Disorders - Depressive Disorders
Cornelius, J. R., Bukstein, O. G., Douaihy, A. B., Clark, D. B., Chung, T. A., Daley, D. C., Wood, D. S., Brown, S. J.
Objective: This study compared the acute phase (12-week) efficacy of fluoxetine versus placebo for the treatment of the depressive symptoms and the cannabis use of adolescents and young adults with comorbid major depression (MDD) and a cannabis use disorder (CUD) (cannabis dependence or cannabis abuse). We hypothesized that fluoxetine would demonstrate efficacy versus placebo for the treatment of the depressive symptoms and the cannabis use of adolescents and young adults with comorbid MDD/CUD. Methods: We conducted the first double-blind placebo-controlled study of fluoxetine in adolescents and young adults with comorbid MDD/CUD. All participants in both treatment groups also received manual-based cognitive behavioral therapy (CBT) and motivation enhancement therapy (MET) during the 12-week course of the study. Results: Fluoxetine was well tolerated in this treatment population. No significant group-by-time interactions were noted for any depression-related or cannabis-use related outcome variable over the 12-week study. Subjects in both the fluoxetine group and the placebo group showed significant within-group improvement in depressive symptoms and in number of DSM diagnostic criteria for a CUD. Large magnitude decreases in depressive symptoms were noted in both treatment groups, and end-of-study levels of depressive symptoms were low in both treatment groups. Conclusions: Fluoxetine did not demonstrate greater efficacy than placebo for treating either the depressive symptoms or the cannabis-related symptoms of our study sample of comorbid adolescents and young adults. The lack of a significant between-group difference in these symptoms may reflect limited medication efficacy, or may result from efficacy of the CBT/MET psychotherapy or from limited sample size. (copyright) 2010 Elsevier Ireland Ltd.
Drug & Alcohol Dependence, 112(1-2) : 39-45
- Year: 2010
- Problem: Depressive Disorders, Cannabis Use
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions (any)
, Selective serotonin reuptake inhibitors (SSRIs), Psychological Interventions (any)
, Cognitive & behavioural therapies (CBT)
, Motivational interviewing, includes Motivational Enhancing Therapy
Sawada, T., Yokoi, K
European journal of clinical nutrition, 64(3) : 331
- Year: 2010
- Problem: Anxiety Disorders (any), Depressive Disorders
- Type: Randomised controlled trials
-
Stage: Universal prevention
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Treatment and intervention: Complementary & Alternative Interventions (CAM)
, Vitamins and supplements
Dobson, Keith S., Hopkins, Jamie Ahnberg, Fata, Ladan, Scherrer, Martin, Allan, Lauren C.
This study investigated the efficacy of cognitive behavioural therapy (CBT) techniques in preventing depression and anxiety in a group of adolescent high school students with elevated risk for developing emotional disorders. Students were screened using a measure of depression severity and clinical interview. Following screening procedures, students at risk for, but not currently diagnosed with, depression were randomly assigned to one of two intervention groups: a CBT (n = 25) or an active control group (n = 21). Assessment measures were administered before treatment, after treatment, and at 3- and 6-month follow-up. Both groups exhibited significant improvements in mood symptomatology and self-esteem outcomes over time. Significant differences between groups were not observed at posttreatment and two follow-up points of assessment. The efficacy of CBT techniques was also examined using a "benchmarking" strategy. The limitations of this study and future research directions are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved) (journal abstract)
Canadian Journal of School Psychology, 25(4) : 291-310
- Year: 2010
- Problem: Depressive Disorders
- Type: Randomised controlled trials
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Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Psychological Interventions (any)
, Cognitive & behavioural therapies (CBT)
Emslie, Graham J., Mayes, Taryn, Porta, Giovanna, Vitiello, Benedetto, Clarke, Greg, Wagner, Karen Dineen, Asarnow, Joan Rosenbaum, et -al
Objective: Method: Results: Conclusions: The purpose of this study was to report on the outcome of participants in the Treatment of Resistant Depression in Adolescents (TORDIA) trial after 24 weeks of treatment, including remission and relapse rates and predictors of treatment outcome.Adolescents (ages 12-18 years) with selective serotonin reuptake inhibitor (SSRI)-resistant depression were randomly assigned to either a medication switch alone (alternate SSRI or venlafaxine) or a medication switch plus cognitive-behavioral therapy (CBT). At week 12, responders could continue in their assigned treatment arm and nonresponders received open treatment (medication and/or CBT) for 12 more weeks (24 weeks total). The primary outcomes were remission and relapse, defined by the Adolescent Longitudinal Interval Follow-Up Evaluation as rated by an independent evaluator.Of 334 adolescents enrolled in the study, 38.9% achieved remission by 24 weeks, and initial treatment assignment did not affect rates of remission. Likelihood of remission was much higher (61.6% versus 18.3%) and time to remission was much faster among those who had already demonstrated clinical response by week 12. Remission was also higher among those with lower baseline depression, hopelessness, and self-reported anxiety. At week 12, lower depression, hopelessness, anxiety, suicidal ideation, family conflict, and absence of comorbid dysthymia, anxiety, and drug/alcohol use and impairment also predicted remission. Of those who responded by week 12, 19.6% had a relapse of depression by week 24.Continued treatment for depression among treatment-resistant adolescents results in remission in approximately one-third of patients, similar to adults. Eventual remission is evident within the first 6 weeks in many, suggesting that earlier intervention among nonresponders could be important.
American Journal of Psychiatry, 167(7) : 782-791
- Year: 2010
- Problem: Depressive Disorders
- Type: Randomised controlled trials
-
Stage: Treatment resistant/treatment refractory
-
Treatment and intervention: Biological Interventions (any)
, Selective serotonin reuptake inhibitors (SSRIs), Serotonin-norepinephrine reuptake inhibitors (SNRIs), Psychological Interventions (any)
, Cognitive & behavioural therapies (CBT)
Dubicka, B., Elvins, R., Roberts, C., Chick, G., Wilkinson, P., Goodyer, I. M.
Background: The treatment of adolescent depression is controversial and studies of combined treatment (antidepressants and cognitive-behavioural therapy, CBT) have produced conflicting findings. Aims: To address the question of whether CBT confers additional benefit to antidepressant treatment in adolescents with unipolar depression for depressive symptoms, suicidality, impairment and global improvement. Method: Meta-analysis of randomised controlled trials (RCTs) of newer-generation antidepressants and CBT in adolescent depression. Results: There was no evidence of a statistically significant benefit of combined treatment over antidepressants for depressive symptoms, suicidality and global improvement after acute treatment or at follow-up. There was a statistically significant advantage of combined treatment for impairment in the short-term (at 12 weeks) only. There was some evidence of heterogeneity between studies. Conclusions: Adding CBT to antidepressants confers limited advantage for the treatment of an episode of depression in adolescents. The variation in sampling and methodology between studies, as well as the small number of trials, limits the generalisability of the findings and any conclusions that can be drawn. Future studies should examine predictors of response to treatment as well as clinical components that may affect outcome.
British Journal of Psychiatry, 197(6) : 433-440
- Year: 2010
- Problem: Depressive Disorders
- Type: Systematic reviews
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions (any)
, Antidepressants (any)
, Psychological Interventions (any)
, Cognitive & behavioural therapies (CBT)
Haeffel, Gerald J.
A randomized trial was conducted to test the efficacy of three self-directed prevention intervention workbooks for depression. Cognitively at-risk college freshmen were randomly assigned to one of three conditions: traditional cognitive, non-traditional cognitive, and academic skills. Consistent with hypotheses, participants who were high in rumination and experienced stress exhibited significantly greater levels of depressive symptoms after completing the traditional cognitive skills workbook than after completing the other two workbooks. This pattern of results held post-intervention and 4 months later. These findings indicate that rumination may hinder ones ability to identify and dispute negative thoughts (at least without the help of a trained professional). The results underscore the importance of identifying individual difference variables that moderate intervention efficacy. They also raise concerns about the potential benefits of self-help books, an industry that generates billions of dollars each year.
Copyright 2009 Elsevier Ltd. All rights reserved.
Behaviour Research & Therapy, 48(2) : 152-157
- Year: 2010
- Problem: Depressive Disorders
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Psychological Interventions (any)
, Self-help
Gentile, Salvatore
Objective: Data Sources: Search Strategy: Data Selection: Data Synthesis: Conclusions: The consequences of major depression disorder (MDD) in youths are likely to be devastating for both the patient and his/her family. Thus, this review analyzes systematically the effectiveness of antidepressant drugs (ADDs) in managing such patients.Medical literature reporting primary data on use of ADDs in children and adolescents was identified through searches (1966-January 2010) of MEDLINE/PubMed, EMBASE, SCOPUS, and The Cochrane Library databases. Additional studies were manually identified from the reference lists of published articles.Search terms (variously combined) were: children, childhood, adolescents, adolescence, MDD, mood/affective disorders, depression, tricyclic antidepressants (TCAs) SSRIs, Serotonin-Norepinephrine Reuptake inhibitors (SNRIs), noradrenergic/specific serotoninergic antidepressants (NaSSA). A separate search was conducted to complete the profile of effectiveness of each single antidepressant agent.43 peer-reviewed articles met the inclusion criteria.Reviewed information does not definitively support the use of antidepressants in children younger than 10 years old. In contrast, robust information suggests that fluoxetine should be considered as first-line agent in depressed adolescents whose clinical conditions require psychopharmacological approach.Depressed children should be primarily approached with non-pharmacological interventions that should include the evaluation of potential parental psychiatric disorders. In adolescents with MDD, the decision to use fluoxetine should be associated with specific social and health protocols focused to reinforce self-esteem, improve the quality of relationships with parents and peers, facilitate healthy life-style changes, and identify the potential onset/worsening of suicidality.
Reviews on Recent Clinical Trials, 5(1) : 63-75
- Year: 2010
- Problem: Depressive Disorders
- Type: Systematic reviews
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions (any)
, Antidepressants (any)
Hides, Leanne, Samet, Sharon, Lubman, Dan I.
ISSUES AND APPROACH: The high rates of co-occurring depression and substance use, and the negative impact of this on illness course and outcomes have been well established. Despite this, few clinical trials have examined the efficacy of cognitive behaviour therapy (CBT). This paper systematically reviews these clinical trials, with an aim of providing recommendations for how future research can develop a more robust evidence base for the treatment of these common comorbidities. Leading electronic databases, including PubMed (ISI) and PsychINFO (CSA), were searched for peer-reviewed journal articles using CBT for the treatment of co-occurring depression and substance use. Of the 55 articles identified, 12 met inclusion criteria and were included in the review. KEY FINDINGS: There is only a limited evidence for the effectiveness of CBT either alone or in combination with antidepressant medication for the treatment of co-occurring depression and substance use. While there is support for the efficacy of CBT over no treatment control conditions, there is little evidence that CBT is more efficacious than other psychotherapies. There is, however, consistent evidence of improvements in both depression and substance use outcomes, regardless of the type of treatment provided and there is growing evidence that that the effects of CBT are durable and increase over time during follow up. CONCLUSIONS: Rather than declaring the 'dodo bird verdict' that CBT and all other psychotherapies are equally efficacious, it would be more beneficial to develop more potent forms of CBT by identifying variables that mediate treatment outcomes.
Drug & Alcohol Review, 29(5) : 508-517
- Year: 2010
- Problem: Depressive Disorders
- Type: Systematic reviews
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions (any)
, Cognitive & behavioural therapies (CBT)
Koelsch, Stefan, Offermanns, Kristin, Franzke, Peter
Music listening and making activates a multitude of brain structures, the engagement of which is likely to have beneficial effects on the psychological and physiological health of individuals. We first briefly review functional neuroimaging experiments on music and emotion, showing that music-evoked emotions can change activity in virtually all core areas of emotional processing. We then enumerate social functions that are automatically and effortlessly engaged when humans make music. Engagement in these social functions fulfils basic human needs, is part of what makes us human, and is an important source for pleasure and happiness. Finally, we present a new method for music therapy, including an exploratory empirical study on effects of music making. Results show that the music making increased the mood of individuals compared to a control group. This music therapy method is promising in encouraging further development for the treatment of affective disorders, and can be used in both single- and double-blinded studies for empirical, evidence-based medical research. (PsycINFO Database Record (c) 2010 APA, all rights reserved) (journal abstract)
Music Perception, 27(4) : 307-316
- Year: 2010
- Problem: Depressive Disorders
- Type: Randomised controlled trials
-
Stage: Universal prevention
-
Treatment and intervention: Complementary & Alternative Interventions (CAM)
, Creative expression: music, dance, drama, art
Kennard, B. D., Silva, S. G., Tonev, S., Rohde, P., Hughes, J. L., Vitiello, B., Kratochvil, C. J., Curry, J. F., Emslie, G. J., Reinecke, M., March, J.
Objective: We examine remission rate probabilities, recovery rates, and residual symptoms across 36 weeks in the Treatment for Adolescents with Depression Study (TADS). Method: The TADS, a multisite clinical trial, randomized 439 adolescents with major depressive disorder to 12 weeks of treatment with fluoxetine, cognitive-behavioral therapy, their combination, or pill placebo. The pill placebo group, treated openly after week 12, was not included in the subsequent analyses. Treatment differences in remission rates and probabilities of remission over time are compared. Recovery rates in remitters at weeks 12 (acute phase remitters) and 18 (continuation phase remitters) are summarized. We also examined whether residual symptoms at the end of 12 weeks of acute treatment predicted later remission. Results: At week 36, the estimated remission rates for intention-to-treat cases were as follows: combination, 60%; fluoxetine, 55%; cognitive-behavioral therapy, 64%; and overall, 60%. Paired comparisons reveal that, at week 24, all active treatments converge on remission outcomes. The recovery rate at week 36 was 65% for acute phase remitters and 71% for continuation phase remitters, with no significant between-treatment differences in recovery rates. Residual symptoms at the end of acute treatment predicted failure to achieve remission at weeks 18 and 36. Conclusions: Most depressed adolescents in all three treatment modalities achieved remission at the end of 9 months of treatment. (copyright)2009 by the American Academy of Child and Adolescent Psychiatry.
Journal of the American Academy of Child & Adolescent Psychiatry, 48(2) : 186-195
- Year: 2009
- Problem: Depressive Disorders
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions (any)
, Selective serotonin reuptake inhibitors (SSRIs), Psychological Interventions (any)
, Cognitive & behavioural therapies (CBT)
Kennard, B. D., Silva, S. G., Mayes, T. L., Rohde, P., Hughes, J. L., Vitiello, B., Kratochvil, C. J., Curry, J. F., Emslie, G. J., Reinecke, M. A., March, J. S.
Objective: The authors examined whether initial assignment to receive placebo for 12 weeks followed by open active treatment as clinically indicated was associated with different levels of benefit and risk of harm across 36 weeks as compared with initial assignment to receive active treatments. Method: Adolescents with major depressive disorder (N=439) were randomly assigned to receive an initial 12 weeks of treatment with fluoxetine, cognitive-behavioral therapy (CBT), combination treatment with fluoxetine and CBT, or clinical management with placebo; those assigned to placebo received open active treatment as clinically indicated after 12 weeks of placebo. Assessments were conducted every 6 weeks for 36 weeks. The primary outcome measures were response and remission based on scores on the Children's Depression Rating Scale-Revised and the Clinical Global Impression improvement subscale. Results: At week 36, the response rate was 82% in the placebo/open group and 83% in the active treatment groups. The remission rate was 48% in the placebo/open group and 59% in the act ive treatment groups, a difference that approached statistical significance. Patients who responded to placebo generally retained their response. Those who did not respond to placebo subsequently responded to active treatment at the same rate as those initially assigned to active treatments. There were no differences between groups in rates of suicidal events, study retention, or symptom worsening. Conclusions: Remis s ion rates at 9 months were lower in patients treated initially with placebo, but 3 months of placebo treatment was not associated with any harm or diminished response to subsequent treatment.
American Journal of Psychiatry, 166(3) : 337-344
- Year: 2009
- Problem: Depressive Disorders
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions (any)
, Selective serotonin reuptake inhibitors (SSRIs), Psychological Interventions (any)
, Cognitive & behavioural therapies (CBT)
, Other Psychological Interventions
Kang, Yune Sik, Choi, So Young, Ryu, Eunjung
This study examined the effectiveness of a stress coping program based on mindfulness meditation on the stress, anxiety, and depression experienced by nursing students in Korea. A nonequivalent, control group, pre-posttest design was used. A convenience sample of 41 nursing students were randomly assigned to experimental (n=21) and control groups (n=20). Stress was measured with the PWI-SF (5-point) developed by Chang. Anxiety was measured with Spieberger's state anxiety inventory. Depression was measured with the Beck depression inventory. The experimental group attended 90-min sessions for eight weeks. No intervention was administered to the control group. Nine participants were excluded from the analysis because they did not complete the study due to personal circumstances, resulting in 16 participants in each group for the final analysis. Results for the two groups showed (1) a significant difference in stress scores (F=6.145, p=0.020), (2) a significant difference in anxiety scores (F=6.985, p=0.013), and (3) no significant difference in depression scores (t=1.986, p=0.056). A stress coping program based on mindfulness meditation was an effective intervention for nursing students to decrease their stress and anxiety, and could be used to manage stress in student nurses. In the future, long-term studies should be pursued to standardize and detail the program, with particular emphasis on studies to confirm the effects of the program in patients with diseases, such as cancer.
Nurse Education Today, 29(5) : 538-543
- Year: 2009
- Problem: Depressive Disorders
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Psychological Interventions (any)
, Mindfulness based therapy