Evidence-Based Treatments and Pathways to Care

Psychological interventions such as interpersonal psychotherapy, cognitive behavioral therapy, and nondirective counseling are effective interventions for postnatal depression. Less work has addressed perinatal anxiety and antenatal depression. Preventive interventions, delivered during pregnancy or soon after delivery, also have been found to be effective for high-risk women. Pharmacologic treatments are widely used during both pregnancy and the postpartum period. Few randomized trials have evaluated antidepressant medication, but their wide use in practice and observational studies suggest that they are as effective. Complementary and alternative medicine (CAM) interventions are increasingly preferred by perinatal women, and early research suggests that many of them will prove to be efficacious. Pathways to care are diverse around the world. Collaborative care entails the coordination of primary care (general practice, obstetrics) and mental health care to ensure that perinatal women receive needed mental health care. The maternal-child health-care system is another venue for the delivery of mental health care through the direct delivery of brief counseling to depressed perinatal women in both high-income and low- and middle-income countries. Although much progress has been made in delivering mental health care to perinatal women, access to this care remains a challenge around the world

The efficacy of antidepressant medication and interpersonal psychotherapy for adult acute-phase depression: Study protocol of a systematic review and meta-analysis of individual participant data

Background: Antidepressant medication and interpersonal psychotherapy (IPT) are both recommended interventions in depression treatment guidelines based on literature reviews and meta-analyses. However, 'conventional' meta-analyses comparing their efficacy are limited by their reliance on reported study-level information and a narrow focus on depression outcome measures assessed at treatment completion. Individual participant data (IPD) meta-analysis, considered the gold standard in evidence synthesis, can improve the quality of the analyses when compared with conventional meta-analysis. Aims: We describe the protocol for a systematic review and IPD meta-analysis comparing the efficacy of antidepressants and IPT for adult acute-phase depression across a range of outcome measures, including depressive symptom severity as well as functioning and well-being, at both post-treatment and follow-up (PROSPERO: CRD42020219891). Method: We will conduct a systematic literature search in PubMed, PsycINFO, Embase and the Cochrane Library to identify randomised clinical trials comparing antidepressants and IPT in the acute-phase treatment of adults with depression. We will invite the authors of these studies to share the participant-level data of their trials. One-stage IPD meta-analyses will be conducted using mixed-effects models to assess treatment effects at post-treatment and follow-up for all outcome measures that are assessed in at least two studies. Conclusions: This will be the first IPD meta-analysis examining antidepressants versus IPT efficacy. This study has the potential to enhance our knowledge of depression treatment by comparing the short- and long-term effects of two widely used interventions across a range of outcome measures using state-of-the-art statistical techniques

The efficacy of antidepressant medication and interpersonal psychotherapy for adult acute-phase depression: Study protocol of a systematic review and meta-analysis of individual participant data

Contains fulltext : 230571.pdf (publisher's version ) (Open Access)Background: Antidepressant medication and interpersonal psychotherapy (IPT) are both recommended interventions in depression treatment guidelines based on literature reviews and meta-analyses. However, 'conventional' meta-analyses comparing their efficacy are limited by their reliance on reported study-level information and a narrow focus on depression outcome measures assessed at treatment completion. Individual participant data (IPD) meta-analysis, considered the gold standard in evidence synthesis, can improve the quality of the analyses when compared with conventional meta-analysis. Aims: We describe the protocol for a systematic review and IPD meta-analysis comparing the efficacy of antidepressants and IPT for adult acute-phase depression across a range of outcome measures, including depressive symptom severity as well as functioning and well-being, at both post-treatment and follow-up (PROSPERO: CRD42020219891). Method: We will conduct a systematic literature search in PubMed, PsycINFO, Embase and the Cochrane Library to identify randomised clinical trials comparing antidepressants and IPT in the acute-phase treatment of adults with depression. We will invite the authors of these studies to share the participant-level data of their trials. One-stage IPD meta-analyses will be conducted using mixed-effects models to assess treatment effects at post-treatment and follow-up for all outcome measures that are assessed in at least two studies. Conclusions: This will be the first IPD meta-analysis examining antidepressants versus IPT efficacy. This study has the potential to enhance our knowledge of depression treatment by comparing the short- and long-term effects of two widely used interventions across a range of outcome measures using state-of-the-art statistical techniques.6 p