disorders - depressive disorders
Le-Noury, J., Nardo, J. M., Healy, D., Jureidini, J., Raven, M., Tufanaru, C., Abi-Jaoude, E.,
Objectives: To reanalyse SmithKline Beecham's Study 329 (published by Keller and colleagues in 2001), the primary objective of which was to compare the efficacy and safety of paroxetine and imipramine with placebo in the treatment of adolescents with unipolar major depression. The reanalysis under the restoring invisible and abandoned trials (RIAT) initiative was done to see whether access to and reanalysis of a full dataset from a randomised controlled trial would have clinically relevant implications for evidence based medicine.; Design: Double blind randomised placebo controlled trial.; Setting: 12 North American academic psychiatry centres, from 20 April 1994 to 15 February 1998.; Participants: 275 adolescents with major depression of at least eight weeks in duration. Exclusion criteria included a range of comorbid psychiatric and medical disorders and suicidality.; Interventions: Participants were randomised to eight weeks double blind treatment with paroxetine (20-40 mg), imipramine (200-300 mg), or placebo.; Main Outcome Measures: The prespecified primary efficacy variables were change from baseline to the end of the eight week acute treatment phase in total Hamilton depression scale (HAM-D) score and the proportion of responders (HAM-D score ≤8 or ≥50% reduction in baseline HAM-D) at acute endpoint. Prespecified secondary outcomes were changes from baseline to endpoint in depression items in K-SADS-L, clinical global impression, autonomous functioning checklist, self-perception profile, and sickness impact scale; predictors of response; and number of patients who relapse during the maintenance phase. Adverse experiences were to be compared primarily by using descriptive statistics. No coding dictionary was prespecified.; Results: The efficacy of paroxetine and imipramine was not statistically or clinically significantly different from placebo for any prespecified primary or secondary efficacy outcome. HAM-D scores decreased by 10.7 (least squares mean) (95% confidence interval 9.1 to 12.3), 9.0 (7.4 to 10.5), and 9.1 (7.5 to 10.7) points, respectively, for the paroxetine, imipramine and placebo groups (P=0.20). There were clinically significant increases in harms, including suicidal ideation and behaviour and other serious adverse events in the paroxetine group and cardiovascular problems in the imipramine group.; Conclusions: Neither paroxetine nor high dose imipramine showed efficacy for major depression in adolescents, and there was an increase in harms with both drugs. Access to primary data from trials has important implications for both clinical practice and research, including that published conclusions about efficacy and safety should not be read as authoritative. The reanalysis of Study 329 illustrates the necessity of making primary trial data and protocols available to increase the rigour of the evidence base.; © Le Noury et al 2015.
BMJ, 351 : h4320-h4320
- Year: 2015
- Problem: Depressive Disorders
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions (any)
, Selective serotonin reuptake inhibitors (SSRIs), Tricyclic antidepressants, Antidepressants (any)
Livheim, F., Hayes, L., Ghaderi, A., Magnusdottir, T, Hogfeldt, A., Rowse, J., Turner, S., Hayes, S., Tengstrom, A.
Depression, anxiety and stress are common problems among adolescents. Teaching young people coping strategies in school-based intervention programs is one promising approach hoped to remedy the negative consequences of distress in adolescence. The aim of the two pilot studies was to examine the effect of a brief intervention based on the principles of Acceptance and Commitment Therapy (ACT) on depressive symptomatology (Australian study, N = 66) and stress (Swedish study, N = 32) among adolescents screened for psychosocial problems in school settings. In both studies, subjects were assigned to receive the ACT-group-intervention, or a control intervention featuring individual support from the school health care. The Australian study was a planned comparison, with random allocation for girls, plus one replication of a boys group. The Swedish study used a randomized controlled design. The ACT-intervention was an 8-session manualized group program. The Australian study showed significant reductions in depressive symptoms with a large effect, and significant reductions in psychological inflexibility with a medium effect when compared to the control group who received standard care. In the Swedish study, the ACT-intervention group, when compared to the control group, reported significantly lower levels of stress with a large effect size, and marginally significant decrease of anxiety, and marginally significant increased mindfulness skills. Taken together, the ACT-intervention seems to be a promising intervention for reducing stress and depressive symptoms among young adolescents in school and should be tested in full-sized studies. Limitations of these two pilots include small samples.
Journal of Child and Family Studies, 24(4) : 1016-1030
- Year: 2015
- Problem: Depressive Disorders
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Psychological Interventions (any)
, Acceptance & commitment therapy (ACT)
Kilburn, K., Thirumurthy, H., Halpern, C. T., Pettifor, A., Handa, S.
Purpose: This study investigates the causal effect of Kenya's unconditional cash transfer program on mental health outcomes of young people. Methods: Selected locations in Kenya were randomly assigned to receive unconditional cash transfers in the first phase of Kenya's Cash Transfer Program for orphans and Vulnerable Children. In intervention locations, low-income households and those with orphans and vulnerable childrens began receiving monthly cash transfers of $20 in 2007. In 2011, 4 years after program onset, data were collected on the psychosocial status for youth aged 15-24 years from households in intervention and control locations (N = 1960). The primary outcome variable was an indicator of depressive symptoms using the 10-question Center for Epidemiologic Studies Depression Scale. Secondary outcomes include an indicator for hopefulness and physical health measures. Logistic regression models that adjusted for individual and household characteristics were used to determine the effect of the cash transfer program. Results: The cash transfer reduced the odds of depressive symptoms by 24 percent among young persons living in households that received cash transfers. Further analysis by gender and age revealed that the effects were only significant for young men and were larger among men aged 20-24 years and orphans. Conclusions: This study provides evidence that poverty-targeted unconditional cash transfer programs, can improve the mental health of young people in low-income countries.
Journal of Adolescent Health, :
- Year: 2015
- Problem: Depressive Disorders
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Service Delivery & Improvement, Other service delivery and improvement interventions
Kobak, K. A., Mundt, J. C., Kennard, B.
[Correction Notice: An Erratum for this article was reported in Vol 15[2] of Annals of General Psychiatry (see record 2016-03082-001). In the original article, there was an error in Table 7. The corrections are present in the erratum.] Background: Rapid advances in information technology and telecommunications have resulted in a dramatic increase in the use of mobile devices and the internet to enhance and facilitate access to treatment. Cognitive behavior therapy (CBT) is an empirically based treatment that is well suited for enhancement by new technologies, particularly with youth. To facilitate the dissemination of this evidence-based treatment, we developed a technology-enhanced CBT intervention for the treatment of adolescent depression consisting of (1) online therapist training (2) in-session use of tablets for teaching clients CBT concepts and skills, and (3) text messaging for between session homework reminders and self-monitoring. Methods: Eighteen licensed clinicians (social workers n = 7, psychologists n = 9) were randomized to have their patients receive either the intervention (CBT) or treatment as usual (TAU). Each clinician treated four adolescents for 12 weeks. Clinicians in the CBT arm completed an online tutorial on CBT treatment of adolescent depression, then received an iPad with access to patient education materials for teaching CBT concepts to patients during sessions. Individualized text messages were integrated into treatment for homework reminders, support, and outcomes measurement. Outcome measures included a 49-item multiple choice test for tutorial effectiveness; the system usability scale (SUS) for user satisfaction; quick inventory of depressive symptomatology-adolescent version (QIDS-A-Pat); and clinician and patient ratings on the therapeutic alliance scale for adolescents (TASA). Results: A significant increase in knowledge of CBT concepts was found after completing the tutorial, t(8) = 7.02, p < 0.001. Clinician and patient ratings of user satisfaction were high for both the iPad teaching tools, and the text messaging. Ninety-five percent of teens said reviewing their text messages with their therapist was helpful, and all said they would use text messaging in treatment again. Ratings of the therapeutic alliance were higher in the CBT arm t(131) = 4.03, p = 0.001. A significant reduction in depression was found in both groups [t(34) = 8.453, p < 0.001 and t(29) = 6.67, p < 0.001 for CBT and TAU, respectively). Clinical ratings of improvement were greater on all outcome measures for the CBT arm; however, none reached statistical significance. Effect sizes (Cohen's d) ranged from small (QIDS-A) to large (TASA). Conclusions: Results support the feasibility of this technology-enhanced CBT intervention as a means of improving CBT treatment of adolescent depression and may help address the critical shortage of therapists trained on empirically based treatments. (PsycINFO Database Record (c) 2016 APA, all rights reserved) (journal abstract).
Annals of General Psychiatry, 14 : ArtID 37
- Year: 2015
- Problem: Depressive Disorders
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Service Delivery & Improvement, Psychological Interventions (any)
, Cognitive & behavioural therapies (CBT)
, Technology, interventions delivered using technology (e.g. online, SMS)
Kosters, M. P., Chinapaw, M. J., Zwaanswijk, M., van-der-Wal, M. F., Koot, H. M.
OBJECTIVES: We investigated whether intervention effects of FRIENDS for Life, a school-based prevention program for children with anxiety or depression symptoms, were maintained over a period of 12 months after the intervention in a naturalistic setting.
METHODS: We used a quasi-experimental design, with 339 children in the intervention group and 157 in the control group (aged 8-13 years) in schools in Amsterdam, the Netherlands. We collected self-, teacher, and peer reports of anxiety and depression scores before and after intervention, and 6 and 12 months after intervention, from 2010 to 2012.
RESULTS: Intervention-group children reported a continuing and significant decrease in anxiety and depression scores compared with the control group. Twelve months after the intervention, participants' anxiety and depression levels were comparable to those of the general population. Girls reported a stronger decrease in anxiety scores than did boys. Teacher reports suggested no effects. Although classmates reported increased internalizing problems in intervention-group children immediately after intervention, these effects disappeared over time.
CONCLUSIONS: FRIENDS for Life, an indicated prevention program, yielded long-lasting and continuing reduction in anxiety and depression problems when implemented in daily school practice.
American Journal of Public Health, 105(10) : 2005-2013
- Year: 2015
- Problem: Anxiety Disorders (any), Depressive Disorders
- Type: Controlled clinical trials
-
Stage: Universal prevention
, At risk (indicated or selected prevention)
-
Treatment and intervention: Psychological Interventions (any)
, Other Psychological Interventions
Kallapiran, K., Koo, S., Kirubakaran, R., Hancock, K.
Background: Mindfulness-based interventions (MBIs) are increasingly used in the management of various mental health disorders in children and adolescents. However, there is limited evidence about the efficacy of various interventions used. Method: A systematic review was performed to examine the effects of different MBIs on mental health symptoms and quality of life in both clinical and nonclinical samples of children and adolescents using data from only randomized control trials. The studies were also assessed for quality. Based on the type of MBI, study population, and control arm we had three comparisons for meta-analyses. Results: Fifteen studies were included in the qualitative analysis but only 11 trials with comparable interventions and controls were included for meta-analyses. Mindfulness-based stress reduction/mindfulness-based cognitive therapy arm was more effective than nonactive control in the nonclinical populations. Acceptance commitment therapy was comparable to active treatments in patients in the clinical range. Other MBIs were also effective improving anxiety and stress but not depression in nonclinical populations compared to nonactive control. Conclusions: Mindfulness-based interventions can be effective in children and adolescents with mental health symptoms. As there were significant limitations these results must be interpreted with caution.
Child & Adolescent Mental Health, 20(4) : 182-194
- Year: 2015
- Problem: Anxiety Disorders (any), Depressive Disorders
- Type: Systematic reviews
-
Stage: Universal prevention
, At risk (indicated or selected prevention)
, Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions (any)
, Mindfulness based therapy
Hetrick, S. E., Cox, G. R., Fisher, C. A., Bhar, S. S., Rice, S. M., Davey, C.G., Parker, A. G.,
Aim: Recent findings from systematic reviews and primary research studies have shown more modest effects of cognitive behavioural therapy (CBT) for youth depression than previously shown, highlighting the need to further enhance the effectiveness of this intervention, or components of this intervention. Therefore, the aim of this review is to summarize the work that has been done to identify the different components of CBT and their varying effectiveness for young people with depression.; Methods: Narrative overview of English language reviews/meta-analyses and primary intervention studies retrieved from searches of computerized databases as well as ancestry searches.; Results: Reviews of intervention studies of adults as well as young people with depression have shown that behavioural approaches are equally as effective as cognitive approaches in reducing depression symptoms. Post-hoc analyses of large studies in youth depression have also shown that behavioural approaches might be more suitable for young people.; Conclusions: Behaviourally based approaches appear promising in treating youth depression; however, further research is required. This research will represent an essential step towards refining interventions for youth depression, and enabling interventions to be targeted to particular subgroups, to optimize their effectiveness.; © 2014 Wiley Publishing Asia Pty Ltd.
Early Intervention in Psychiatry, 9(2) : 93-99
- Year: 2015
- Problem: Depressive Disorders
- Type: Systematic reviews
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions (any)
, Cognitive & behavioural therapies (CBT)
Hetrick, S. E., Cox, G. R., Merry, S. N.
Objective: To examine the overall effect of individual depression prevention programs on future likelihood of depressive disorder and reduction in depressive symptoms. In addition, we have investigated whether Cognitive Behavioural Therapy (CBT), Interpersonal Therapy (IPT) and other therapeutic techniques may modify this effectiveness.; Methods: This study is based on and includes the trial data from meta-analyses conducted in the Cochrane systematic review of depression prevention programs for children and adolescents by Merry et al. (2011). All trials were published or unpublished English language randomized controlled trials (RCTs) or cluster RCTs of any psychological or educational intervention compared to no intervention to prevent depression in children and adolescents aged 5-19 years.; Results: There is some evidence that the therapeutic approach used in prevention programs modifies the overall effect. CBT is the most studied type of intervention for depression prevention, and there is some evidence of its effectiveness in reducing the risk of developing a depressive disorder, particularly in targeted populations. Fewer studies employed IPT, however this approach appears promising. To our knowledge, this is the first study to have explored how differences in the approach taken in the prevention programs modify the overall treatment effects of prevention programs for children and adolescents.; Conclusions: More research is needed to identify the specific components of CBT that are most effective or indeed if there are other approaches that are more effective in reducing the risk of future depressive episodes. It is imperative that prevention programs are suitable for large scale roll-out, and that emerging popular modes of delivery, such as online dissemination continue to be rigorously tested.;
International Journal of Environmental Research & Public Health, 12(5) : 4758-4795
- Year: 2015
- Problem: Depressive Disorders
- Type: Systematic reviews
-
Stage: Universal prevention
, At risk (indicated or selected prevention)
-
Treatment and intervention: Psychological Interventions (any)
, Cognitive & behavioural therapies (CBT)
, Interpersonal therapy (IPT)
Kaseva, K., Pulkki-Raback, L., Elovainio, M., Pahkala, K., Keltikangas-Jarvinen, L., Hintsanen, M., Hakulinen, C., Lagstrom, H., Jula, A., Niinikoski, H., Ronnemaa, T., Viikari, J., Simell, O., Raitakari, O.
Aim This study examined whether there was an association between a repeated dietary and lifestyle intervention that began in infancy and participants' psychological wellbeing at the age of 20. Methods We examined the psychological wellbeing of 457 young adults participating in the Special Turku Coronary Risk Factor Intervention Project (STRIP), a randomised controlled trial conducted in Finland between 1989 and 2011. We assessed potential differences in psychological wellbeing between the intervention and control groups by examining participants' satisfaction with life, how they rated their health, their experiences of stress and the consequences of experiencing stress and symptoms of depression at the age of 20. We also assessed socio-economic status during childhood as a potential confounding factor. Results We found no association between the long-term dietary and lifestyle intervention and participants' psychological wellbeing in adulthood. Adjusting for sex and childhood socio-economic status did not affect the results and socio-economic status did not moderate the association between the intervention and psychological wellbeing. Conclusion Our findings showed no association between intensive dietary and lifestyle counselling that was initiated in infancy with psychological wellbeing in adulthood and the initiative did not appear to pose any psychological risks.
Acta Paediatrica, International Journal of Paediatrics, 104(8) : 815-822
- Year: 2015
- Problem: Depressive Disorders
- Type: Randomised controlled trials
-
Stage: Universal prevention
-
Treatment and intervention: Complementary & Alternative Interventions (CAM)
, Dietary advice, dietary change
Iftene, F., Predescu, E., Stefan, S., David, D.
Major depressive disorder is a highly prevalent and debilitating condition in youth, so developing efficient treatments is a priority for mental health professionals. Psychotherapy (i.e., cognitive behavioral therapy/CBT), pharmacotherapy (i.e., SSRI medication), and their combination have been shown to be effective in treating youth depression; however, the results are still mixed and there are few studies engaging multi-level analyses (i.e., subjective, cognitive, and biological). Therefore, the aims of this randomized control study (RCT) were both theoretical-integrating psychological and biological markers of depression in a multi-level outcome analysis - and practical-testing the generalizability of previous results on depressed Romanian youth population. Eighty-eight (N = 88) depressed Romanian youths were randomly allocated to one of the three treatment arms: group Rational Emotive Behavior Therapy (REBT)/CBT (i.e., a form of CBT), pharmacotherapy (i.e., sertraline), and group REBT/CBT plus pharmacotherapy. The results showed that all outcomes (i.e., subjective, cognitive, and biological) significantly change from pre to post-treatment under all treatment conditions at a similar rate and there were no significant differences among conditions at post-test. In case of categorical analysis of the clinical response rate, we found a non-significant trend favoring group REBT/CBT therapy. Results of analyses concerning outcome interrelations are discussed. (PsycINFO Database Record (c) 2015 APA, all rights reserved) (journal abstract).
Psychiatry Research, 225(3) : 687-694
- Year: 2015
- Problem: Depressive Disorders
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions (any)
, Selective serotonin reuptake inhibitors (SSRIs), Antidepressants (any)
, Service Delivery & Improvement, Psychological Interventions (any)
, Cognitive & behavioural therapies (CBT)
, Other service delivery and improvement interventions
Harrison, S. J., Tyrer, A. E., Levitan, R. D., Xu, X., Houle, S., Wilson, A. A., Nobrega, J. N., Rusjan, P. M., Meyer, J. H.
Objective: To investigate the effects of light therapy on serotonin transporter binding (5-HTT BPND), an index of 5-HTT levels, in the anterior cingulate and prefrontal cortices (ACC and PFC) of healthy individuals during the fall and winter. Twenty-five per cent of healthy individuals experience seasonal mood changes that affect functioning. 5-HTT BPND has been found to be higher across multiple brain regions in the fall and winter relative to spring and summer, and elevated 5-HTT BPND may lead to extracellular serotonin loss and low mood. We hypothesized that, during the fall and winter, light therapy would reduce 5-HTT BPND in the ACC and PFC, which sample brain regions involved in mood regulation. Method: In a single-blind, placebo-controlled, counterbalanced, crossover design, [11C]DASB positron emission tomography was used measure 5-HTT BPND following light therapy and placebo conditions during fall and winter. Results: In winter, light therapy significantly decreased 5-HTT BPND by 12% in the ACC relative to placebo (F1,9 = 18.04, P = 0.002). In the fall, no significant change in 5-HTT BPND was found in any region across conditions. Conclusion: These results identify, for the first time, a central biomarker associated with the intervention of light therapy in humans which may be applied to further develop this treatment for prevention of seasonal depression.
Acta Psychiatrica Scandinavica, 132(5) : 379-388
- Year: 2015
- Problem: Depressive Disorders
- Type: Randomised controlled trials
-
Stage: Universal prevention
-
Treatment and intervention: Complementary & Alternative Interventions (CAM)
, Bright light therapy
Hashemian, P., Sadjadi, S. A.
Introduction: Major depression is one of the most common psychiatric disorders that is with depressed mood and characterized by feelings of sadness, low self esteem and lack of interest or pleasure in daily activities. Objective: The main aim of this article is comparison of efficacy of real neurofeedback therapy versus sham (unreal or placebo) in adolescents with major depressive disorder in Iran, Mashhad. Material&Method: This study included 28 adolescents with major depression that were diagnosed by psychiatric interview according to DSM -V and Hamilton scale. They were randomly divided into two groups. All patients were treated with 20 mg of fluoxetine. Half received neurofeedback treatment on F3 region and the other half received unreal neurofeedback treatment or sham (placebo). Immediately after the 20th session Hamilton test was conducted. Results: The efficacy of treatment with real and unreal neurofeedback on adolescents' depression shows difference in scores. The differences between pre-test and post-test scores within each group and finally between the two groups were compared using independent t-test. According to the results, the index calculated t (-0.9) is not significant. So there is no significant difference between real and unreal neurofeedback effects. Conclusion: This study shows that real neurofeedback therapy was effective; but this efficacy was not significantly different from unreal neurofeedback therapy in adolescent depression. This means that in F3 region, the effect of real neurofeedback therapy was not any different from unreal neurofeedback on adolescents' depression. Experiments on other regions are suggested.
African Journal of Psychiatry (South Africa), 18(1) :
- Year: 2015
- Problem: Depressive Disorders
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions (any)
, Biofeedback, neurofeedback, audio/video feedback