIVES To provide advice and guidance regarding the management of mood disorders, derived from scientific evidence and supplemented by expert clinical consensus to formulate s that maximise clinical utility. METHODS Articles and information sourced from search engines including PubMed, EMBASE, MEDLINE, PsycINFO and Google Scholar were supplemented by literature known to the mood disorders committee (e.g. books, book chapters and government reports) and from published depression and bipolar disorder guidelines. Relevant information was appraised and discussed in detail by members of the mood disorders committee, with a view to formulating and developing consensus-based recommendations and clinical guidance. The guidelines were subjected to rigorous consultation and external review involving: expert and clinical advisors, key stakeholders, professional bodies and specialist groups with interest in mood disorders. RESULTS The Royal Australian and New Zealand College of Psychiatrists mood disorders clinical practice guidelines 2020 (MDcpg2020) provide up-to-date guidance regarding the management of mood disorders that is informed by evidence and clinical experience. The guideline is intended for clinical use by psychiatrists, psychologists, primary care physicians and others with an interest in mental health care. CONCLUSION The MDcpg2020 builds on the previous 2015 guidelines and maintains its joint focus on both depressive and bipolar disorders. It provides up-to-date recommendations and guidance within an evidence-based framework, supplemented by expert clinical consensus. MOOD DISORDERS COMMITTEE Gin S Malhi (Chair), Erica Bell, Darryl Bassett, Philip Boyce, Richard Bryant, Philip Hazell, Malcolm Hopwood, Bill Lyndon, Roger Mulder, Richard Porter, Ajeet B Singh and Greg Murray.
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Affiliation(s)
- Gin S Malhi
- The University of Sydney, Faculty of Medicine and Health, Northern Clinical School, Department of Psychiatry, Sydney, NSW, Australia.,Academic Department of Psychiatry, Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, NSW, Australia.,CADE Clinic, Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, NSW, Australia
| | - Erica Bell
- The University of Sydney, Faculty of Medicine and Health, Northern Clinical School, Department of Psychiatry, Sydney, NSW, Australia.,Academic Department of Psychiatry, Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, NSW, Australia.,CADE Clinic, Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, NSW, Australia
| | | | - Philip Boyce
- Department of Psychiatry, Westmead Hospital and the Westmead Clinical School, Wentworthville, NSW, Australia.,Discipline of Psychiatry, Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Richard Bryant
- School of Psychology, University of New South Wales, Sydney, NSW, Australia
| | - Philip Hazell
- Discipline of Psychiatry, Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Malcolm Hopwood
- Department of Psychiatry, University of Melbourne and Professorial Psychiatry Unit, Albert Road Clinic, Melbourne, VIC, Australia
| | - Bill Lyndon
- The University of Sydney, Faculty of Medicine and Health, Northern Clinical School, Department of Psychiatry, Sydney, NSW, Australia
| | - Roger Mulder
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - Richard Porter
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - Ajeet B Singh
- The Geelong Clinic Healthscope, IMPACT - Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Deakin University, Geelong, VIC, Australia
| | - Greg Murray
- Centre for Mental Health, Swinburne University of Technology, Hawthorn, VIC, Australia
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Kan K, Feenstra TL, de Vries SO, Visser E, Schoevers RA, Jörg F. The clinical effectiveness of an algorithm-guided treatment program for depression in specialized mental healthcare: A comparison with efficacy trials. J Affect Disord 2020; 275:216-223. [PMID: 32734911 DOI: 10.1016/j.jad.2020.07.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Revised: 09/13/2019] [Accepted: 07/04/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Doubts exist on whether effects found in randomized controlled trials (RCTs) are directly generalizable to daily clinical practice. This study aimed (a) to investigate the effectiveness of treatment options within an algorithm-guided treatment (AGT) program for depression and compare their effectiveness with outcomes of efficacy trials and (b) to assess the relation between treatment continuity and outcomes. METHODS This naturalistic study linked treatment data from January 2012 to November 2014 from a Dutch mental healthcare provider, to routine outcome monitoring (ROM) data (N = 351). Effectiveness of the treatment options (pharmacotherapy, psychotherapy and their combination) was compared to the efficacy reported in the meta-analyses. We included treatment continuity as binary variable "early terminators versus completers of the recommended number of treatment sessions". RESULTS Remission rates for psychotherapy (38% [95% CI: 32-45]), pharmacotherapy (31% [95% CI: 22-42]) and combination therapy (46% [95% CI: 19-75]) were respectively lower, comparable, and comparable to those reported in the meta-analyses. Similarly, response rates were respectively lower (24% [95% CI: 19-30]), lower (21% [95% CI: 13-31]), and comparable (46% [95% CI: 19-75]) to meta-analyses results. A similar share of early terminators and completers achieved remission and response. LIMITATIONS A substantial proportion of patients had incomplete ROM data after data linkage. Limited set of patient characteristics to check for selection bias. CONCLUSIONS Despite the more heterogeneous patient population in clinical practice, the effectiveness of an AGT program, emphasizing strict guideline adherence, approached that found in RCTs. A fixed number of treatment sessions may not suit all individual patients.
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Affiliation(s)
- Kaying Kan
- University of Groningen, University Medical Center Groningen, University Center for Psychiatry, Rob Giel Research Center, Interdisciplinary Center for Psychopathology and Emotion Regulation, Hospital Zip Code CC72, PO Box 30001, 9700 RB Groningen, the Netherlands.
| | - Talitha L Feenstra
- University of Groningen, Department of Science and Engineering, Groningen Research Institute of Pharmacy, Groningen, the Netherlands; National Institute for Public Health and the Environment (RIVM), PO Box 1, 3720 BA Bilthoven, the Netherlands
| | - Sybolt O de Vries
- The Van Andel Department of Psychiatry for the Elderly, GGZ Friesland, Borniastraat 34b, 8934 CE Leeuwarden, the Netherlands
| | - Ellen Visser
- University of Groningen, University Medical Center Groningen, University Center for Psychiatry, Rob Giel Research Center, Hospital Zip Code CC72, PO Box 30001, 9700 RB Groningen, the Netherlands
| | - Robert A Schoevers
- University of Groningen, University Medical Center Groningen, University Center for Psychiatry, Interdisciplinary Center for Psychopathology and Emotion Regulation, PO Box 30001, 9700 RB Groningen, the Netherlands
| | - Frederike Jörg
- GGZ Friesland, Research Department, PO Box 932, 8901 BS Leeuwarden, the Netherlands; University of Groningen, University Medical Center Groningen, University Center for Psychiatry, Rob Giel Research Center, Interdisciplinary Center for Psychopathology and Emotion Regulation, Hospital Zip Code CC72, PO Box 30001, 9700 RB Groningen, the Netherlands
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13
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Gambaro E, Gramaglia C, Baldon G, Chirico E, Martelli M, Renolfi A, Zeppegno P. "Gut-brain axis": Review of the role of the probiotics in anxiety and depressive disorders. Brain Behav 2020; 10:e01803. [PMID: 32910544 PMCID: PMC7559609 DOI: 10.1002/brb3.1803] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 07/01/2020] [Accepted: 07/30/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Depressive disorders are the leading cause of disability worldwide and together with anxiety contribute to a very high burden of disease. Therefore, improving their treatment is a significant medical research target: The role of probiotics is a topic of great interest for the current research in this field. OBJECTIVES To explore the current literature about the impact of probiotics on anxious and depressive symptoms. METHODS Scoping review following the PRISMA guidelines. RESULTS The selection process yielded 23 studies. Probiotics positively affected depressive symptomatology and anxiety symptoms according to 53.83% and 43.75% of the selected studies, respectively. Among the studies assessing inflammatory biomarkers, 58.31% found they were decreased after administration of probiotics. CONCLUSION The results emerging from the existing literature about probiotic supplementation for depression treatment are encouraging, but further research is needed considering the shortage of clinical trials on this topic and the heterogeneity of the samples analyzed.
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Affiliation(s)
- Eleonora Gambaro
- Department of Translational Medicine, Institute of Psychiatry, Università del Piemonte Orientale, Novara, Italy.,Psychiatry Ward, Maggiore della Carità University Hospital, Novara, Italy
| | - Carla Gramaglia
- Department of Translational Medicine, Institute of Psychiatry, Università del Piemonte Orientale, Novara, Italy.,Psychiatry Ward, Maggiore della Carità University Hospital, Novara, Italy
| | - Giulia Baldon
- Department of Translational Medicine, Institute of Psychiatry, Università del Piemonte Orientale, Novara, Italy
| | - Emilio Chirico
- Department of Translational Medicine, Institute of Psychiatry, Università del Piemonte Orientale, Novara, Italy
| | - Maria Martelli
- Department of Translational Medicine, Institute of Psychiatry, Università del Piemonte Orientale, Novara, Italy
| | - Alessia Renolfi
- Department of Translational Medicine, Institute of Psychiatry, Università del Piemonte Orientale, Novara, Italy
| | - Patrizia Zeppegno
- Department of Translational Medicine, Institute of Psychiatry, Università del Piemonte Orientale, Novara, Italy.,Psychiatry Ward, Maggiore della Carità University Hospital, Novara, Italy
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14
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Heißel A. Sporttherapie als adjuvante oder alternative Behandlung bei Depression. PSYCHOTHERAPEUT 2020. [DOI: 10.1007/s00278-020-00425-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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15
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Heissel A, Pietrek A, Schwefel M, Abula K, Wilbertz G, Heinzel S, Rapp M. STEP.De study-a multicentre cluster-randomised effectiveness trial of exercise therapy for patients with depressive symptoms in healthcare services: study protocol. BMJ Open 2020; 10:e036287. [PMID: 32295779 PMCID: PMC7200038 DOI: 10.1136/bmjopen-2019-036287] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
INTRODUCTION Although exercise therapy has widely been shown to be an efficacious treatment modality for depression, evidence for its effectiveness and cost efficiency is lacking. The Sport/Exercise Therapy for Depression study is a multicentre cluster-randomised effectiveness trial that aims to compare the effectiveness and cost efficiency of exercise therapy and psychotherapy as antidepressant treatment. METHODS AND ANALYSIS 480 patients (aged 18-65) with an International Classification of Diseases diagnosis associated with depressive symptoms are recruited. Up to 30 clusters (psychotherapists) are randomly assigned to allocate patients to either an exercise or a psychotherapy treatment as usual in a 2:1 ratio. The primary outcome (depressive symptoms) and the secondary outcomes (work and social adjustment, quality of life) will be assessed at six measurement time points (t0: baseline, t1: 8 weeks after treatment initiation, t2: 16 weeks after treatment initiation, t3/4/5: 2, 6, 12 months after treatment). Linear regression analyses will be used for the primary endpoint data analysis. For the secondary endpoints, mixed linear and logistic regression models with fixed and random factors will be added. For the cost efficiency analysis, expenditures in the 12 months before and after the intervention and the outcome difference will be compared between groups in a multilevel model. Recruitment start date was 1 July 2018 and the planned recruitment end date is 31 December 2020. ETHICS AND DISSEMINATION The study protocol was approved by the ethics committee of the University of Potsdam (No. 17/2018) and the Freie Universität Berlin (No. 206/2018) and registered in the ISRCTN registry. Informed written consent will be obtained from all participants. The study will be reported in accordance with the Consolidated Standards of Reporting Trials and the Recommendations for Interventional Trials statements. The results will be published in peer-reviewed academic journals and disseminated to the public. TRIAL REGISTRATION NUMBER ISRCTN28972230.
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Affiliation(s)
- Andreas Heissel
- Social and Preventive Medicine, Department Sport and Health Sciences, Faculty of Human Sciences, University of Potsdam, Potsdam, Brandenburg, Germany
| | - Anou Pietrek
- Social and Preventive Medicine, Department Sport and Health Sciences, Faculty of Human Sciences, University of Potsdam, Potsdam, Brandenburg, Germany
| | - Melanie Schwefel
- Social and Preventive Medicine, Department Sport and Health Sciences, Faculty of Human Sciences, University of Potsdam, Potsdam, Brandenburg, Germany
| | - Kahar Abula
- Social and Preventive Medicine, Department Sport and Health Sciences, Faculty of Human Sciences, University of Potsdam, Potsdam, Brandenburg, Germany
| | - Gregor Wilbertz
- Department of Education and Psychology, Freie Universität Berlin, Berlin, Germany
| | - Stephan Heinzel
- Department of Education and Psychology, Freie Universität Berlin, Berlin, Germany
| | - Michael Rapp
- Social and Preventive Medicine, Department Sport and Health Sciences, Faculty of Human Sciences, University of Potsdam, Potsdam, Brandenburg, Germany
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16
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DeRubeis RJ, Zajecka J, Shelton RC, Amsterdam JD, Fawcett J, Xu C, Young PR, Gallop R, Hollon SD. Prevention of Recurrence After Recovery From a Major Depressive Episode With Antidepressant Medication Alone or in Combination With Cognitive Behavioral Therapy: Phase 2 of a 2-Phase Randomized Clinical Trial. JAMA Psychiatry 2020; 77:237-245. [PMID: 31799993 PMCID: PMC6902236 DOI: 10.1001/jamapsychiatry.2019.3900] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
IMPORTANCE Antidepressant medication (ADM) maintenance treatment is associated with the prevention of depressive recurrence in patients with major depressive disorder (MDD), but whether cognitive behavioral therapy (CBT) treatment is associated with recurrence prevention remains unclear. OBJECTIVE To determine the effects of combining CBT with ADM on the prevention of depressive recurrence when ADMs are withdrawn or maintained after recovery in patients with MDD. DESIGN, SETTING, AND PARTICIPANTS A total of 292 adult outpatients with chronic or recurrent MDD who participated in the second phase of a 2-phase trial. Participants had recovered in the first phase of the trial receiving ADM, either alone or in combination with CBT. The trial was conducted in research clinics in 3 university medical centers in the United States. Patients in phase 2 were randomized to receive maintenance of or withdrawal from ADM and were followed up for 3 years. The first and last patients entered phase 2 in August 2003 and October 2009, respectively. The last patient completed phase 2 in August 2012. Data were analyzed from December 2013 to December 2018. INTERVENTIONS Maintenance of or withdrawal from treatment with ADM. MAIN OUTCOMES AND MEASURES Recurrence of an MDD episode using longitudinal interval follow-up evaluations; sustained recovery across both phases. RESULTS A total of 292 participants (171 women, 121 men; mean [SD] age 45.1 [12.9] years) were included in analyses of depressive recurrence. Maintenance ADM yielded lower rates of recurrence compared with ADM withdrawal regardless of whether patients had achieved recovery in phase 1 with ADM alone (48.5% vs 74.8%; z = -3.16; P = .002; number needed to treat [NNT], 2.8; 95% CI, 1.8-7.0) or ADM plus CBT (48.5% vs 76.7%; z = -3.49; P < .001; NNT, 2.7; 95% CI, 1.9-5.9). Sustained recovery rates differed as a function of phase 2 condition, with maintenance ADM superior to ADM withdrawal (z = 2.90; P = .004; OR, 2.54; 95% CI, 1.37-4.84; NNT, 2.3; 95% CI, 1.5-6.4). Phase 1 condition was not associated with differential rates of sustained recovery (ADM alone vs ADM plus CBT; z = 0.22; P = .83; OR, 1.08; 95% CI, 0.52-2.11; NNT, 26.0; 95% CI, number needed to harm 3.2 to NNT 2.8), nor was there a significant interaction of phase 1 condition and phase 2 condition (z = 0.30; P = .77; OR, 1.14; 95% CI, 0.49-2.88). CONCLUSIONS AND RELEVANCE Maintenance ADM treatment, but not previous exposure to CBT, was associated with reduced rates of depressive recurrence. In previous studies, when CBT has been provided without ADM, CBT has shown a preventive effect on depressive relapse. Whether CBT also has a preventive effect on depressive recurrence, or if adding ADM interferes with any such preventive effect, remains unclear. TRIAL REGISTRATION ClinicalTrial.gov identifier: NCT00057577.
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Affiliation(s)
| | - John Zajecka
- Department of Psychiatry, Rush University, Chicago, Illinois
| | - Richard C. Shelton
- Department of Psychiatry, Vanderbilt University, Nashville, Tennessee,Department of Psychiatry, University of Alabama at Birmingham, Birmingham
| | - Jay D. Amsterdam
- Department of Psychiatry, University of Pennsylvania, Philadelphia
| | - Jan Fawcett
- Department of Psychiatry, University of New Mexico, Albuquerque
| | - Colin Xu
- Department of Psychology, University of Pennsylvania, Philadelphia
| | - Paula R. Young
- Department of Psychiatry, Rush University, Chicago, Illinois
| | - Robert Gallop
- Department of Mathematics and Applied Statistics, West Chester University, West Chester, Pennsylvania
| | - Steven D. Hollon
- Department of Psychology, Vanderbilt University, Nashville, Tennessee
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Treatment of Depression in Primary Care with Computerized Psychological Therapies: Systematic Reviews. J Med Syst 2020; 44:67. [PMID: 32060635 DOI: 10.1007/s10916-020-1543-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2019] [Accepted: 02/07/2020] [Indexed: 10/25/2022]
Abstract
Depression is one of the most important causes of disability due to illness in our environment. The primary care health system receives a high percentage of this consultation about psychological distress. Often this end in a pharmacological overtreatment in patients with mild depression, due to a lack of access to alternative tools for management. To analyze the evidence that exists by now about the effectiveness of computerized psychological therapies, in people with depression in primary care setting. The search process was mainly done through MEDLINE and Cochrane using keywords such as: "depression", "treatment", "primary care", "online", "internet", "computerized", "Cognitive Behavioral Therapy" and delimiting the search by years and types of studies. The Oxman quality scale was used to analyze quality of Systematic Reviews (SR). 11 previous SR were analyzed. Almost all research is experimental and has not been implemented in the public health network except in the United Kingdom, where there is a tradition in the use of the Beating the Blues program. It requires research in our country and development of programs in Spanish, or adaptation of those of other countries, to test the effectiveness in our health system and to study, in turn, the cost-efficiency. But it is proven to be effective in reducing depressive symptoms and must be study as a possible tool to be introduced in the management of depression in non-specialized care.
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Flux MC, Lowry CA. Finding intestinal fortitude: Integrating the microbiome into a holistic view of depression mechanisms, treatment, and resilience. Neurobiol Dis 2020; 135:104578. [PMID: 31454550 PMCID: PMC6995775 DOI: 10.1016/j.nbd.2019.104578] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2019] [Revised: 06/27/2019] [Accepted: 08/14/2019] [Indexed: 02/07/2023] Open
Abstract
Depression affects at least 322 million people globally, or approximately 4.4% of the world's population. While the earnestness of researchers and clinicians to understand and treat depression is not waning, the number of individuals suffering from depression continues to increase over and above the rate of global population growth. There is a sincere need for a paradigm shift. Research in the past decade is beginning to take a more holistic approach to understanding depression etiology and treatment, integrating multiple body systems into whole-body conceptualizations of this mental health affliction. Evidence supports the hypothesis that the gut microbiome, or the collective trillions of microbes inhabiting the gastrointestinal tract, is an important factor determining both the risk of development of depression and persistence of depressive symptoms. This review discusses recent advances in both rodent and human research that explore bidirectional communication between the gut microbiome and the immune, endocrine, and central nervous systems implicated in the etiology and pathophysiology of depression. Through interactions with circulating inflammatory markers and hormones, afferent and efferent neural systems, and other, more niche, pathways, the gut microbiome can affect behavior to facilitate the development of depression, exacerbate current symptoms, or contribute to treatment and resilience. While the challenge of depression may be the direst mental health crisis of our age, new discoveries in the gut microbiome, when integrated into a holistic perspective, hold great promise for the future of positive mental health.
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Affiliation(s)
- M C Flux
- Department of Psychology and Neuroscience, University of Colorado Boulder, Boulder, CO 80309, USA.
| | - Christopher A Lowry
- Department of Integrative Physiology, Center for Neuroscience, and Center for Microbial Exploration, University of Colorado Boulder, Boulder, CO 80309, USA; Department of Physical Medicine & Rehabilitation and Center for Neuroscience, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA; Veterans Health Administration, Rocky Mountain Mental Illness Research Education and Clinical Center (MIRECC), Rocky Mountain Regional Veterans Affairs Medical Center (RMRVAMC), Aurora, CO 80045, USA; Military and Veteran Microbiome: Consortium for Research and Education (MVM-CoRE), Aurora, CO 80045, USA; Senior Fellow, VIVO Planetary Health, Worldwide Universities Network (WUN), West New York, NJ 07093, USA.
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Wang G, Han C, Liu CY, Chan S, Kato T, Tan W, Zhang L, Feng Y, Ng CH. Management of Treatment-Resistant Depression in Real-World Clinical Practice Settings Across Asia. Neuropsychiatr Dis Treat 2020; 16:2943-2959. [PMID: 33299316 PMCID: PMC7721287 DOI: 10.2147/ndt.s264813] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 11/09/2020] [Indexed: 12/12/2022] Open
Abstract
PURPOSE Consensus is lacking on the management of treatment-resistant depression (TRD), resulting in significant variations on how TRD patients are being managed in real-world practice. A survey explored how clinicians managed TRD across Asia, followed by an expert panel that interpreted the survey results and provided recommendations on how TRD could be managed in real-world clinical settings. METHODS Between March and July 2018, 246 clinicians from Hong Kong, Japan, Mainland China, South Korea, and Taiwan completed a survey related to their treatment approaches for TRD. RESULTS The survey showed physicians using more polytherapy (71%) compared to maintaining patients on monotherapy (29%). The most commonly (23%) administered polytherapy involved antidepressant augmentation with antipsychotics that 19% of physicians also indicated as their most important approach for managing TRD. The highest number of physicians (34%) ranked switching to another class of antidepressants as their most important approach, while 16% and 9% chose antidepressant combinations and electroconvulsive therapy (ECT), respectively. CONCLUSION Taking into account the survey results, the expert panel made general recommendations on the management of TRD. TRD partial-responders to antidepressants should be considered for augmentation with second-generation antipsychotics. For non-responders, switching to another class of antidepressants ought to be considered. TRD patients achieving remission with acute treatment should consider continuing their antidepressants for at least another 6 months to prevent relapse. ECT is a treatment consideration for patients with severe depression or persistent symptoms despite multiple adequate trials of antidepressants. Physicians should also consider the response, tolerability and adherence to the current and previous antidepressants, the severity of symptoms, comorbidities, concomitant medications, preferences, and cost when choosing a TRD treatment approach for each individual patient.
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Affiliation(s)
- Gang Wang
- The National Clinical Research Center for Mental Disorder & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, People's Republic of China.,Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, People's Republic of China
| | - Changsu Han
- Department of Psychiatry, Korea University College of Medicine, Seoul, South Korea
| | - Chia-Yih Liu
- Department of Psychiatry, Chang Gung Medical Center, and Chang Gung University School of Medicine, Taoyuan City, Taiwan
| | - Sandra Chan
- Department of Psychiatry, The Chinese University of Hong Kong, Hong Kong, People's Republic of China
| | - Tadafumi Kato
- RIKEN Center for Brain Science, Wako, Saitama, Japan.,Department of Psychiatry and Behavioral Science, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Wilson Tan
- Regional Medical Affairs, Janssen Pharmaceutical Companies of Johnson and Johnson, Singapore, Singapore
| | - Lili Zhang
- Medical Affairs, Xian Janssen Pharmaceutical Ltd, Beijing, People's Republic of China
| | - Yu Feng
- Medical Affairs, Xian Janssen Pharmaceutical Ltd, Beijing, People's Republic of China
| | - Chee H Ng
- Department of Psychiatry, The University of Melbourne, Melbourne, Victoria, Australia
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20
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Levy R, Mathai M, Chatterjee P, Ongeri L, Njuguna S, Onyango D, Akena D, Rota G, Otieno A, Neylan TC, Lukwata H, Kahn JG, Cohen CR, Bukusi D, Aarons GA, Burger R, Blum K, Nahum-Shani I, McCulloch CE, Meffert SM. Implementation research for public sector mental health care scale-up (SMART-DAPPER): a sequential multiple, assignment randomized trial (SMART) of non-specialist-delivered psychotherapy and/or medication for major depressive disorder and posttraumatic stress disorder (DAPPER) integrated with outpatient care clinics at a county hospital in Kenya. BMC Psychiatry 2019; 19:424. [PMID: 31883526 PMCID: PMC6935499 DOI: 10.1186/s12888-019-2395-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Accepted: 12/05/2019] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Mental disorders are a leading cause of global disability, driven primarily by depression and anxiety. Most of the disease burden is in Low and Middle Income Countries (LMICs), where 75% of adults with mental disorders have no service access. Our research team has worked in western Kenya for nearly ten years. Primary care populations in Kenya have high prevalence of Major Depressive Disorder (MDD) and Posttraumatic Stress Disorder (PTSD). To address these treatment needs with a sustainable, scalable mental health care strategy, we are partnering with local and national mental health stakeholders in Kenya and Uganda to identify 1) evidence-based strategies for first-line and second-line treatment delivered by non-specialists integrated with primary care, 2) investigate presumed mediators of treatment outcome and 3) determine patient-level moderators of treatment effect to inform personalized, resource-efficient, non-specialist treatments and sequencing, with costing analyses. Our implementation approach is guided by the Exploration, Preparation, Implementation, Sustainment (EPIS) framework. METHODS/DESIGN We will use a Sequential, Multiple Assignment Randomized Trial (SMART) to randomize 2710 patients from the outpatient clinics at Kisumu County Hospital (KCH) who have MDD, PTSD or both to either 12 weekly sessions of non-specialist-delivered Interpersonal Psychotherapy (IPT) or to 6 months of fluoxetine prescribed by a nurse or clinical officer. Participants who are not in remission at the conclusion of treatment will be re-randomized to receive the other treatment (IPT receives fluoxetine and vice versa) or to combination treatment (IPT and fluoxetine). The SMART-DAPPER Implementation Resource Team, (IRT) will drive the application of the EPIS model and adaptations during the course of the study to optimize the relevance of the data for generalizability and scale -up. DISCUSSION The results of this research will be significant in three ways: 1) they will determine the effectiveness of non-specialist delivered first- and second-line treatment for MDD and/or PTSD, 2) they will investigate key mechanisms of action for each treatment and 3) they will produce tailored adaptive treatment strategies essential for optimal sequencing of treatment for MDD and/or PTSD in low resource settings with associated cost information - a critical gap for addressing a leading global cause of disability. TRIAL REGISTRATION ClinicalTrials.gov NCT03466346, registered March 15, 2018.
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MESH Headings
- Adult
- Ambulatory Care/methods
- Ambulatory Care/trends
- Ambulatory Care Facilities/trends
- Antidepressive Agents, Second-Generation/administration & dosage
- Combined Modality Therapy/methods
- Combined Modality Therapy/trends
- Delivery of Health Care, Integrated/methods
- Delivery of Health Care, Integrated/trends
- Depressive Disorder, Major/epidemiology
- Depressive Disorder, Major/psychology
- Depressive Disorder, Major/therapy
- Female
- Fluoxetine/administration & dosage
- Hospitals, County/trends
- Humans
- Kenya/epidemiology
- Male
- Mental Health Services/trends
- Psychotherapy/methods
- Public Sector/trends
- Stress Disorders, Post-Traumatic/epidemiology
- Stress Disorders, Post-Traumatic/psychology
- Stress Disorders, Post-Traumatic/therapy
- Treatment Outcome
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Affiliation(s)
- Rachel Levy
- Medical School, University of California, San Francisco, CA, USA
| | - Muthoni Mathai
- Department of Psychiatry, University of Nairobi, Nairobi, Kenya
| | - Purba Chatterjee
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, CA, USA
| | - Linnet Ongeri
- Kenya Medical Research Institute (KEMRI), Nairobi, Kenya
| | - Simon Njuguna
- Director of Mental Health, Kenyan Ministry of Health, Nairobi, Kenya
| | | | - Dickens Akena
- Department of Psychiatry, Makerere University, Kampala, Uganda
| | | | | | - Thomas C Neylan
- Departments of Psychiatry and Neurology, University of California, San Francisco, CA, USA
| | - Hafsa Lukwata
- Division of Mental Health and Control of Substance Abuse, Ministry of Health -, Kampala, Uganda
| | - James G Kahn
- Department of Epidemiology and Biostatistics, Institute for Health Policy Studies, University of California, San Francisco, CA, USA
| | - Craig R Cohen
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, UC Global Health Institute, San Francisco, CA, USA
| | - David Bukusi
- Department of Psychiatry, Kenyatta National Hospital, University of Nairobi, Nairobi, Kenya
| | - Gregory A Aarons
- Department of Psychiatry, University of California, San Diego, CA, USA
| | - Rachel Burger
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, CA, USA
| | - Kelly Blum
- Department of Psychiatry, University of California, San Francisco, CA, USA
| | - Inbal Nahum-Shani
- Institute for Social Research, University of Michigan, Ann Arbor, Michigan, USA
| | - Charles E McCulloch
- Division of Mental Health and Control of Substance Abuse, Ministry of Health -, Kampala, Uganda
| | - Susan M Meffert
- Department of Psychiatry, University of California, San Francisco, CA, USA.
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21
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Carta MG, Paribello P, Nardi AE, Preti A. Current pharmacotherapeutic approaches for dysthymic disorder and persistent depressive disorder. Expert Opin Pharmacother 2019; 20:1743-1754. [DOI: 10.1080/14656566.2019.1637419] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Affiliation(s)
- Mauro Giovanni Carta
- Department of Health Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Pasquale Paribello
- Department of Health Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Antonio Egidio Nardi
- Medical School - Institute of Psychiatry, Federal University of Rio de Janeiro National Academy of Medicine, Rio de Janeiro, Brazil
| | - Antonio Preti
- Department of Health Sciences and Public Health, University of Cagliari, Cagliari, Italy
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22
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Woike K, Sim EJ, Keller F, Schönfeldt-Lecuona C, Sosic-Vasic Z, Kiefer M. Common Factors of Psychotherapy in Inpatients With Major Depressive Disorder: A Pilot Study. Front Psychiatry 2019; 10:463. [PMID: 31333515 PMCID: PMC6614726 DOI: 10.3389/fpsyt.2019.00463] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Accepted: 06/12/2019] [Indexed: 11/13/2022] Open
Abstract
Background: Psychotherapeutic interventions share common factors, which might contribute to treatment success independent of the type of psychotherapy. Previous research on common factors of psychotherapy was mostly conducted in outpatients and covered the development of common factors throughout a therapy over months or years. However, the role of common factors for the psychotherapeutic treatment success in inpatients during their hospital stay has not been addressed so far. The present research therefore aimed to explore changes of the common factors within a short-term stay at the psychiatric hospital for inpatients with major depressive disorder (MDD) and their relation to treatment outcome. Method: We developed a standardized manualized individual cognitive-behavioral psychotherapy (SMiCBT) for depression. The SMiCBT treatment lasted 4 weeks with eight therapy sessions. Following each treatment session, patients and therapists separately completed the questionnaire of "Stundenbogen für die Allgemeine und Differentielle Einzel-Psychotherapie" (STEP) to assess common factors from the perspective of the patient and the therapist. Severity of depression was also measured by the German version of the "Beck Depression Inventory" (BDI-II) before and after the treatment (SMiCBT). We conducted multilevel analysis for the longitudinal data for each scale of the STEP. Results: We found an improvement in the severity of depressive symptoms across the treatment period according to BDI-II scores. Regarding the STEP scales, motivational clarification and problem-solving scores increased over the treatment period for both patient and therapist perspectives. This was not the case for the scale therapeutic relationship. Furthermore, baseline levels of motivational clarification and problem solving were related to the treatment response. Limitations: The results have to be interpreted with care because of the small sample with MDD and the lack of a control group for comparison of treatment outcome. Conclusion: Our data demonstrate that common factors improve within a short-term psychotherapy in inpatients with MDD. Most importantly, our research highlights the distinguished role of motivational clarification and problem solving for the improvement of depressive symptoms during short-term psychotherapy in inpatient settings.
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Affiliation(s)
- Kathrin Woike
- Department of Psychiatry and Psychotherapy III, Ulm University, Ulm, Germany
| | - Eun-Jin Sim
- Department of Psychiatry and Psychotherapy III, Ulm University, Ulm, Germany
| | - Ferdinand Keller
- Department of Child and Adolescent Psychiatry and Psychotherapy, Ulm University, Ulm, Germany
| | | | - Zrinka Sosic-Vasic
- Department of Psychiatry and Psychotherapy III, Ulm University, Ulm, Germany
| | - Markus Kiefer
- Department of Psychiatry and Psychotherapy III, Ulm University, Ulm, Germany
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23
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Rosso G, Aragno E, Cuomo A, Fagiolini A, Di Salvo G, Maina G. Five-year follow-up of first-episode depression treated with psychodynamic psychotherapy or antidepressants. Psychiatry Res 2019; 275:27-30. [PMID: 30878853 DOI: 10.1016/j.psychres.2019.02.073] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Revised: 02/26/2019] [Accepted: 02/27/2019] [Indexed: 10/27/2022]
Abstract
Short-term psychodynamic psychotherapy (STPP) both combined with medication and alone has been shown to be effective in major depressive disorder (MDD). However, few studies compared STTP and pharmacotherapy in monotherapy during acute phase and there is lack of data concerning the prevention of recurrences. The aim of this retrospective study was to evaluate the clinical course of patients who achieved remission from their first life-time major depressive episode after treatment with antidepressant (AD) therapy or brief dynamic therapy (BDT), a specific type of STPP, examining the recurrence rates during a 5-year treatment-free period. The analysis was conducted on 93 subjects (remitters to BDT n = 46; remitters to AD n = 47). Treatment with BDT was associated with a significantly higher proportion of patients without depressive recurrences during the observation period. Among patients who were remitters to BDT, 71.7% did not experience depressive recurrences at the end of the observation period, compared to 46.8% of those treated with pharmacotherapy. BDT may be more effective than AD pharmacotherapy in improving the long-term outcome of patients with a first major depressive episode; further studies comparing STPP and AD in terms of efficacy and cost-effectiveness are needed.
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Affiliation(s)
- Gianluca Rosso
- Psychiatric Unit, San Luigi Gonzaga University Hospital, Regione Gonzole 10, 10043, Orbassano, Turin, Italy
| | - Elena Aragno
- Psychiatric Unit, San Luigi Gonzaga University Hospital, Regione Gonzole 10, 10043, Orbassano, Turin, Italy; Department of Neuroscience, University of Turin, Via Cherasco 15, 10126, Turin, Italy
| | - Alessandro Cuomo
- Department of Molecular and Developmental Medicine, University of Siena, via Aldo Moro 2, 5300, Siena, Italy
| | - Andrea Fagiolini
- Department of Molecular and Developmental Medicine, University of Siena, via Aldo Moro 2, 5300, Siena, Italy
| | - Gabriele Di Salvo
- Psychiatric Unit, San Luigi Gonzaga University Hospital, Regione Gonzole 10, 10043, Orbassano, Turin, Italy; Department of Neuroscience, University of Turin, Via Cherasco 15, 10126, Turin, Italy.
| | - Giuseppe Maina
- Psychiatric Unit, San Luigi Gonzaga University Hospital, Regione Gonzole 10, 10043, Orbassano, Turin, Italy; Department of Neuroscience, University of Turin, Via Cherasco 15, 10126, Turin, Italy
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24
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Glozier N, Christensen H, Griffiths KM, Hickie IB, Naismith SL, Biddle D, Overland S, Thorndike F, Ritterband L. Adjunctive Internet-delivered cognitive behavioural therapy for insomnia in men with depression: A randomised controlled trial. Aust N Z J Psychiatry 2019; 53:350-360. [PMID: 30191722 DOI: 10.1177/0004867418797432] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Internet-delivered cognitive behavioural therapy for insomnia is efficacious for insomnia, and post hoc analyses suggest mood improvements. We undertook the first clinical trial evaluating the efficacy of Internet-delivered cognitive behavioural therapy for insomnia on depressive symptoms as an adjunct to guideline-based treatment of depressive disorders. METHODS Older men undergoing psychiatrist-coordinated treatment for major depressive disorder or dysthymia and who had significant insomnia symptoms were randomised to either adjunctive Internet-delivered cognitive behavioural therapy for insomnia (Sleep Healthy Using The Internet) or online sleep psychoeducation. The primary outcome was change in depressive symptoms (Centre for Epidemiological Studies Depression scale) from baseline to week 12 (post intervention). Secondary outcomes were insomnia and anxiety symptoms. RESULTS In all, 87 men were randomised (Internet-delivered cognitive behavioural therapy for insomnia = 45; psychoeducation = 42). The mean observed Centre for Epidemiological Studies Depression scale changes by week 12 were 8.2 (standard deviation = 11.5) and 3.9 (standard deviation = 12.8) for Internet-delivered cognitive behavioural therapy for insomnia and psychoeducation, respectively. The adjunctive effect size of 0.35 in favour of Sleep Healthy Using The Internet programme was not statistically significant (group × time difference in the Mixed effect Model Repeat Measurement analysis difference 4.3; 95% confidence interval = [-1.2, 9.8]; p = 0.15). There was a statistically significant effect on insomnia symptoms (group × time p = 0.02, difference 2.7; 95% confidence interval = [0.2, 5.3]; effect size = 0.62). There were no differences in insomnia or depression at 6 months or differential effects on anxiety at any time point. There were no reported adverse trial-related events in the intervention arm. CONCLUSION Adjunctive Internet-delivered cognitive behavioural therapy for insomnia for older men being treated for depression can improve insomnia in the short term, without apparent harm. The short-term depressive symptom effect size in this pilot trial was comparable to other adjunctive interventions and may warrant a larger, definitive trial.
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Affiliation(s)
- Nick Glozier
- 1 Brain and Mind Centre, Sydney Medical School and Central Clinical School, The University of Sydney, Sydney, NSW, Australia
| | - Helen Christensen
- 2 Black Dog Institute, The University of New South Wales, Randwick, NSW, Australia
| | - Kathleen M Griffiths
- 3 Research School of Psychology, The Australian National University, Canberra, ACT, Australia
| | - Ian B Hickie
- 1 Brain and Mind Centre, Sydney Medical School and Central Clinical School, The University of Sydney, Sydney, NSW, Australia
| | - Sharon L Naismith
- 1 Brain and Mind Centre, Sydney Medical School and Central Clinical School, The University of Sydney, Sydney, NSW, Australia.,4 School of Psychology and Charles Perkins Centre, The University of Sydney, Sydney, NSW, Australia
| | - Daniel Biddle
- 1 Brain and Mind Centre, Sydney Medical School and Central Clinical School, The University of Sydney, Sydney, NSW, Australia
| | - Simon Overland
- 1 Brain and Mind Centre, Sydney Medical School and Central Clinical School, The University of Sydney, Sydney, NSW, Australia.,5 Management and Staff for Mental and Physical Health, Norwegian Institute of Public Health, Bergen, Norway.,6 Department of Psychosocial Science, University of Bergen, Bergen, Norway
| | | | - Lee Ritterband
- 8 Center for Behavioral Health and Technology, Department of Psychiatry and Neurobehavioral Sciences, University of Virginia School of Medicine, Charlottesville, VA, USA
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25
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Meeuwissen JAC, Feenstra TL, Smit F, Blankers M, Spijker J, Bockting CLH, van Balkom AJLM, Buskens E. The cost-utility of stepped-care algorithms according to depression guideline recommendations - Results of a state-transition model analysis. J Affect Disord 2019; 242:244-254. [PMID: 30216769 DOI: 10.1016/j.jad.2018.08.024] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Revised: 07/12/2018] [Accepted: 08/07/2018] [Indexed: 11/15/2022]
Abstract
BACKGROUND Evidence-based clinical guidelines for major depressive disorder (MDD) recommend stepped-care strategies for sequencing evidence-based treatments conditional on treatment outcomes. This study aims to evaluate the cost-effectiveness of stepped care as recommended by the multidisciplinary clinical guideline vis-à-vis usual care in the Netherlands. METHODS Guideline-congruent care as described in stepped-care algorithms for either mild MDD or moderate and severe MDD was compared with usual care in a health-economic state-transition simulation model. Incremental costs per QALY gained were estimated over five years from a healthcare perspective. RESULTS For mild MDD, the cost-utility analysis showed a 67% likelihood of better health outcomes against lower costs, and 33% likelihood of better outcomes against higher costs, implying dominance of guideline-congruent stepped care. For moderate and severe MDD, the cost-utility analysis indicated a 67% likelihood of health gains at higher costs following the stepped-care approach and 33% likelihood of health gains at lower costs, with a mean ICER of about €3,200 per QALY gained. At a willingness to pay threshold of €20,000 per QALY, the stepped-care algorithms for both mild MDD and moderate or severe MDD is deemed cost-effective compared to usual care with a greater than 95% probability. LIMITATIONS The findings of our decision-analytic modelling are limited by the accuracy and availability of the underlying evidence. This hampers taking into account all individual differences relevant to optimise treatment to individual needs. CONCLUSIONS It is highly likely that guideline-congruent stepped care for MDD is cost-effective compared to usual care. Our findings support current guideline recommendations.
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Affiliation(s)
- Jolanda A C Meeuwissen
- Trimbos Institute, Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands.
| | - Talitha L Feenstra
- Department of Epidemiology, Unit Health Technology Assessment, University Medical Center Groningen, The University of Groningen, Groningen, The Netherlands; Center for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - Filip Smit
- Trimbos Institute, Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands; Department of Epidemiology and Biostatistics and Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, VU University Medical Centre, Amsterdam, The Netherlands
| | - Matthijs Blankers
- Trimbos Institute, Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands; Department of Research, Arkin Mental Health Care, Amsterdam, The Netherlands; Department of Psychiatry, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands; Program for Mood Disorders, Pro Persona Mental Health Care, Nijmegen, The Netherlands
| | - Jan Spijker
- Trimbos Institute, Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands; Behavioral Science Institute, Radboud University, Nijmegen, The Netherlands
| | - Claudi L H Bockting
- Department of Psychiatry, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | | | - Erik Buskens
- Department of Epidemiology, Unit Health Technology Assessment, University Medical Center Groningen, The University of Groningen, Groningen, The Netherlands
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26
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Karyotaki E, Ebert DD, Donkin L, Riper H, Twisk J, Burger S, Rozental A, Lange A, Williams AD, Zarski AC, Geraedts A, van Straten A, Kleiboer A, Meyer B, Ünlü Ince BB, Buntrock C, Lehr D, Snoek FJ, Andrews G, Andersson G, Choi I, Ruwaard J, Klein JP, Newby JM, Schröder J, Laferton JAC, Van Bastelaar K, Imamura K, Vernmark K, Boß L, Sheeber LB, Kivi M, Berking M, Titov N, Carlbring P, Johansson R, Kenter R, Perini S, Moritz S, Nobis S, Berger T, Kaldo V, Forsell Y, Lindefors N, Kraepelien M, Björkelund C, Kawakami N, Cuijpers P. Do guided internet-based interventions result in clinically relevant changes for patients with depression? An individual participant data meta-analysis. Clin Psychol Rev 2018; 63:80-92. [PMID: 29940401 DOI: 10.1016/j.cpr.2018.06.007] [Citation(s) in RCA: 181] [Impact Index Per Article: 30.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Revised: 06/06/2018] [Accepted: 06/14/2018] [Indexed: 12/22/2022]
Abstract
Little is known about clinically relevant changes in guided Internet-based interventions for depression. Moreover, methodological and power limitations preclude the identification of patients' groups that may benefit more from these interventions. This study aimed to investigate response rates, remission rates, and their moderators in randomized controlled trials (RCTs) comparing the effect of guided Internet-based interventions for adult depression to control groups using an individual patient data meta-analysis approach. Literature searches in PubMed, Embase, PsycINFO and Cochrane Library resulted in 13,384 abstracts from database inception to January 1, 2016. Twenty-four RCTs (4889 participants) comparing a guided Internet-based intervention with a control group contributed data to the analysis. Missing data were multiply imputed. To examine treatment outcome on response and remission, mixed-effects models with participants nested within studies were used. Response and remission rates were calculated using the Reliable Change Index. The intervention group obtained significantly higher response rates (OR = 2.49, 95% CI 2.17-2.85) and remission rates compared to controls (OR = 2.41, 95% CI 2.07-2.79). The moderator analysis indicated that older participants (OR = 1.01) and native-born participants (1.66) were more likely to respond to treatment compared to younger participants and ethnic minorities respectively. Age (OR = 1.01) and ethnicity (1.73) also moderated the effects of treatment on remission.Moreover, adults with more severe depressive symptoms at baseline were more likely to remit after receiving internet-based treatment (OR = 1.19). Guided Internet-based interventions lead to substantial positive treatment effects on treatment response and remission at post-treatment. Thus, such interventions may complement existing services for depression and potentially reduce the gap between the need and provision of evidence-based treatments.
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Affiliation(s)
- Eirini Karyotaki
- Department of Clinical Psychology, Amsterdam Public Health research institute, VU, Amsterdam, the Netherlands.
| | - David Daniel Ebert
- Department of Clinical Psychology and Psychotherapy, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
| | - Liesje Donkin
- The Brain and Mind Research Institute, University of Sydney, NSW 2050, Australia
| | - Heleen Riper
- Department of Clinical Psychology, Amsterdam Public Health research institute, VU, Amsterdam, the Netherlands
| | - Jos Twisk
- Department of Epidemiology and Biostatistics, EMGO Institute for Health and Care Research, VU University Amsterdam, Amsterdam, the Netherlands
| | - Simone Burger
- Department of Clinical Psychology, Amsterdam Public Health research institute, VU, Amsterdam, the Netherlands
| | - Alexander Rozental
- Institute of Child Health, University College London, United Kingdom; Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Sweden
| | - Alfred Lange
- Department of Clinical Psychology, University of Amsterdam, Amsterdam, the Netherlands
| | - Alishia D Williams
- Department of Clinical Psychology, Utrecht University, Utrecht, the Netherlands
| | - Anna Carlotta Zarski
- Department of Clinical Psychology and Psychotherapy, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
| | | | - Annemieke van Straten
- Department of Clinical Psychology, Amsterdam Public Health research institute, VU, Amsterdam, the Netherlands
| | - Annet Kleiboer
- Department of Clinical Psychology, Amsterdam Public Health research institute, VU, Amsterdam, the Netherlands
| | - Björn Meyer
- Research Department, Gaia AG, Hamburg, Germany; Department of Psychology, City, University of London, London, United Kingdom
| | | | - Claudia Buntrock
- Department of Clinical Psychology and Psychotherapy, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
| | - Dirk Lehr
- Institute of Psychology, Leuphana University Lüneburg, Germany
| | - Frank J Snoek
- Department of Medical Psychology, VU Medical Center, Academic Medical Center, Public Health Research institute, Amsterdam, the Netherlands
| | - Gavin Andrews
- Clinical Research Unit for Anxiety and Depression, School of Psychiatry, University of New South Wales at St Vincent's Hospital, Darlinghurst, NSW, Australia
| | - Gerhard Andersson
- Department of Behavioral Sciences and Learning, Linköping University, Department of Clinical Neuroscience, Psychiatry Section, Karolinska Institute for Disability Research, Stockholm, Sweden
| | - Isabella Choi
- Brain and Mind Centre, University of Sydney, Sydney, Australia
| | - Jeroen Ruwaard
- Department of Clinical Psychology, Amsterdam Public Health research institute, VU, Amsterdam, the Netherlands
| | - Jan Philipp Klein
- Department of Psychiatry and Psychotherapy, Luebeck University, Luebeck, Germany
| | - Jill M Newby
- Clinical Research Unit for Anxiety and Depression, School of Psychiatry, University of New South Wales at St Vincent's Hospital, Darlinghurst, NSW, Australia; The MRC Cognition and Brain Sciences Unit, Cambridge, United Kingdom; School of Psychology, the University of New South Wales, Sydney, Australia
| | - Johanna Schröder
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Institute for Sex Research and Forensic Psychiatry, Hamburg, Germany
| | - Johannes A C Laferton
- Department of Clinical Psychology and Psychotherapy, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
| | - Kim Van Bastelaar
- Department of Medical Psychology, VU Medical Center, Amsterdam, the Netherlands
| | - Kotaro Imamura
- Department of Mental Health, School of Public Health, Graduate School of Medicine, The University of Tokyo, Bunkyō-ku, Tokyo, Japan
| | - Kristofer Vernmark
- Department of Behavioural Sciences and Learning, Linkoping University, Linkoping, Sweden
| | - Leif Boß
- Institute of Psychology, Leuphana University Lüneburg, Germany
| | | | - Marie Kivi
- Department of Psychology, University of Gothenburg, Göteborg, Sweden
| | - Matthias Berking
- Department of Clinical Psychology and Psychotherapy, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
| | - Nickolai Titov
- MindSpot Clinic and eCentreClinic, Department of Psychology, Macquarie University, Australia
| | - Per Carlbring
- Department of Psychology, Stockholm University, Stockholm, Sweden; Department of Psychology, University of Southern Denmark, Denmark
| | - Robert Johansson
- Department of Behavioral Sciences and Learning, Linköping University, and Department of Clinical Neuroscience, Division of Psychiatry, Karolinska Institutet, Stockholm, Sweden
| | - Robin Kenter
- Department of Clinical Psychology, University of Bergen, Bergen, Norway
| | - Sarah Perini
- Clinical Research Unit for Anxiety and Depression, St Vincent's Hospital, Sydney, New South Wales, Australia
| | - Steffen Moritz
- Department of Clinical Psychology, Amsterdam Public Health research institute, VU, Amsterdam, the Netherlands
| | - Stephanie Nobis
- Division of Online Health Training, Innovation Incubator, Leuphana University Lüneburg, Germany
| | - Thomas Berger
- Department of Clinical Psychology and Psychotherapy, University of Bern, Bern, Switzerland
| | - Viktor Kaldo
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Sweden; Department of Psychology, Faculty of Health and Life Sciences, Linnaeus University, Växjö, Sweden
| | - Yvonne Forsell
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Sweden
| | - Nils Lindefors
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Sweden
| | - Martin Kraepelien
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Sweden
| | - Cecilia Björkelund
- Department of Primary Health Care, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Norito Kawakami
- Department of Mental Health, School of Public Health, Graduate School of Medicine, The University of Tokyo, Bunkyō-ku, Tokyo, Japan
| | - Pim Cuijpers
- Department of Clinical Psychology, Amsterdam Public Health research institute, VU, Amsterdam, the Netherlands
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Bekhuis E, Schoevers R, de Boer M, Peen J, Dekker J, Van H, Boschloo L. Symptom-Specific Effects of Psychotherapy versus Combined Therapy in the Treatment of Mild to Moderate Depression: A Network Approach. PSYCHOTHERAPY AND PSYCHOSOMATICS 2018; 87:121-123. [PMID: 29495015 PMCID: PMC5969070 DOI: 10.1159/000486793] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Accepted: 12/16/2017] [Indexed: 01/14/2023]
Affiliation(s)
- Ella Bekhuis
- Department of Psychiatry, Interdisciplinary Center Psychopathology and Emotion Regulation (ICPE), University Medical Center Groningen, University of Groningen, Groningen, The Netherlands,*Ella Bekhuis, Department of Psychiatry, University Medical Center Groningen, PO Box 30.001, NL-9700 RB Groningen (The Netherlands), E-Mail
| | - Robert Schoevers
- Department of Psychiatry, Interdisciplinary Center Psychopathology and Emotion Regulation (ICPE), University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Marrit de Boer
- Department of Psychiatry, Interdisciplinary Center Psychopathology and Emotion Regulation (ICPE), University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Jaap Peen
- Research Department, Arkin Mental Health Care, Amsterdam, The Netherlands
| | - Jack Dekker
- Research Department, Arkin Mental Health Care, Amsterdam, The Netherlands
| | - Henricus Van
- Research Department, Arkin Mental Health Care, Amsterdam, The Netherlands
| | - Lynn Boschloo
- Department of Psychiatry, Interdisciplinary Center Psychopathology and Emotion Regulation (ICPE), University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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Hartogs BM, Bartels-Velthuis AA, Van der Ploeg K, Bos EH. Heart Rate Variability Biofeedback Stress Relief Program for Depression. Methods Inf Med 2018; 56:419-426. [DOI: 10.3414/me16-02-0033] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
SummaryBackground: Depressive disorders often have a chronic course and the efficacy of evidence-based treatments may be overestimated.Objective: To examine the effectiveness of the Heart Rate Variability Stress Reduction Program (SRP) as a supplement to standard treatment in patients with depressive disorders.Methods: The SRP was individually administered in eight weekly sessions. Seven participants completed the full protocol and were enrolled in a single-subject ABA multiple baseline experimental design. To perform interrupted time-series analyses, daily measures were completed in a diary (depression, resilience, happiness, heart coherence and a personalized outcome measure).Results: Five out of seven patients improved in depressed mood and/or a personalized outcome measure. The effect of treatment was reversed in four patients during the withdrawal phase. One patient reliably improved on depression, whereas two patients recovered on autonomy and one on social optimism. No consistent relationship was found between the heart rate variability-related level of coherence and self-reported mood levels.Conclusions: The SRP is beneficial in some domains and for some patients. A prolonged treatment or continued home practice may be required for enduring effects. The intervention had more clinical impact on resilience-related outcome measures than on symptoms. The small sample size does not permit generalization of the results. We recommend future investigation of the underlying mechanisms of the SRP.
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Caldwell YT, Steffen PR. Adding HRV biofeedback to psychotherapy increases heart rate variability and improves the treatment of major depressive disorder. Int J Psychophysiol 2018; 131:96-101. [PMID: 29307738 DOI: 10.1016/j.ijpsycho.2018.01.001] [Citation(s) in RCA: 79] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Revised: 12/20/2017] [Accepted: 01/03/2018] [Indexed: 12/24/2022]
Abstract
Heart rate variability (HRV) is a significant marker of health outcomes with decreased HRV predicting increased disease risk. HRV is decreased in major depressive disorder (MDD) but existing treatments for depression do not return heart rate variability to normal levels even with successful treatment of depression. Heart rate variability biofeedback (HRVB) increases heart rate variability but no studies to date have examined whether combining HRVB with psychotherapy improves outcome in MDD treatment. The present study used a randomized controlled design to compare the effects of HRVB combined with psychotherapy on MDD relative to a psychotherapy treatment as usual group and to a non-depressed control group. The HRVB+psychotherapy group showed a larger increase in HRV and a larger decrease in depressive symptoms relative to the other groups over a six-week period, whereas the psychotherapy group only did not improve HRV. Results support the supplementation of psychotherapy with HRVB in the treatment of MDD.
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Dereboy Ç, Şenel H, Şafak Öztürk C, Şakiroğlu M, Eskin M. Psychotherapy: Playing the Three Monkeys in Mental Health Service Provision? ACTA ACUST UNITED AC 2017; 54:301-306. [PMID: 29321701 DOI: 10.5152/npa.2017.13785] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Introduction The purpose of the present study was to investigate the effect of sociodemographic variables on the knowledge of, demand for, and reception of psychotherapy as a treatment modality among psychiatric outpatients. Methods Participants of the study were 240 psychiatric outpatients (170 females and 70 males). Data for mental health services were collected from a subgroup of 103 "experienced" patients (42.9%) having had received psychiatric help previously. All participants were administered a questionnaire containing questions about various forms of psychiatric services. Results Of all participants, 40.83% reported having heard of psychotherapy a few of times before, mostly (44.58%) from the media and only 3.33% from a mental health professional. Most participants with previous applications to psychiatric outpatient clinic had first received mental health service from a psychiatrist (93.2%) and at a state hospital (72.8%), and a small minority (17.4%) had subsequently received care from a psychologist. None had demanded to, but 5 patients (4.86%) had been recommended to receive psychotherapy by mental health professionals. Of these experienced patients, 20 (19.41%) have an idea that the interviews they had previously at the outpatient clinics were sort of psychotherapeutic interviews; yet, only 7 (6.79%) retained the same idea after reading the definition of appropriate psychotherapy written on the questionnaire. All of these patients declared that they have received both their medication and psychotherapy at the same time. Thus, only 2.91% of 240 participants received psychotherapy that corresponds to the given definition. Conclusions Findings from this study suggest that mental health care is mostly performed by psychiatrists alone, with a limited contribution by psychologists. Consequently, the choice of treatment is solely pharmacotherapy for most patients, while psychotherapy as a treatment modality is neither offered nor demanded in routine practice.
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Affiliation(s)
- Çiğdem Dereboy
- Department of Psychiatry, Adnan Menderes University School of Medicine, Aydın, Turkey
| | - Hakan Şenel
- Clinic of Psychiatry, Nazilli State Hospital, Aydın, Turkey
| | - Cennet Şafak Öztürk
- Department of Psychology, Adnan Menderes Univesity Faculty of Arts and Sciences, Aydın, Turkey
| | - Mehmet Şakiroğlu
- Department of Psychology, Adnan Menderes Univesity Faculty of Arts and Sciences, Aydın, Turkey
| | - Mehmet Eskin
- Department of Psychiatry, Adnan Menderes University School of Medicine, Aydın, Turkey
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Driot D, Bismuth M, Maurel A, Soulie-Albouy J, Birebent J, Oustric S, Dupouy J. Management of first depression or generalized anxiety disorder episode in adults in primary care: A systematic metareview. Presse Med 2017; 46:1124-1138. [DOI: 10.1016/j.lpm.2017.10.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Revised: 09/28/2017] [Accepted: 10/04/2017] [Indexed: 01/09/2023] Open
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Heinzel S, Rapp MA, Fydrich T, Ströhle A, Terán C, Kallies G, Schwefel M, Heissel A. Neurobiological mechanisms of exercise and psychotherapy in depression: The SPeED study-Rationale, design, and methodological issues. Clin Trials 2017; 15:53-64. [PMID: 28905640 DOI: 10.1177/1740774517729161] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND/AIMS Even though cognitive behavioral therapy has become a relatively effective treatment for major depressive disorder and cognitive behavioral therapy-related changes of dysfunctional neural activations were shown in recent studies, remission rates still remain at an insufficient level. Therefore, the implementation of effective augmentation strategies is needed. In recent meta-analyses, exercise therapy (especially endurance exercise) was reported to be an effective intervention in major depressive disorder. Despite these findings, underlying mechanisms of the antidepressant effect of exercise especially in combination with cognitive behavioral therapy have rarely been studied to date and an investigation of its neural underpinnings is lacking. A better understanding of the psychological and neural mechanisms of exercise and cognitive behavioral therapy would be important for developing optimal treatment strategies in depression. The SPeED study (Sport/Exercise Therapy and Psychotherapy-evaluating treatment Effects in Depressive patients) is a randomized controlled trial to investigate underlying physiological, neurobiological, and psychological mechanisms of the augmentation of cognitive behavioral therapy with endurance exercise. It is investigated if a preceding endurance exercise program will enhance the effect of a subsequent cognitive behavioral therapy. METHODS This study will include 105 patients diagnosed with a mild or moderate depressive episode according to the Diagnostic and Statistical Manual of Mental Disorders (4th ed.). The participants are randomized into one of three groups: a high-intensive or a low-intensive endurance exercise group or a waiting list control group. After the exercise program/waiting period, all patients receive an outpatient cognitive behavioral therapy treatment according to a standardized therapy manual. At four measurement points, major depressive disorder symptoms (Beck Depression Inventory, Hamilton Rating Scale for Depression), (neuro)biological measures (neural activations during working memory, monetary incentive delay task, and emotion regulation, as well as cortisol levels and brain-derived neurotrophic factor), neuropsychological test performance, and questionnaires (psychological needs, self-efficacy, and quality of life) are assessed. RESULTS In this article, we report the design of the SPeED study and refer to important methodological issues such as including both high- and low-intensity endurance exercise groups to allow the investigation of dose-response effects and physiological components of the therapy effects. CONCLUSION The main aims of this research project are to study effects of endurance exercise and cognitive behavioral therapy on depressive symptoms and to investigate underlying physiological and neurobiological mechanisms of these effects. Results may provide important implications for the development of effective treatment strategies in major depressive disorder, specifically concerning the augmentation of cognitive behavioral therapy by endurance exercise.
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Affiliation(s)
- Stephan Heinzel
- 1 Clinical Psychology and Psychotherapy, Freie Universität Berlin, Berlin, Germany.,2 Social and Preventive Medicine, University of Potsdam, Potsdam, Germany.,3 Department of Psychology, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Michael A Rapp
- 2 Social and Preventive Medicine, University of Potsdam, Potsdam, Germany
| | - Thomas Fydrich
- 3 Department of Psychology, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Andreas Ströhle
- 4 Department of Psychiatry and Psychotherapy, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Christina Terán
- 2 Social and Preventive Medicine, University of Potsdam, Potsdam, Germany.,4 Department of Psychiatry and Psychotherapy, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Gunnar Kallies
- 4 Department of Psychiatry and Psychotherapy, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Melanie Schwefel
- 1 Clinical Psychology and Psychotherapy, Freie Universität Berlin, Berlin, Germany.,2 Social and Preventive Medicine, University of Potsdam, Potsdam, Germany.,3 Department of Psychology, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Andreas Heissel
- 2 Social and Preventive Medicine, University of Potsdam, Potsdam, Germany
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Nejati V, Salehinejad MA, Shahidi N, Abedin A. Psychological intervention combined with direct electrical brain stimulation (PIN-CODES) for treating major depression: A pre-test, post-test, follow-up pilot study. ACTA ACUST UNITED AC 2017. [DOI: 10.1016/j.npbr.2017.05.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Zhou X, Cipriani A, Zhang Y, Cuijpers P, Hetrick SE, Weisz JR, Pu J, Giovane CD, Furukawa TA, Barth J, Coghill D, Leucht S, Yang L, Ravindran AV, Xie P. Comparative efficacy and acceptability of antidepressants, psychological interventions, and their combination for depressive disorder in children and adolescents: protocol for a network meta-analysis. BMJ Open 2017; 7:e016608. [PMID: 28801423 PMCID: PMC5629731 DOI: 10.1136/bmjopen-2017-016608] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Depressive disorder is common in children and adolescents, with important consequences and serious impairments in terms of personal and social functioning. While both pharmacological and psychological interventions have been shown to be effective, there is still uncertainty about the balance between these and what treatment strategy should be preferred in clinical practice. Therefore, we aim to compare and rank in a network meta-analysis (NMA) the commonly used psychological, pharmacological and combined interventions for depressive disorder in children and adolescents. METHODS AND ANALYSIS We will update the literature search of two previous NMAs for the identification of trials of antidepressant and psychotherapy alone for depressive disorder in children and adolescents. For identification of trials of combination interventions, seven databases (PubMed, EMBASE, CENTRAL (Cochrane Central Register of Controlled Trials), Web of Science, PsycINFO, CINAHL, LiLACS) will be searched from date of inception. We will also search ClinicalTrials.gov, the WHO International Clinical Trials Registry Platform and check relevant reports on the US Food and Drug Administration website for unpublished data. Building on our previous findings in the field, we will include any commonly prescribed oral antidepressants and any manualised or structured psychotherapies, as well as their combinations. Randomised controlled trials assessing any active intervention against active comparator or pill placebo/psychological controls in acute treatment for depressive disorder in children and adolescents will be included. The primary outcomes will be efficacy (mean change in depressive symptoms), and acceptability of treatment (dropout rate due to any cause). The secondary outcomes will be remission rate, tolerability of treatment (dropouts for adverse events), as well as suicide-related outcomes (suicidal behaviour or ideation). We will perform Bayesian NMAs for all relative outcome measures. Subgroup analyses and sensitivity analyses will be conducted to assess the robustness of the findings. DISSEMINATION This NMA will provide the most up to date and clinically useful information about the comparative efficacy and acceptability of antidepressants, psychological intervention and their combination in the acute treatment of children and adolescents with depressive disorder. This is the newest NMA and therefore these results are very important in terms of evidence-based medicine. The results will be disseminated through peer-reviewed publication. PROTOCOL REGISTRATION PROSPERO CRD42015020841.
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Affiliation(s)
- Xinyu Zhou
- Department of Psychiatry, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Andrea Cipriani
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK
- Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, UK
| | - Yuqing Zhang
- Department of Neurology, Institute of Neuroscience and the Collaborative Innovation Centre for Brain Science,The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Pim Cuijpers
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health research institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Sarah E Hetrick
- Orygen, The National Centre of Excellence in Youth Mental Health, and the Centre of Youth Mental Health, University of Melbourne, Melbourne, Australia
| | - John R Weisz
- Department of Psychology, Harvard University, Cambridge, USA
| | - Juncai Pu
- Department of Neurology, Institute of Neuroscience and the Collaborative Innovation Centre for Brain Science,The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Cinzia Del Giovane
- Department of Diagnostic, Clinical and Public Health Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - Toshiaki A Furukawa
- Department of Health Promotion and Human Behaviour, Kyoto University Graduate School of Medicine and School of Public Health, Kyoto, Japan
| | - Jürgen Barth
- Institute for Complementary and Integrative Medicine,UniversityHospital and University of Zurich, Zurich, Switzerland
| | - David Coghill
- Departments of Paediatrics and Psychiatry, University of Melbourne, Melbourne, Australia
| | - Stefan Leucht
- Department of Psychiatry and Psychotherapy, Technische Universität München, Munich, Germany
| | - Lining Yang
- Department of Neurology, Institute of Neuroscience and the Collaborative Innovation Centre for Brain Science,The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Arun V Ravindran
- Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Peng Xie
- Department of Neurology, Institute of Neuroscience and the Collaborative Innovation Centre for Brain Science,The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
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Callan JA, Wright J, Siegle GJ, Howland RH, Kepler BB. Use of Computer and Mobile Technologies in the Treatment of Depression. Arch Psychiatr Nurs 2017; 31:311-318. [PMID: 28499574 DOI: 10.1016/j.apnu.2016.10.002] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Revised: 09/14/2016] [Accepted: 10/26/2016] [Indexed: 01/04/2023]
Abstract
Major depression (MDD) is a common and disabling disorder. Research has shown that most people with MDD receive either no treatment or inadequate treatment. Computer and mobile technologies may offer solutions for the delivery of therapies to untreated or inadequately treated individuals with MDD. The authors review currently available technologies and research aimed at relieving symptoms of MDD. These technologies include computer-assisted cognitive-behavior therapy (CCBT), web-based self-help, Internet self-help support groups, mobile psychotherapeutic interventions (i.e., mobile applications or apps), technology enhanced exercise, and biosensing technology.
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Affiliation(s)
- Judith A Callan
- University of Pittsburgh, School of Nursing, 3500 Victoria Street, 419B Victoria Building, Pittsburgh, PA 15261, USA.
| | - Jesse Wright
- University of Louisville Psychiatric Group, 401 E. Chestnut Street, Louisville, KY 40202, USA.
| | - Greg J Siegle
- Western Psychiatric Institute and Clinic, 3811 O'Hara Street, Pittsburgh, PA 15213-2593, USA.
| | - Robert H Howland
- Western Psychiatric Institute and Clinic, 3811 O'Hara Street, Pittsburgh, PA 15213, USA.
| | - Britney B Kepler
- University of Pittsburgh, 3500 Victoria Street, Pittsburgh, PA 152611, USA.
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Weitz E, Kleiboer A, van Straten A, Hollon SD, Cuijpers P. Individual patient data meta-analysis of combined treatments versus psychotherapy (with or without pill placebo), pharmacotherapy or pill placebo for adult depression: a protocol. BMJ Open 2017; 7:e013478. [PMID: 28193851 PMCID: PMC5318563 DOI: 10.1136/bmjopen-2016-013478] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Revised: 12/30/2016] [Accepted: 01/03/2017] [Indexed: 01/05/2023] Open
Abstract
INTRODUCTION There are many proven treatments (psychotherapy, pharmacotherapy or their combination) for the treatment of depression. Although there is growing evidence for the effectiveness of combination treatment (psychotherapy + pharmacotherapy) over pharmacotherapy alone, psychotherapy alone or psychotherapy plus pill placebo, for depression, little is known about which specific groups of patients may respond best to combined treatment versus monotherapy. Conventional meta-analyses techniques have limitations when tasked with examining whether specific individual characteristics moderate the effect of treatment on depression. Therefore, this protocol outlines an individual patient data (IPD) meta-analysis to explore which patients, with which clinical characteristics, have better outcomes in combined treatment compared with psychotherapy (alone or with pill placebo), pharmacotherapy and pill placebo. METHODS AND ANALYSIS Study searches are completed using an established database of randomised controlled trials (RCTs) on the psychological treatment of adult depression that has previously been reported. Searches were conducted in PubMed, PsycInfo, Embase and the Cochrane Central Register of Controlled Trials. RCTs comparing combination treatment (psychotherapy + pharmacotherapy) with psychotherapy (with or without pill placebo), pharmacotherapy or pill placebo for the treatment of adult depression will be included. Study authors of eligible trials will be contacted and asked to contribute IPD. Conventional meta-analysis techniques will be used to examine differences between studies that have contributed data and those that did not. Then, IPD will be harmonised and analysis using multilevel regression will be conducted to examine effect moderators of treatment outcomes. DISSEMINATION Study results outlined above will be published in peer-reviewed journals. Study results will contribute to better understanding whether certain patients respond best to combined treatment or other depression treatments and provide new information on moderators of treatment outcome that can be used by patients, clinicians and researchers. TRIAL REGISTRATION NUMBER CRD42016039028.
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Affiliation(s)
- Erica Weitz
- Department of Clinical, Neuro and Developmental Psychology, and EMGO Institute for Health and Care Research, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Annet Kleiboer
- Department of Clinical, Neuro and Developmental Psychology, and EMGO Institute for Health and Care Research, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Annemieke van Straten
- Department of Clinical, Neuro and Developmental Psychology, and EMGO Institute for Health and Care Research, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Steven D Hollon
- Department of Psychology, Vanderbilt University, Nashville, Tennessee, USA
| | - Pim Cuijpers
- Department of Clinical, Neuro and Developmental Psychology, and EMGO Institute for Health and Care Research, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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de Roten Y, Ambresin G, Herrera F, Fassassi S, Fournier N, Preisig M, Despland JN. Efficacy of an adjunctive brief psychodynamic psychotherapy to usual inpatient treatment of depression: Results of a randomized controlled trial. J Affect Disord 2017; 209:105-113. [PMID: 27894036 DOI: 10.1016/j.jad.2016.11.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Revised: 10/03/2016] [Accepted: 11/14/2016] [Indexed: 01/07/2023]
Abstract
BACKGROUND For severe and chronic depression, inpatient treatment may be necessary. Current guidelines recommend combined psychological and pharmacological treatments for moderate to severe depression. Results for positive effects of combined treatment for depressed inpatients are still ambiguous. METHODS This randomised controlled trial examined the efficacy of adding an intensive and brief psychodynamic psychotherapy (IBPP) to treatment-as-usual (TAU) for inpatients with DSM-IV major depressive episode. The primary outcomes were reduction in depression severity, and response and remission rates at post-treatment, 3-month and 12-month follow-up points. RESULTS A linear mixed model analysis (N=149) showed a higher reduction in the observer-rated severity of depressive symptoms at each follow-up point for the IBPP condition compared with the TAU condition (post-treatment ES=0.39, 95%CI 0.06-0.71; 3-month ES=0.46, 95%CI 0.14-0.78; 12-month ES=0.32, 95%CI 0.01-0.64). Response rate was superior in the IBPP group compared with the TAU group at all follow-up points (post-treatment OR =2.69, 95%CI 1.18-6.11; 3-month OR=3.47, 95%CI 1.47-8.25; 12-month OR=2.26, 95%CI 1.02-4.97). IBPP patients were more likely to be remitted 3 months (OR=2.82, 95%CI 1.12-7.10) and 12 months (OR=2.93, 95%CI 1.12-7.68) after discharge than TAU patients. LIMITATIONS Heterogeneous sample with different subtypes of depression and comorbidity. CONCLUSIONS IBPP decreased observer-rated depression severity up to 12 months after the end of treatment. IBPP demonstrated immediate and distant treatment responses as well as substantial remissions at follow-up. IBPP appears to be a valuable adjunct in the treatment of depressed inpatients.
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Affiliation(s)
- Yves de Roten
- Institute of Psychotherapy, Department of Psychiatry, University Hospital Centre and University of Lausanne, Switzerland
| | - Gilles Ambresin
- Institute of Psychotherapy, Department of Psychiatry, University Hospital Centre and University of Lausanne, Switzerland; General Practice and Primary Health Care Academic Centre, The University of Melbourne, Melbourne, Australia.
| | - Fabrice Herrera
- Institute of Psychotherapy, Department of Psychiatry, University Hospital Centre and University of Lausanne, Switzerland; Service of General Psychiatry, Department of Psychiatry, University Hospital Centre and University of Lausanne, Switzerland
| | - Sylfa Fassassi
- Service of General Psychiatry, Department of Psychiatry, University Hospital Centre and University of Lausanne, Switzerland
| | - Nicolas Fournier
- Institute of Social and Preventive Medicine (IUMSP), Lausanne University Hospital, Lausanne, Switzerland
| | - Martin Preisig
- Centre for Epidemiology and Psychopathology, Department of Psychiatry, University Hospital Centre and University of Lausanne, Switzerland
| | - Jean-Nicolas Despland
- Institute of Psychotherapy, Department of Psychiatry, University Hospital Centre and University of Lausanne, Switzerland
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Johnson B, Flores Mosri D. The Neuropsychoanalytic Approach: Using Neuroscience as the Basic Science of Psychoanalysis. Front Psychol 2016; 7:1459. [PMID: 27790160 PMCID: PMC5063004 DOI: 10.3389/fpsyg.2016.01459] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2016] [Accepted: 09/12/2016] [Indexed: 12/31/2022] Open
Abstract
Neuroscience was the basic science behind Freud's psychoanalytic theory and technique. He worked as a neurologist for 20 years before being aware that a new approach to understand complex diseases, namely the hysterias, was needed. Solms coined the term neuropsychoanalysis to affirm that neuroscience still belongs in psychoanalysis. The neuropsychoanalytic field has continued Freud's original ideas as stated in 1895. Developments in psychoanalysis that have been created or revised by the neuropsychoanalysis movement include pain/relatedness/opioids, drive, structural model, dreams, cathexis, and dynamic unconscious. Neuroscience has contributed to the development of new psychoanalytic theory, such as Bazan's (2011) description of anxiety driven by unconscious intentions or “phantoms.” Results of adopting the “dual aspect monism” approach of idiographic psychoanalytic clinical observation combined with nomothetic investigation of related human phenomena include clarification and revision of theory, restoration of the scientific base of psychoanalysis, and improvement of clinical treatments. By imbricating psychoanalytic thinking with neuroscience, psychoanalysts are also positioned to make contributions to neuroscience research. Freud's original Project for a Scientific Psychology/Psychology for Neurologists can be carried forward in a way that moves psychoanalysis into the twenty-first century as a core contemporary science (Kandel, 1999). Neuroscience as the basic science of psychoanalysis both improves the field, and enhances its scientific and cultural status.
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Affiliation(s)
- Brian Johnson
- Department of Psychiatry, State University of New York Upstate Medical University Syracuse, NY, USA
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Boumparis N, Karyotaki E, Kleiboer A, Hofmann SG, Cuijpers P. The effect of psychotherapeutic interventions on positive and negative affect in depression: A systematic review and meta-analysis. J Affect Disord 2016; 202:153-62. [PMID: 27262637 DOI: 10.1016/j.jad.2016.05.019] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Accepted: 05/13/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Depression is a mental disorder characterized by high and dysregulated negative affect in addition to diminished positive affect. To our knowledge, there has been no systematic review of the impact of psychotherapeutic interventions on these affective dimensions. METHODS Two comprehensive literature searches for all randomized controlled trials of psychotherapy in adults with depression were performed. The first from 1996 to December 31, 2014 and the second from January 1, 2015 to December 31, 2015. The primary outcome was the mean score of positive and negative affect. Depressive symptoms were measured to be included as a predictor in the meta-regression analyses. RESULTS Ten studies with 793 adults with depression were included. All studies assessed positive and negative affect. Psychotherapeutic interventions resulted in significantly increased positive affect (g=0.41; 95% CI: 0.16-0.66 p=0.001), and significantly decreased negative affect (g=0.32; 95% CI: 0.15-0.78, p=0.001) in depressed adults. Because of the small number and substantial heterogeneity of the existing studies the meta-regression analyses produced conflicting results. As a consequence, we were unable to sufficiently demonstrate whether NA and depressive symptoms are in fact correlated or not. LIMITATIONS Given the small number and heterogeneity of the included studies, the findings should be considered with caution. CONCLUSIONS Psychotherapeutic interventions demonstrate low to moderate effects in enhancing positive and reducing negative affect in depressed adults.
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Affiliation(s)
- Nikolaos Boumparis
- Department of Clinical Psychology, VU University Amsterdam, Amsterdam, The Netherlands.
| | - Eirini Karyotaki
- Department of Clinical Psychology, VU University Amsterdam, Amsterdam, The Netherlands; EMGO, Institute of Health Care Research, VU University Medical Centre, Amsterdam, The Netherlands
| | - Annet Kleiboer
- Department of Clinical Psychology, VU University Amsterdam, Amsterdam, The Netherlands; EMGO, Institute of Health Care Research, VU University Medical Centre, Amsterdam, The Netherlands
| | - Stefan G Hofmann
- Department of Psychological and Brain Sciences, Boston University, Boston, MA, USA
| | - Pim Cuijpers
- Department of Clinical Psychology, VU University Amsterdam, Amsterdam, The Netherlands; EMGO, Institute of Health Care Research, VU University Medical Centre, Amsterdam, The Netherlands
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Parikh SV, Quilty LC, Ravitz P, Rosenbluth M, Pavlova B, Grigoriadis S, Velyvis V, Kennedy SH, Lam RW, MacQueen GM, Milev RV, Ravindran AV, Uher R. Canadian Network for Mood and Anxiety Treatments (CANMAT) 2016 Clinical Guidelines for the Management of Adults with Major Depressive Disorder: Section 2. Psychological Treatments. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2016; 61:524-39. [PMID: 27486150 PMCID: PMC4994791 DOI: 10.1177/0706743716659418] [Citation(s) in RCA: 196] [Impact Index Per Article: 24.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
BACKGROUND The Canadian Network for Mood and Anxiety Treatments (CANMAT) has revised its 2009 guidelines for the management of major depressive disorder (MDD) in adults by updating the evidence and recommendations. The target audiences for these 2016 guidelines are psychiatrists and other mental health professionals. METHODS Using the question-answer format, we conducted a systematic literature search focusing on systematic reviews and meta-analyses. Evidence was graded using CANMAT-defined criteria for level of evidence. Recommendations for lines of treatment were based on the quality of evidence and clinical expert consensus. "Psychological Treatments" is the second of six sections of the 2016 guidelines. RESULTS Evidence-informed responses were developed for 25 questions under 5 broad categories: 1) patient characteristics relevant to using psychological interventions; 2) therapist and health system characteristics associated with optimizing outcomes; 3) descriptions of major psychotherapies and their efficacy; 4) additional psychological interventions, such as peer interventions and computer- and technology-delivered interventions; and 5) combining and/or sequencing psychological and pharmacological interventions. CONCLUSIONS First-line psychological treatment recommendations for acute MDD include cognitive-behavioural therapy (CBT), interpersonal therapy (IPT), and behavioural activation (BA). Second-line recommendations include computer-based and telephone-delivered psychotherapy. Where feasible, combining psychological treatment (CBT or IPT) with antidepressant treatment is recommended because combined treatment is superior to either treatment alone. First-line psychological treatments for maintenance include CBT and mindfulness-based cognitive therapy (MBCT). Patient preference, in combination with evidence-based treatments and clinician/system capacity, will yield the optimal treatment strategies for improving individual outcomes in MDD.
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Affiliation(s)
- Sagar V Parikh
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan Department of Psychiatry, University of Toronto, Toronto, Ontario
| | - Lena C Quilty
- Department of Psychiatry, University of Toronto, Toronto, Ontario
| | - Paula Ravitz
- Department of Psychiatry, University of Toronto, Toronto, Ontario
| | | | - Barbara Pavlova
- Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia
| | | | | | - Sidney H Kennedy
- Department of Psychiatry, University of Toronto, Toronto, Ontario
| | - Raymond W Lam
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia
| | | | - Roumen V Milev
- Department of Psychiatry, Queen's University, Kingston, Ontario
| | - Arun V Ravindran
- Department of Psychiatry, University of Toronto, Toronto, Ontario
| | - Rudolf Uher
- Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia
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Negt P, Brakemeier EL, Michalak J, Winter L, Bleich S, Kahl KG. The treatment of chronic depression with cognitive behavioral analysis system of psychotherapy: a systematic review and meta-analysis of randomized-controlled clinical trials. Brain Behav 2016; 6:e00486. [PMID: 27247856 PMCID: PMC4864084 DOI: 10.1002/brb3.486] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Revised: 03/16/2016] [Accepted: 04/01/2016] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Chronic depression is a severe and disabling condition. Compared to an episodic course, chronic depression has been shown to be less responsive to psychopharmacological and psychological treatments. The cognitive behavioral analysis system of psychotherapy (CBASP) has been developed as a specific psychotherapy for chronic depression. However, conflicting results concerning its efficacy have been reported in randomized-controlled trials (RCT). Therefore, we aimed at examining the efficacy of CBASP using meta-analytical methods. METHODS Randomized-controlled trials assessing the efficacy of CBASP in chronic depression were identified by searching electronic databases (PsycINFO, PubMed, Scopus, Cochrane Central Register of Controlled Trials) and by manual searches (citation search, contacting experts). Searching period was restricted from the first available entry to October 2015. Identified studies were systematically reviewed. The standardized mean difference Hedges' g was calculated from posttreatment and mean change scores. The random-effects model was used to compute combined overall effect sizes. A risk of publication bias was addressed using fail-safe N calculations and trim-and-fill analysis. RESULTS Six studies comprising 1.510 patients met our inclusion criteria. The combined overall effect sizes of CBASP versus other treatments or treatment as usual (TAU) pointed to a significant effect of small magnitude (g = 0.34-0.44, P < 0.01). In particular, CBASP revealed moderate-to-high effect sizes when compared to TAU and interpersonal psychotherapy (g = 0.64-0.75, P < 0.05), and showed similar effects when compared to antidepressant medication (ADM) (g = -0.29 to 0.02, ns). The combination of CBASP and ADM yielded benefits over antidepressant monotherapy (g = 0.49-0.59, P < 0.05). LIMITATIONS The small number of included studies, a certain degree of heterogeneity among the study designs and comparison conditions, and insufficient data evaluating long-term effects of CBASP restrict generalizability yet. CONCLUSIONS We conclude that there is supporting evidence that CBASP is effective in the treatment of chronic depression.
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Affiliation(s)
- Philip Negt
- Department of Psychiatry, Social Psychiatry and Psychotherapy Hannover Medical School Hannover Germany
| | - Eva-Lotta Brakemeier
- Department for Clinical Psychology and Psychotherapy Berlin University of Psychology Berlin Germany
| | - Johannes Michalak
- Department of Psychology and Psychotherapy Witten/Herdecke University Witten Germany
| | - Lotta Winter
- Department of Psychiatry, Social Psychiatry and Psychotherapy Hannover Medical School Hannover Germany
| | - Stefan Bleich
- Department of Psychiatry, Social Psychiatry and Psychotherapy Hannover Medical School Hannover Germany
| | - Kai G Kahl
- Department of Psychiatry, Social Psychiatry and Psychotherapy Hannover Medical School Hannover Germany
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When Words are not Enough: Psychotherapy with Clients Who are Living Below the Poverty Level. JOURNAL OF CONTEMPORARY PSYCHOTHERAPY 2016. [DOI: 10.1007/s10879-015-9313-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Strand KB, Chisholm D, Fekadu A, Johansson KA. Scaling-up essential neuropsychiatric services in Ethiopia: a cost-effectiveness analysis. Health Policy Plan 2016; 31:504-13. [PMID: 26491060 PMCID: PMC4986243 DOI: 10.1093/heapol/czv093] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/19/2015] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION There is an immense need for scaling-up neuropsychiatric care in low-income countries. Contextualized cost-effectiveness analyses (CEAs) provide relevant information for local policies. The aim of this study is to perform a contextualized CEA of neuropsychiatric interventions in Ethiopia and to illustrate expected population health and budget impacts across neuropsychiatric disorders. METHODS A mathematical population model (PopMod) was used to estimate intervention costs and effectiveness. Existing variables from a previous WHO-CHOICE regional CEA model were substantially revised. Treatments for depression, schizophrenia, bipolar disorder and epilepsy were analysed. The best available local data on epidemiology, intervention efficacy, current and target coverage, resource prices and salaries were used. Data were obtained from expert opinion, local hospital information systems, the Ministry of Health and literature reviews. RESULTS Treatment of epilepsy with a first generation antiepileptic drug is the most cost-effective treatment (US$ 321 per DALY adverted). Treatments for depression have mid-range values compared with other interventions (US$ 457-1026 per DALY adverted). Treatments for schizophrenia and bipolar disorders are least cost-effective (US$ 1168-3739 per DALY adverted). CONCLUSION This analysis gives the Ethiopian government a comprehensive overview of the expected costs, effectiveness and cost-effectiveness of introducing basic neuropsychiatric interventions.
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Affiliation(s)
- Kirsten Bjerkreim Strand
- Department of Global Public Health and Primary Care University of Bergen Postbox 7804, N- 5020 Bergen,
| | | | - Abebaw Fekadu
- College of Health Sciences, School of Medicine, Department of Psychiatry, University of Addis Abeba, Addis Ababa, Ethiopia and Institute of Psychiatry, Department of Psychological Medicine, King's College London, London, UK
| | - Kjell Arne Johansson
- Department of Global Public Health and Primary Care University of Bergen Postbox 7804, N- 5020 Bergen
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Ormsby SM, Smith CA, Dahlen HG, Hay PJ, Lind JM. Evaluation of an antenatal acupuncture intervention as an adjunct therapy for antenatal depression (AcuAnteDep): study protocol for a pragmatic randomised controlled trial. Trials 2016; 17:93. [PMID: 26887958 PMCID: PMC4758005 DOI: 10.1186/s13063-016-1204-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2015] [Accepted: 01/28/2016] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Depressed pregnant women face difficulty navigating a course between the potentially serious consequences of leaving depression untreated and significant limitations associated with conventional therapies, such as foetal toxicity and teratogenicity. Preliminary evidence is suggestive that acupuncture may provide a safe and effective alternative treatment option for antenatal depression; however, additional research is required. The purpose of this study is to further investigate this treatment possibility, with an additional examination of a potential biomechanistic acupuncture effect. METHODS/DESIGN In this pragmatic randomised controlled trial, we will compare individually tailored, flexible antenatal depression-oriented acupuncture with equivalent attention progressive muscle relaxation and routine antenatal depression hospital care. Eligible women at 24 weeks of gestation with Edinburgh Postnatal Depression Scale scores of 13 or more will be recruited from 2 antenatal clinics in South Western Sydney, Australia. The recruitment goal of 96 is powered to demonstrate a significant difference in Edinburgh Postnatal Depression Scale score severity between acupuncture and usual care, with intervention groups receiving weekly 1-h treatments for 8 weeks from 24 to 31 weeks of gestation. Mental health and quality-of-life assessments will occur at study commencement, intervention weeks 4 and 8 and 6 weeks post-natally via the collection of completed Edinburgh Postnatal Depression Scale scores, Depression, Stress and Anxiety Scale scores and World Health Organisation Quality of Life Scale scores. Adjustment to mothering will also be evaluated at 6 weeks post-natally using the Being a Mother Scale. A putative biomechanistic effect of acupuncture on the oxytocinergic system will additionally be examined by comparing baseline salivary hormone levels with those measured at intervention weeks 4 and 8, as well as leucocyte oxytocin receptor expression at baseline and intervention week 8. DISCUSSION Ethical approval was received in February 2015, and recruitment is underway and expected to be completed in July 2016. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry ACTRN12615000250538, Registered on 19 March 2015.
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Affiliation(s)
- Simone M Ormsby
- PhD Candidate, National Institute of Complementary Medicine, Western Sydney University, Building 5, Campbelltown Campus, Locked Bag 1797, Penrith, NSW, 2751, Australia.
| | - Caroline A Smith
- Professor of Complementary Medicine, National Institute of Complementary Medicine, Western Sydney University, Building 5, Campbelltown Campus, Locked Bag 1797, Penrith, NSW, 2751, Australia.
| | - Hannah G Dahlen
- Professor of Midwifery, Western Sydney University, Building EB, Parramatta Campus, Locked Bag 1797, Penrith, NSW, 2751, Australia.
| | - Phillipa J Hay
- Chair of Mental Health, Western Sydney University, Building 30, Campbelltown Campus, Locked Bag 1797, Penrith, NSW, 2751, Australia.
| | - Joanne M Lind
- Associate Professor, Molecular Biology and Genetics, Western Sydney University, Building 30, Campbelltown Campus, Locked Bag 1797, Penrith, NSW, 2751, Australia.
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Jobst A, Brakemeier EL, Buchheim A, Caspar F, Cuijpers P, Ebmeier KP, Falkai P, Jan van der Gaag R, Gaebel W, Herpertz S, Kurimay T, Sabaß L, Schnell K, Schramm E, Torrent C, Wasserman D, Wiersma J, Padberg F. European Psychiatric Association Guidance on psychotherapy in chronic depression across Europe. Eur Psychiatry 2016; 33:18-36. [PMID: 26854984 DOI: 10.1016/j.eurpsy.2015.12.003] [Citation(s) in RCA: 71] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2015] [Accepted: 12/12/2015] [Indexed: 01/07/2023] Open
Abstract
PURPOSE Patients with chronic depression (CD) by definition respond less well to standard forms of psychotherapy and are more likely to be high utilizers of psychiatric resources. Therefore, the aim of this guidance paper is to provide a comprehensive overview of current psychotherapy for CD. The evidence of efficacy is critically reviewed and recommendations for clinical applications and research are given. METHODS We performed a systematic literature search to identify studies on psychotherapy in CD, evaluated the retrieved documents and developed evidence tables and recommendations through a consensus process among experts and stakeholders. RESULTS We developed 5 recommendations which may help providers to select psychotherapeutic treatment options for this patient group. The EPA considers both psychotherapy and pharmacotherapy to be effective in CD and recommends both approaches. The best effect is achieved by combined treatment with psychotherapy and pharmacotherapy, which should therefore be the treatment of choice. The EPA recommends psychotherapy with an interpersonal focus (e.g. the Cognitive Behavioural Analysis System of Psychotherapy [CBASP]) for the treatment of CD and a personalized approach based on the patient's preferences. DISCUSSION The DSM-5 nomenclature of persistent depressive disorder (PDD), which includes CD subtypes, has been an important step towards a more differentiated treatment and understanding of these complex affective disorders. Apart from dysthymia, ICD-10 still does not provide a separate entity for a chronic course of depression. The differences between patients with acute episodic depression and those with CD need to be considered in the planning of treatment. Specific psychotherapeutic treatment options are recommended for patients with CD. CONCLUSION Patients with chronic forms of depression should be offered tailored psychotherapeutic treatments that address their specific needs and deficits. Combination treatment with psychotherapy and pharmacotherapy is the first-line treatment recommended for CD. More research is needed to develop more effective treatments for CD, especially in the longer term, and to identify which patients benefit from which treatment algorithm.
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Affiliation(s)
- A Jobst
- Department of Psychiatry und Psychotherapy, Ludwig Maximilian University, Munich, Germany
| | - E-L Brakemeier
- Department of Clinical Psychology and Psychotherapy, Berlin University of Psychology, Berlin, Germany
| | - A Buchheim
- Department of Psychology, Clinical Psychology, University of Innsbruck, Innsbruck, Austria
| | - F Caspar
- Institute of Psychology, University of Bern, Bern, Switzerland
| | - P Cuijpers
- Department of Clinical Psychology, VU University, Amsterdam, The Netherlands
| | - K P Ebmeier
- Department of Psychiatry, Division of Clinical Medicine, University of Oxford, Oxford, United Kingdom
| | - P Falkai
- Department of Psychiatry und Psychotherapy, Ludwig Maximilian University, Munich, Germany
| | | | - W Gaebel
- Department of Psychiatry und Psychotherapy, Heinrich Heine University Düsseldorf, Medical Faculty, Düsseldorf, Germany
| | - S Herpertz
- Department of Psychiatry and Psychotherapy, University of Heidelberg, Heidelberg, Germany
| | - T Kurimay
- Institute of Behaviour Sciences, Semmelweis University, Budapest, Hungary
| | - L Sabaß
- Department of Psychiatry und Psychotherapy, Ludwig Maximilian University, Munich, Germany
| | - K Schnell
- Department of Psychiatry and Psychotherapy, University of Freiburg, Freiburg, Germany
| | - E Schramm
- Department of Psychiatry and Psychotherapy, University of Freiburg, Freiburg, Germany
| | - C Torrent
- Clinical Institute of Neuroscience, Hospital Clinic Barcelona, CIBERSAM, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - D Wasserman
- National Centre for Suicide Research and Prevention of Mental lll-Health (NASP), Karolinska Institutet, Stockholm, Sweden
| | - J Wiersma
- Department of Psychiatry, GGZinGeest, Amsterdam, The Netherlands
| | - F Padberg
- Department of Psychiatry und Psychotherapy, Ludwig Maximilian University, Munich, Germany.
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Mori N, Lockwood L, McCall WV. Current Antidepressant Therapy: A Critical Examination. Psychiatr Ann 2015. [DOI: 10.3928/00485713-20150901-04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Interventions for preventing relapse or recurrence of depression in primary health care settings: A systematic review. Prev Med 2015; 76 Suppl:S16-21. [PMID: 25192769 DOI: 10.1016/j.ypmed.2014.07.035] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2014] [Revised: 07/04/2014] [Accepted: 07/23/2014] [Indexed: 11/23/2022]
Abstract
OBJECTIVE A systematic review was conducted to assess the efficacy of pharmacological and psychological interventions for preventing relapse or recurrence of depression in adults with depression in primary care. METHOD Papers published from inception to January 28th 2014 were identified searching the electronic databases MEDLINE, EMBASE, PsycINFO, and CENTRAL. Randomized controlled trials of any pharmacological, psychological or psychosocial intervention or combination of interventions delivered in primary care settings were included, with relapse or recurrence of a depressive disorder as a main outcome. The Cochrane Collaboration risk of bias tool was used to assess study quality. RESULTS Only three studies with a small number of patients fulfilled the inclusion criteria. None of the three randomized controlled trials included in our review showed a statistically significant superiority of an intervention for the prevention of depression relapse or recurrence. CONCLUSIONS There is limited evidence to inform relapse or recurrence prevention strategies specifically in primary care.
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Lopes RT, Gonçalves MM, Fassnacht DB, Machado PPP, Sousa I. Long-term effects of psychotherapy on moderate depression: a comparative study of narrative therapy and cognitive-behavioral therapy. J Affect Disord 2015; 167:64-73. [PMID: 25082116 DOI: 10.1016/j.jad.2014.05.042] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2013] [Revised: 05/23/2014] [Accepted: 05/24/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND In a previous clinical controlled trial (Lopes et al., 2014), narrative therapy (NT) showed promising results in ameliorating depressive symptoms with comparable outcomes to cognitive-behavioral therapy (CBT) when patients completed treatment. This paper aims to assess depressive symptoms and interpersonal problems in this clinical sample at follow-up. METHODS Using the Beck Depression Inventory-II and Outcome Questionnaire-45.2 Interpersonal Relations Scale, naturalistic prospective follow-up assessment was conducted at 21 and 31 months after the last treatment session. RESULTS At follow-up, patients kept improving in terms of depressive symptoms and interpersonal problems. The odds that a patient maintained recovery from depressive symptoms at follow-up were five times higher than the odds that a patient maintained recovery from interpersonal problems. In the same way, the odds of a patient never recovering from interpersonal problems were five times higher than the odds of never recovering from depressive symptoms. LIMITATIONS The study did not control for the natural course of depression or treatment continuation. CONCLUSIONS For depressed patients with greater interpersonal disabilities, longer treatment plans and alternative continuation treatments should be considered.
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Affiliation(s)
- Rodrigo T Lopes
- School of Psychology, University of Minho, 4710-057 Braga, Portugal
| | | | | | | | - Inês Sousa
- Department of Mathematics and Applications, University of Minho, Portugal
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Reisinger S, Khan D, Kong E, Berger A, Pollak A, Pollak DD. The poly(I:C)-induced maternal immune activation model in preclinical neuropsychiatric drug discovery. Pharmacol Ther 2015; 149:213-26. [PMID: 25562580 DOI: 10.1016/j.pharmthera.2015.01.001] [Citation(s) in RCA: 160] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2014] [Accepted: 12/30/2014] [Indexed: 12/28/2022]
Abstract
Increasing epidemiological and experimental evidence implicates gestational infections as one important factor involved in the pathogenesis of several neuropsychiatric disorders. Corresponding preclinical model systems based upon maternal immune activation (MIA) by treatment of the pregnant female have been developed. These MIA animal model systems have been successfully used in basic and translational research approaches, contributing to the investigation of the underlying pathophysiological mechanisms at the molecular, cellular and behavioral levels. The present article focuses on the application of a specific MIA rodent paradigm, based upon treatment of the gestating dam with the viral mimic polyinosinic-polycytidilic acid (Poly(I:C)), a synthetic analog of double-stranded RNA (dsRNA) which activates the Toll-like receptor 3 (TLR3) pathway. Important advantages and constraints of this animal model will be discussed, specifically in light of gestational infection as one vulnerability factor contributing to the complex etiology of mood and psychotic disorders, which are likely the result of intricate multi-level gene×environment interactions. Improving our currently incomplete understanding of the molecular pathomechanistic principles underlying these disorders is a prerequisite for the development of alternative therapeutic approaches which are critically needed in light of the important drawbacks and limitations of currently available pharmacological treatment options regarding efficacy and side effects. The particular relevance of the Poly(I:C) MIA model for the discovery of novel drug targets for symptomatic and preventive therapeutic strategies in mood and psychotic disorders is highlighted in this review article.
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Affiliation(s)
- Sonali Reisinger
- Department of Neurophysiology and Neuropharmacology, Medical University of Vienna, Austria
| | - Deeba Khan
- Department of Neurophysiology and Neuropharmacology, Medical University of Vienna, Austria
| | - Eryan Kong
- Department of Neurophysiology and Neuropharmacology, Medical University of Vienna, Austria
| | - Angelika Berger
- Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Austria
| | - Arnold Pollak
- Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Austria
| | - Daniela D Pollak
- Department of Neurophysiology and Neuropharmacology, Medical University of Vienna, Austria.
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50
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Milgrom J, Gemmill AW, Ericksen J, Burrows G, Buist A, Reece J. Treatment of postnatal depression with cognitive behavioural therapy, sertraline and combination therapy: a randomised controlled trial. Aust N Z J Psychiatry 2015; 49:236-45. [PMID: 25586754 DOI: 10.1177/0004867414565474] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
OBJECTIVES Both antidepressant medications and psychological therapy are common treatments for depression in postpartum women. Antidepressant treatment may have a number of practical disadvantages, including a preference by women to avoid medication while breastfeeding. Consequently, more information about the relative benefits of the two modalities in the perinatal period is helpful. In the treatment of depressive disorders there is some evidence that combination therapies (pharmacological plus psychological treatment) may be more efficacious than either form of mono-therapy in isolation. However, in the treatment of postnatal depression, such evidence is limited. METHOD Forty five postpartum women with a DSM-IV diagnosis of depression were randomised to receive either: 1) cognitive behavioural therapy (CBT); 2) sertraline, or 3) a combination of both treatment modalities. Psychometric measures were collected weekly for 12 weeks, with a follow-up at 24 weeks. RESULTS Symptoms of depression and anxiety were reduced to a significant degree following all three treatments. CBT mono-therapy was found to be superior to both sertraline mono-therapy and combination therapy after 12 weeks. The CBT mono-therapy group appeared to display the most rapid initial gains after treatment commencement. CONCLUSIONS In this sample, a specialised CBT program for postnatal depression was found to be superior as a mono-therapy compared to sertraline, a commonly prescribed SSRI antidepressant. This is in contrast to previous studies which have found no detectable difference in the efficacies of drug and psychological treatment for postnatal depression. Unlike some previous work, this study allowed a statistically independent evaluation of CBT mono-therapy for postnatal depression compared to both antidepressant and combination therapy. In line with previous studies in postpartum women, there was no detectable advantage of combining pharmacological and psychological treatments in the short term.
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Affiliation(s)
- Jeannette Milgrom
- Parent-Infant Research Institute, Department of Clinical & Health Psychology, Heidelberg Repatriation Hospital, Heidelberg West, Australia Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Australia
| | - Alan W Gemmill
- Parent-Infant Research Institute, Department of Clinical & Health Psychology, Heidelberg Repatriation Hospital, Heidelberg West, Australia
| | - Jennifer Ericksen
- Parent-Infant Research Institute, Department of Clinical & Health Psychology, Heidelberg Repatriation Hospital, Heidelberg West, Australia
| | - Graham Burrows
- Department of Psychiatry, Austin Health, Melbourne, Australia Department of Psychiatry, University of Melbourne, Melbourne, Australia
| | - Anne Buist
- Department of Psychiatry, Austin Health, Melbourne, Australia Department of Psychiatry, University of Melbourne, Melbourne, Australia
| | - John Reece
- RMIT University & Australian College of Applied Psychology, Melbourne, Australia
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