Remission in major depressive disorder: a comparison of pharmacotherapy,psychotherapy, and control conditions

OBJECTIVE: The aim of this study was to assess the percentages of full remission in studies of patients with major depressive disorder in which pharmacotherapy, psychotherapy, and control conditions were directly compared. METHOD: Computerized searches of the MEDLINE and PsychINFO databases up to November 2000 were used to identify six multiple-cell randomized, controlled, double-blind trials for well-defined major depressive disorder in which medications, psychotherapy, and control conditions were directly compared and for which remission percentages were reported. RESULTS: The studies included a total of 883 outpatients with mild to moderate, primarily nonmelancholic, nonpsychotic major depressive disorder. Treatment duration ranged from 10 to 34 weeks (median=16 weeks). An intent-to-treat analysis indicated that, according to measurements by independent blind raters, antidepressant medication (tricyclic antidepressants and phenelzine) and psychotherapy (primarily cognitive behavior and interpersonal therapies) were more efficacious than control conditions, but there were no differences between active treatments. The percentages of remission for all patients randomly assigned to medication, psychotherapy, and control conditions were 46.4%, 46.3%, and 24.4%, respectively. Furthermore, significantly more patients dropped out of control conditions (54.4%) than either treatment with medication (37.1%) or psychotherapy (22.2%). CONCLUSIONS: Both antidepressant medication and psychotherapy may be considered first-line treatments for mildly to moderately depressed outpatients.     

Associations of caregiver stressors and uplifts with subjective well-being and depressive mood: a meta-analytic comparison

The present meta-analytic study gives a systematic review of research on depression and the subjective well-being of caregivers. We integrate results from 60 studies on informal caregivers' subjective well-being (e.g., positive affect, life-satisfaction) and contrast them with the result of studies on caregiver depression. Analyses were based on a two-factor model of subjective well-being that distinguishes between positive and negative dimensions of well-being (e.g., happiness and depression). The strongest effects were domain-specific: uplifts of caregiving were associated with subjective well-being and caregiving stressors were associated with depression. In addition, weaker effects that crossed domains were present: uplifts were weakly associated with depressive symptoms. In addition, lower levels of caregivers' subjective well-being were weakly related to care receivers' physical and cognitive impairments, as well as behaviour problems, but not to the amount of caregiving. Type of care recipients' illness and the measure of well-being moderated, in part, the association between stressors/uplifts and subjective well-being.     

Integrating psychotherapy and pharmacotherapy.

In recent years, the dichotomy between psychotherapy and pharmacotherapy vis-à-vis the treatment of mood disorders has begun to be resolved as the benefits of integrating the two modalities are increasingly recognized. This new understanding has expanded the scope of successful treatment, but it has also complicated the process of making decisions about appropriate treatment. The author reviews the literature, illustrates some of the complex issues with case examples, and suggest guidelines for the mental health clinicians who must make such treatment decisions.     

An integrated treatment algorithm for pharmacotherapy and psychotherapy.

OBJECTIVE: As in Australia, demand for psychotherapy is rising in Britain, and the wide variety of psychological treatments available within the National Health Service (NHS), the independent sector, and voluntary agencies leads to uncertainty about which patients are most suitable for which type of psychotherapy, as well as the appropriate balance between psychological and pharmacological interventions. This paper describes how Birmingham Health Authority (HA), the largest HA in England and Wales with a population of just under one million, developed and implemented an evidence-based strategy for the use of psychotherapy services. METHOD: A literature search and health needs assessment for psychotherapy in Birmingham was performed. RESULTS: It was possible to estimate the need for evidence-based psychotherapy services using routinely available epidemiological data. By matching specific techniques to individual diagnosis and estimating the size of the population for whom this was appropriate, demand for psychotherapy exceeded service provision by a factor of four. CONCLUSIONS: The following steps were undertaken: (i) setting priorities for the commissioning of psychotherapy on the basis of the scientific literature including greater use of brief and focused forms of integrative therapy from a variety of psychotherapeutic schools; (ii) targeting interventions on the basis of objective criteria to ensure that patients were referred for the appropriate level and intensity of psychological intervention using the full range of available services within the NHS, the independent sector, and voluntary agencies; (iii) agreeing on an integrated treatment algorithm (ITA) for the use of the most cost-effective treatments while ensuring that a range of alternative interventions was available for patients for whom a first line therapy was not suitable. Such an ITA could be adapted to assist general practitioners in their management and referral decisions; (iv) sharing skills between specialist psychotherapy services and members of primary and mental health teams through training, supervision and consultation-liaison.     

Psychodynamic psychotherapy for the depressive syndrome

Historical approaches of psychotherapy for depression are contrasted with current psychotherapeutic strategies. Now more strategies are focused, structured, time-limited, observable, testable, researchable and data based. The following depressive syndromes are reviewed in terms of the literature that demonstrates the effectiveness of psychotherapy: major depressive disorder, bipolar depressive disorder, depression associated with medical illness such as cancer, myocardial infarction and stroke, resistant depression post-traumatic stress disorder, grief reactions and depression during adolescence, mid-life and the geriatric period of the life cycle. A conceptual model favoring tripartite focus of intervention is recommended. Psychodynamic psychotherapy for depression must consider intrapsychic, interpersonal and family dynamics as well as social supports. A model for each population needs to be studied and developed further. Recommendations for current research are suggested. In the individual modification of psychotherapeutic approaches we must consider the varying maturity of ego defenses and the ego strength of the individual patient. Forty well-designed studies that demonstrate the effectiveness of psychotherapy in the depressive syndromes are quoted in this paper.     

Developmentally informed pharmacotherapy for child and adolescent depressive disorders

This article reviews evidence-based pharmacotherapy for children and adolescents with depression. Several randomized controlled trials (RCTs) support the use of fluoxetine for the treatment of childhood and adolescent depression as well as escitalopram in the treatment of adolescent depression. To date, one RCT has demonstrated the effectiveness of sertraline or citalopram for the treatment of major depressive disorder in youth. Only a small number of RCTs for depression have included children, and none of these trials were adequately powered to detect differences in the efficacy of medication between children and adolescents.     

Outcomes of religious and spiritual adaptations to psychotherapy: A meta-analytic review

Abstract

The use of spiritually oriented psychotherapies has increased dramatically during the past decade. This article reports a meta-analysis of 31 outcome studies of spiritual therapies conducted from 1984 to 2005 with clients suffering from a variety of psychological problems. Across the 31 studies, the random-effects weighted average effect size was 0.56. This finding provides some empirical evidence that spiritually oriented psychotherapy approaches may be beneficial to individuals with certain psychological problems (e.g., depression, anxiety, stress, eating disorders). Recommendations for future research in this domain are offered.     

Effects of structured exercise and pharmacotherapy vs. pharmacotherapy for adults with depressive symptoms: A randomized clinical trial

ObjectivePhysical exercise has been consistently documented as a complementary therapy in the treatment of depressive disorders. However, despite a higher prevalence among women compared to men, the trials developed in women are scarce. In addition, the optimal dosage of exercise capable of producing benefits that reduce depressive symptoms remains unclear. This clinical trial is designed to measure the effect of a structured physical exercise program as a complement to antidepressant medication in the treatment of women with depression.MethodsFrom July 2013 to May 2014, we implemented a randomized controlled trial (HAPPY BRAIN study). A total of 26 women (aged 50.16 ± 12.08) diagnosed with clinical depression were randomized either to a supervised aerobic exercise group (45–50 min/week three times a week for four months) plus pharmacotherapy (intervention group), or only antidepressant medication (control group).ResultsThe exercise group presented a decrease in BDI-II and DASS-21 total score scales. Relatively to DASS-21, it showed a significant decrease in anxiety and stress. The exercise group when compared to a control group showed improvement in relation to physical functioning parameters between baseline and post-intervention. Moreover, anthropometric parameters presented only significant differences between groups in fat mass percentage. Nonetheless, no differences were found between groups in weight, body mass index, waist circumference, and self-esteem.ConclusionOur results showed that supervised structured aerobic exercise training could be an effective adjuvant therapy for treating women with depression, reducing depressive symptomatology and improving physical fitness. A key factor of this improvement included strict control of exercise workload parameters and adjustment to each subject's capacity.In our study, due to the sample size there is an increase in the probability of type II errors.