A randomized clinical trial comparing family-focused treatment and individual supportive therapy for depression in childhood and early adolescence

OBJECTIVE: Despite the morbidity and negative outcomes associated with early-onset depression, few studies have examined the efficacy of psychosocial treatment for depressive disorders during childhood. Integrating family in treatment could have particularly salutary effects during this developmental period. This trial compared immediate posttreatment effects of family-focused treatment for childhood depression (FFT-CD) with those of individual supportive psychotherapy (IP) for children 7 to 14 years old with depressive disorders. METHOD: Children were randomized to 15 sessions of FFT-CD (n = 67) or IP (n = 67) over 4 months. The primary treatment outcome was adequate clinical depression response, defined as at least a 50% decrease in score on the Children's Depression Rating Scale-Revised (CDRS-R). Additional outcomes included patient-centered outcomes (parent- and child-reported treatment satisfaction), remission (defined as CDRS-R score ≤28), change in continuous CDRS-R score, and change in child and parent reports of depressive and non-depressive symptoms and social adjustment. RESULTS: Significant improvement was evident across groups for depressive and non-depressive symptoms, global response, and functioning and social adjustment. Compared with children randomized to IP, children randomized to FFT-CD showed higher rates of adequate clinical depression response (77.7% versus 59.9%; number needed to treat = 5.72; odds ratio 2.29; 95% CI 1.001-5.247; t = 1.97, p = .0498). Across treatments, families reported high satisfaction; compared with IP families, FFT-CD families reported greater knowledge and skills for managing depression. There were no significant differences between treatment arms on secondary outcomes. CONCLUSION: Results support the value of psychosocial intervention, emphasize the important role that families play, and highlight the potential for FFT-CD for supporting recovery in children with depression. Clinical trial registration information-Systems of Support Study for Childhood Depression; http://clinicaltrials.gov; NCT01159041.R01 MH082856 - NIMH NIH HHS; R01 MH082861 - NIMH NIH HH

Comparing the effects of repetitive transcranial magnetic stimulation and electroconvulsive therapy in the treatment of depression : a systematic review and meta-analysis

Electroconvulsive therapy (ECT) is the longest standing psychiatric treatment available and has unequivocal benefit in severe depression. However this treatment comes with a number of side effects such as memory impairment. On the other hand, Repetitive Transcranial Magnetic Stimulation (rTMS) is a relatively new form of treatment which has been shown to be efficacious in patients suffering from a number of psychopathologies, including severe depression, with few reported side effects. Due to its potential therapeutic efficacy and lack of side effects, rTMS has gained traction in the treatment of depression, with a number of authors keen to see it take over from ECT. However, it is not clear whether rTMS represents a therapeutic alternative to ECT. This meta-analysis will therefore compare the "gold standard" treatment for severe depression, with the relatively new but promising rTMS. A literature search will be performed with the intention to include all randomised clinical trials. The null hypothesis is that there is no difference in the antidepressant efficacy between the two types of treatment modalities. Statistical analysis of Hamilton Depression Rating Scale (HDRS) scores will be performedpeer-reviewe

ROLE OF OMEGA-3 FATTY ACIDS ON POSTPARTUM DEPRESSION

Introduction: Women in child-bearing age are at risk of postpartum depression. Several drugs have been introduced for treatment, but because of their side effects and also breast feeding women's desire for dietary complements rather than chemical drugs. This study has been done to determine effect of omega-3 fatty acids on postpartum depression in women referring to health care centers affiliated to Tabriz medical university in 2008. Methods and Materials: This study was a double-blind randomized placebo controlled trial, which was done on 120 women with postpartum depression, who had included criteria's. First by using Edinburgh postnatal depression scale in women who gave birth 2 weeks to 3 months before, postpartum depression approved; for determining the severity of depression, Beck depression Inventory scale was used. Women with mild to moderate depression who had a score ≤ 46 on the (BDI) enrolled in the study and randomly assigned to receive either placebo or 1gr of Omega-3 capsules for 8 weeks. Severity of depression was measured before treatment and weekly during treatment in both groups. The data was analyzed, T-Test, repeated measurements of one way ANOVA and chi square test in SPSS 14/Win. Results: There were no significant differences between two groups with respect to demographic characteristics. Results show that mean depression scores before treatment in omega-3 group (35.4 + 9.2) was decreased after treatment (17.7+7.0), and there was significant difference (p<0.0005). Mean depression scores before treatment in placebo group (34.2+3.4) decreased after treatment (33.6+9.3).there wasn't significant difference (p=0.57). There was significant deference between reductions of depression scores in two groups. Conclusion: Use of omega-3 1gr/day for 8 weeks decreases postpartum depression

Cognitive behavior therapy in panic disorder and comorbid major depression - A naturalistic study

Background: There is a lack of evidence about the effectiveness of cognitive behavior therapies (CBT) in settings of routine clinical care as well as in the treatment of panic and comorbid disorders. Methods: We investigated a group-oriented CBT approach for 80 patients with panic disorder including 35 patients with current comorbid major depression. Assessments took place 6 months before treatment, at the beginning and end of treatment, and 1 year later. Structured interviews and multiple clinical self-rating scales were used. Results: Panic patients with comorbid major depression showed higher anxiety-specific and nonspecific pathology. The most striking benefits were in reducing avoidance behavior, while improvements concerning catastrophic beliefs were smaller, but still significant. For most self-rating scale results, patients with and without comorbid depression improved to a comparable degree. However, the end-state functioning of patients with panic disorder and current comorbid depression at admission is significantly lower than for patients with panic disorder alone, Conclusions: The results point to the necessity to develop and improve treatment approaches for patients with comorbidity of panic disorder and current major depression. Copyright (C) 2000 S.Karger AG, Basel

Depression and anxiety in prostate cancer: a systematic review and meta-analysis of prevalence rates

ObjectivesTo systematically review the literature pertaining to the prevalence of depression and anxiety in patients with prostate cancer as a function of treatment stage.DesignSystematic review and meta-analysis.Participants4494 patients with prostate cancer from primary research investigations.Primary outcome measureThe prevalence of clinical depression and anxiety in patients with prostate cancer as a function of treatment stage.ResultsWe identified 27 full journal articles that met the inclusion criteria for entry into the meta-analysis resulting in a pooled sample size of 4494 patients. The meta-analysis of prevalence rates identified pretreatment, on-treatment and post-treatment depression prevalences of 17.27% (95% CI 15.06% to 19.72%), 14.70% (95% CI 11.92% to 17.99%) and 18.44% (95% CI 15.18% to 22.22%), respectively. Pretreatment, on-treatment and post-treatment anxiety prevalences were 27.04% (95% CI 24.26% to 30.01%), 15.09% (95% CI 12.15% to 18.60%) and 18.49% (95% CI 13.81% to 24.31%), respectively.ConclusionsOur findings suggest that the prevalence of depression and anxiety in men with prostate cancer, across the treatment spectrum, is relatively high. In light of the growing emphasis placed on cancer survivorship, we consider that further research within this area is warranted to ensure that psychological distress in patients with prostate cancer is not underdiagnosed and undertreated

Psychoanalytic and psychodynamic therapies for depression. The evidence base.

David Taylor, a consultant psychotherapist at the Tavistock & Portman NHS Foundation Trust (120 Belsize Lane, London NW3 5BA, UK. Email: [email protected]), is the clinical lead of the Tavistock Adult Depression Study (a randomised controlled trial of 60 sessions of weekly psychoanalytic psychotherapy v. treatment as usual for patients with chronic, refractory depression). He is a training and supervising psychoanalyst at the Institute of Psychoanalysis. This article argues that the current approach to guideline development for the treatment of depression is not supported by the evidence: clearly depression is not a disease for which treatment efficacy is best determined by short-term randomised controlled trials. As a result, important findings have been marginalised. Different principles of evidence-gathering are described. When a wider range of the available evidence is critically considered the case for dynamic approaches to the treatment of depression can be seen to be stronger than is often thought. Broadly, the benefits of short-term psychodynamic therapies are equivalent in size to the effects of antidepressants and cognitive–behavioural therapy (CBT). The benefits of CBT may occur more quickly, but those of short-term psychodynamic therapies may continue to increase after treatment. There may be a ceiling on the effects of short-term treatments of whatever type. Longer-term psychodynamic treatments may improve associated social, work and personal dysfunctions as well as reductions in depressive symptoms

Levothyroxine effects on depressive symptoms and limbic glucose metabolism in bipolar disorder: a randomized, placebo-controlled positron emission tomography study.

Adding supraphysiologic doses of levothyroxine (L-T4) to standard treatment for bipolar depression shows promise, but the mechanisms underlying clinical improvement are unknown. In a previous pilot study, L-T4 treatment reduced depression scores and activity within the anterior limbic network. Here we extended this work in a randomized, double-blind, placebo-controlled study of patients with bipolar depression. Cerebral glucose metabolism was assessed with positron emission tomography and [F-18]fluorodeoxyglucose before and after 6 weeks of treatment with L-T4 (n=15) or placebo (n=10) in 12 volumes of interest (VOIs): the bilateral thalamus, amygdala, hippocampus, dorsal striatum and ventral striatum, and midline cerebellar vermis and subgenual cingulate cortex. Radioactivity in the VOIs, normalized to whole-brain radioactivity was taken as a surrogate index of glucose metabolism, and markers of thyroid function were assayed. Changes in brain activity and their association with clinical response were assessed using statistical parametric mapping. Adjunctive L-T4 treatment produced a significant decline in depression scores during the 6-week treatment. In patients treated with L-T4, we found a significant decrease in regional activity at P&lt;0.05 after Bonferroni correction in the left thalamus, right amygdala, right hippocampus, left ventral striatum and the right dorsal striatum. Decreases in the left thalamus, left dorsal striatum and the subgenual cingulate were correlated with a reduction in depression scores (P&lt;0.05 after Bonferroni correction). Placebo treatment was associated with a significant decrease in activity only in the right amygdala, and no region had a change in activity that was correlated with change in depression scores. The groups differed significantly in the relationship between the changes in depression scores and in activity in the thalamus bilaterally and the left ventral striatum. The findings provide evidence that administration of supraphysiologic thyroid hormone improves depressive symptoms in patients with bipolar disorder by modulating function in components of the anterior limbic network

Management of Prenatal Depression

Depression affects many women during and after pregnancy. As many as 1 in 5 women will experience a depressive episode during their pregnancy, however, studies have shown that less than 20% of these women will discuss their symptoms with their healthcare provider and receive care. Barriers to treatment include poor screening, lack of understanding about safe treatment, and stigma against mental illness in pregnant women. This project aimed to address this issue locally, by presenting to a group of family medicine providers in Vermont on the topic of prenatal depression screening and treatment. The presentation was received well and developed further discussion on research looking into maternal depression at this site.https://scholarworks.uvm.edu/fmclerk/1341/thumbnail.jp