Antidepressant therapy for unexplained symptoms and symptom syndromes

OBJECTIVE: To determine the efficacy of antidepressant therapy for unexplained symptoms or symptom syndromes. SEARCH STRATEGIES: We identified original studies through searching MEDLINE, EMBASE, PsycLIT, the Federal Research in Progress database, and The Cochrane Library. We also searched the bibliographies of primary and review articles for additional studies. SELECTION CRITERIA: We excluded trials of patients with neuropathic, oncologic, or degenerative joint pain. Independent duplicate review of 392 articles identified 94 relevant reports of randomized trials involving 6595 patients across 6 symptom syndromes. Independent duplicate assessment was made for inclusion and data abstraction. Meta-analysis was performed on extractable placebo-controlled data. MAIN RESULTS: Of 94 included trials, most studied either tricyclic antidepressants, antiserotonin antidepressants, selective serotonin reuptake inhibitors (SSRIs), or multiple agents for the treatment of the following syndromes: headache (50), fibromyalgia (18), functional gastrointestinal syndromes (13), idiopathic pain (11), tinnitus (2), and chronic fatigue (2). The quality of the studies was fair (mean score = 4.8 on a scale of 0 to 8). A majority of the studies (69%) demonstrated benefit for at least one outcome measure. Symptom improvement typically did not correlate with depression response in the few studies where it was assessed. Meta-analysis of all extractable data showed a substantial benefit from antidepressants: For the dichotomous outcome of improvement, the odds ratio was 3.4 (95% confidence interval [CI], 2.6 - 4.5), and for continuous outcomes, the standardized mean difference was 0.87 (95% CI, 0.59-1.14). The absolute percentage difference in improvement between the antidepressant and placebo arms was 32%, yielding a number needed to treat of 3 to improve one person's symptoms. Meta-regression indicated no differential effect across the classes of antidepressants; however, onbivariate tally tricyclic studies were associated with a greater likelihood of efficacy than SSRI studies (P = .02). CONCLUSIONS: Antidepressants can be effective for various physical symptoms and symptom syndromes. The relation of outcome to depression and the efficacy of SSRIs needs further study.     

The charges for ESRD treatment of diabetics

To evaluate the differential charges for treating end-stage renal disease (ESRD) associated with diabetes mellitus, Medicare billing data are analyzed. The charges of 244 patients in the Michigan Kidney Registry identified as having (ESRD) from diabetes are compared with charges of 902 nondiabetic patients. Average annual charges for ESRD treatment for diabetics are +29,671 (+/- 27,662) which are +4695 (+/- 1344) higher than charges for nondiabetics. The majority of the difference (84.3%) is attributable to higher inpatient hospital charges. Most of the remainder (14.5%) is attributable to higher physician and medical supply charges. Charges for treatment of diabetics are higher on all modalities of treatment, but differences are not significant among modalities.     

作业疗法对复发性抑郁症疗效的观察

目的探讨作业疗法对复发性抑郁症患者的治疗效果。方法将82例复发性抑郁症患者随机分为治疗组(42例)和对照组(40例)。治疗组在日常药物治疗的基础上使用作业疗法进行合理情绪治疗,对照组仅进行相应的药物治疗及一般的康复治疗。于治疗前后分别用汉密尔顿抑郁量表(HAMD)、临床疗效总评量表(CGI-GI)评定疗效,1年后随访。结果治疗42天后,两组的HAMD量表评分自治疗1周后均有有显著性差异,至6周差异最为显著,P0.05,CGI-GI评分比较自第4周后出现显著性差异,P0.05;治疗结束后,研究组及对照组总有效率分别为95.23%和90.0%,两组比较差异无显著性,P0.05;显效率为78.6%和52.5%,两组比较有显著性差异,P0.05。一年后复发率治疗组为7.14%,对照组为22.5%(χ2=3.87,P0.05)有显著性差异。结论作业疗法对复发性抑郁症患者是一种有效的康复治疗方法,能降低复发率。     

Exercise treatment for depression: efficacy and dose response

BACKGROUND: This study, conducted between 1998 and 2001 and analyzed in 2002 and 2003, was designed to test (1) whether exercise is an efficacious treatment for mild to moderate major depressive disorder (MDD), and (2) the dose-response relation of exercise and reduction in depressive symptoms. DESIGN: The study was a randomized 2x2 factorial design, plus placebo control. SETTING/PARTICIPANTS: All exercise was performed in a supervised laboratory setting with adults (n =80) aged 20 to 45 years diagnosed with mild to moderate MDD. INTERVENTION: Participants were randomized to one of four aerobic exercise treatment groups that varied total energy expenditure (7.0 kcal/kg/week or 17.5 kcal/kg/week) and frequency (3 days/week or 5 days/week) or to exercise placebo control (3 days/week flexibility exercise). The 17.5-kcal/kg/week dose is consistent with public health recommendations for physical activity and was termed "public health dose" (PHD). The 7.0-kcal/kg/week dose was termed "low dose" (LD). MAIN OUTCOME MEASURES: The primary outcome was the score on the 17-item Hamilton Rating Scale for Depression (HRSD(17)). RESULTS: The main effect of energy expenditure in reducing HRSD(17) scores at 12 weeks was significant. Adjusted mean HRSD(17) scores at 12 weeks were reduced 47% from baseline for PHD, compared with 30% for LD and 29% for control. There was no main effect of exercise frequency at 12 weeks. CONCLUSIONS: Aerobic exercise at a dose consistent with public health recommendations is an effective treatment for MDD of mild to moderate severity. A lower dose is comparable to placebo effect.     

Application of occupational therapy in the treatment of depression

Depression as a major social and public health problem is a challenge for clinicians and occupational therapists throughout the world. This theoretical paper is based on a literature review and the author's experience as an occupational therapist in mental health in Finland, working with severely long-term depressed patients. The basic concepts of a cognitive–behavioural model are introduced and evaluated. The relationship of depression, mourning and suicide is discussed and a model for occupational therapy intervention acting.     

Short duration of post-amputation antibiotic therapy in diabetic foot patients with total resection of osteomyelitis

BackgroundShort duration of post-amputation antibiotic therapy (2–5 days) is recommended in patients with diabetic foot osteomyelitis after total resection of infected bone tissue.ObjectiveTo evaluate the long-term effectiveness of short-duration post-amputation antibiotic therapy in diabetic patients with total resection of osteomyelitis assessed by sterile bone bacteriological samples obtained from the resection margin.MethodsThe endpoint was the absence of osteomyelitis relapse at 6 months, defined as recurrence of osteomyelitis with the need for surgical revision and/or new bone antibiotic therapy.ResultsAmong 15 patients included, 12 (80%) were cured without recurrence of osteomyelitis at 6 months, with a mean duration of antibiotic therapy of 8.3 ± 5.9 days post surgery. This result is comparable to literature data, while all of them reported longer duration of antibiotic therapy and/or shorter follow-up.ConclusionShort duration of post-amputation antibiotic therapy in diabetic patients with sterile bacteriological samples obtained from resection margin seems effective.     

Biochemistry and treatment strategies for depression

Major depressive disorder is a relatively common illness. Many depressed patients are seen by a primary care physician and not a psychiatrist. Several lines of evidence suggest a biochemical etiology for depression. Some research suggests at least two distinct biochemical depressions, one involving an abnormality of the norepinephrine neurotransmitter system and the other involving an abnormality of the serotonin system. Individual tricyclic antidepressants appear to have differential effects on these two neurotransmitters. This may explain why some depressed patients respond better to one tricyclic than to another. This factor also provides a treatment rationale for switching a nonresponsive depressed patient from one tricyclic, after an adequate trial, to the "opposite" tricyclic. Pretreatment levels of 3-methoxy-4-hydroxyphenylglycol (MHPG) separate depressed patients quite accurately into two groups: imipramine responders and amitriptyline responders. Future research in this area may lead to clinically useful laboratory tests for the treatment of depression.     

经络氧疗法合并氟西汀治疗抑郁症的对照研究

目的:探讨经络氧对抑郁症的治疗作用.方法:选择60例抑郁症患者,随机分为两组,每组30例.实验组采用经络氧加口服氟西汀的治疗方法,对照组单纯服用氟西汀,疗程6周.采用汉密顿抑郁量表(HAMD)评价疗效,副反应量表(TESS)评价药物副反应.结果:治疗后第1、2周末,两组HAMD评分,实验组显著低于对照组(P＜0.05).治疗6周末,显效率:实验组80%,对照组70%,两组显效率比较差异无显著性(P》0.05);不良反应发生率:实验组16.7%,对照组60%,两组不良反应发生率比较差异极显著(P＜0.01).结论:经络氧合并氟西汀治疗抑郁症起效快、疗效好、副作用少.     

Breast preserving therapy: shorter treatment duration by the peroperative introduction of iridium guide needles]

In the Deventer Radiotherapeutic Institute from January 1981 through December 1989, 359 patients who had undergone a breast-saving operation were irradiated. Since 1987, iridium guiding needles were introduced peroperatively in 79 of these patients. Subsequently, irradiation was administered. With this method the total duration of treatment was 16 days shorter on average than in patients who postoperatively were treated with iridium or external irradiation; also, the patients treated peroperatively needed only to be anaesthetized once. In addition, better positioning of the needles was possible, reducing the risk of faulty localization. The follow-up was short but the preliminary results of the treatment were good (one local recurrence after an average follow-up of 20 months) and no adverse effect on wound healing was seen.     

Counseling versus antidepressant therapy for the treatment of mild to moderate depression in primary care: economic analysis

OBJECTIVE: To compare the cost-effectiveness of generic psychological therapy (counseling) with routinely prescribed antidepressant drugs in a naturalistic general practice setting for a follow-up period of 12 months. METHODs: Economic analysis alongside a randomized clinical trial with patient preference arm. Comparison of depression-related health service costs at 12 months. Cost-effectiveness analysis of bootstrapped trial data using net monetary benefits and acceptability curves. RESULTS: No significant difference between the mean observed costs of patients randomized to antidepressants or to counseling (342 pounds sterling vs 302 pounds sterling , p = .56 [t test]). If decision makers are not willing to pay more for additional benefits (value placed on extra patient with good outcome, denoted by K, is zero), then we find little difference between the treatment modalities in terms of cost-effectiveness. If decision makers do place value on additional benefit (K > 0 pounds sterling), then the antidepressant group becomes more likely to be cost-effective. This likelihood is in excess of 90% where decision makers are prepared to pay an additional 2,000 pounds sterling or more per additional patient with a good global outcome. The mean values for incremental net monetary benefits (INMB) from antidepressants are substantial for higher values of K (INMB = 406 pounds sterling when K = 2,500 pounds sterling). CONCLUSION: For a small proportion of patients, the counseling intervention (as specified in this trial) is a dominant cost-effective strategy. For a larger proportion of patients, the antidepressant intervention (as specified in this trial) is the dominant cost-effective strategy. For the remaining group of patients, cost-effectiveness depends on the value of K. Since we cannot observe K, acceptability curves are a useful way to inform decision makers.     

Average hospital charges for asthma treatment vary dramatically by region and state

Asthma is one of the most frequent causes of hospitalization among children and adults and it's a costly chronic condition. But treatment costs and utilization vary geographically. Here's the data developed by a group health insurance company, which surveyed total charges for its asthma patients across 50 states and came up with broad variations in costs.