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

Being depleted and being shaken: an interpretative phenomenological analysis of the experiential features of a first episode of depression

- Objectives: This article presents a detailed idiographic analysis of patients' experience of first-episode depression. - Design: This is a qualitative interview study using interpretative phenomenological analysis (IPA). - Methods: Semi-structured interviews were carried out with a purposive sample of seven patients presenting to a mental health service in London, UK with symptoms of first-episode major depression. There were four males and three females; mean age was 44 years. Interviews were audio-recorded and subjected to IPA. - Results: Participants described a significant loss event prior to onset of depression. The depression involved a major diminishing of the life-world with relational, corporeal, and temporal depletion. This depletion was accompanied in each case by occasional extreme emotions, frenzied thoughts, confused sense of self. - Conclusions: Depression can represent a major existential threat to the sufferer. We discuss how our findings can illuminate the extant literature. The study suggests the value of exploring these existential features in early therapy

Nosology, epidemiology and pathogenesis of bipolar disorder: Recent approaches

Bipolar disorder is a highly prevalent, chronic and deteriorating mental illness that requires medical, psychological and social care for life. Realizing that bipolar disorder is more common than initially thought, the associated disability and the heterogeneity in their clinical presentation, has strengthened the research on this topic. Recent advances in the field of nosology, epidemiology and pathogenesis have begun to unravel some of the complexity of this disorder and have had a marked influence on the changes in the way they are beginning to diagnose a broad spectrum of bipolar disorders according to the latest version of the Diagnostic and Statistical Manual of Mental Disorders (DSM 5)

Therapeutic touch for anxiety disorders

Background Anxiety disorders are a common occurrence in today's society. There is interest from the community in the use of complementary therapies for anxiety disorders. This review examined the currently available evidence supporting the use of therapeutic touch in treating anxiety disorders. Objectives To examine the efficacy and adverse effects of therapeutic touch for anxiety disorders. Search strategy We searched the Cochrane Collaboration Depression, Anxiety and Neurosis Controlled Trials Registers (CCDANCTR-Studies and CCDANCTR-References) (search date 13/01/06), the Controlled Trials website and Dissertation Abstracts International. Searches of reference lists of retrieved papers were also carried out and experts in the field were contacted. Selection criteria Inclusion criteria included all published and unpublished randomised and quasi-randomised controlled trials comparing therapeutic touch with sham (mimic) TT, pharmacological therapy, psychological treatment, other treatment or no treatment /waiting list.The participants included adults with an anxiety disorder defined by the Diagnostic and Statistical Manual (DSM-IV),the International Classification of Diseases (ICD-10), validated diagnostic instruments, or other validated clinician or self-report instruments. Data collection and analysis Two review authors independently applied inclusion criteria. Further information was sought from trialists where papers contained insufficant information to make a decision about eligibility. Main results No randomised or quasi-randomised controlled trials of therapeutic touch for anxiety disorders were identified. Authors' conclusions Given the high prevalence of anxiety disorders and the current paucity of evidence on therapeutic touch in this population, there is a need for well conducted randomised controlled trials to examine the effectiveness of therapeutic touch for anxiety disorders

Cohort differences in disease and disability in the young-old: findings from the MRC Cognitive Function and Ageing Study (MRC-CFAS).

BACKGROUND: Projections of health and social care need are highly sensitive to assumptions about cohort trends in health and disability. We use a repeated population-based cross-sectional study from the Cambridgeshire centre of the UK Medical Research Council Cognitive Function and Ageing Study to investigate trends in the health of the young-old UK population METHODS: Non-overlapping cohorts of men and women aged 65-69 years in 1991/2 (n = 689) and 1996/7 (n = 687) were compared on: self-reported diseases and conditions; self-rated health; mobility limitation; disability by logistic regression and four-year survival by Cox Proportional Hazards Regression models, with adjustments for differences in socio-economic and lifestyle factors. RESULTS: Survival was similar between cohorts (HR: 0.91, 95% CI: 0.62 to 1.32). There was a significant increase in the number of conditions reported between cohorts, with more participants reporting 3 or more conditions in the new cohort (14.2% vs. 10.1%). When individual conditions were considered, there was a 10% increase in the reporting of arthritis and a significant increase in the reporting of chronic airways obstruction (OR: 1.36, 95% CI: 1.04 to 1.78). CONCLUSION: This study provides evidence of rising levels of ill-health, as measured by the prevalence of self-reported chronic conditions, in the newer cohorts of the young-old. Though changes in diagnosis or reporting of disease cannot, as yet, be excluded, to better understand whether our findings reflect real increases in ill-health, investment should be made into improved population-based databases, linking self-report and objective measures of health and function, and including those in long-term care

Traumatic life events and suicide risk among jail inmates: The influence of types of events, time period and significant others.

Relationships between traumatic life events and suicide risk were studied in two samples of jail inmates with a low (N D 216) and a high (N D 51) suicide risk. Although nonsuicidal inmates reported a high prevalence of traumatic life events, suicidal inmates reported even higher prevalence rates. Suicidal inmates reported more episodes of sexual abuse, physical maltreatment, emotional maltreatment, abandonment, and suicide attempts by significant others. They also had experienced more traumatic life events during childhood, later life, and detention. It is concluded that traumatic life events are associated with suicide risk and that such an association remains in a population with a high prevalence of traumatic life events. It is also concluded that suicide risk is dependent of the type of life event, the timing of the event, and the type of persons involved in the event