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Romano A, Pace L, Tempesta B, Lavecchia AM, Macheda T, Bedse G, Petrella A, Cifani C, Serviddio G, Vendemiale G, Gaetani S, Cassano T. Depressive-like behavior is paired to monoaminergic alteration in a murine model of Alzheimer's disease. Int J Neuropsychopharmacol 2015; 18:pyu020. [PMID: 25609597 PMCID: PMC4360228 DOI: 10.1093/ijnp/pyu020] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Neuropsychiatric signs are critical in primary caregiving of Alzheimer patients and have not yet been fully investigated in murine models. METHODS 18-month-old 3×Tg-AD male mice and their wild-type male littermates (non-Tg) were used. The open field test and the elevated plus maze test were used to evaluate anxiety-like behaviors, whereas the Porsolt forced swim test, the tail suspension test, and the sucrose preference test for antidepressant/depression-coping behaviors. Neurochemical study was conducted by microdialysis in freely-moving mice, analyzing the basal and K(+)-stimulated monoamine output in the frontal cortex and ventral hippocampus. Moreover by immunohistochemistry, we analysed the expression of Tyrosin hydroxylase and Tryptophan hydroxylase, which play a key role in the synthesis of monoamines. RESULTS Aged 3×Tg-AD mice exhibited a higher duration of immobility in the forced swim and tail suspension tests (predictors of depression-like behavior) which was not attenuated by a noradrenaline reuptake inhibitor, desipramine. In the sucrose preference test, 3×Tg-AD mice showed a significantly lower sucrose preference compared to the non-Tg group, without any difference in total fluid intake. In contrast, the motor functions and anxiety-related emotional responses of 3×Tg-AD mice were normal, as detected by the open-field and elevated plus-maze tests. To strengthen these results, we then evaluated the monoaminergic neurotransmissions by in vivo microdialysis and immunohistochemistry. In particular, with the exception of the basal hippocampal dopamine levels, 3×Tg-AD mice exhibited a lower basal extracellular output of amines in the frontal cortex and ventral hippocampus and also a decreased extracellular response to K(+) stimulation. Such alterations occur with obvious local amyloid-β and tau pathologies and without gross alterations in the expression of Tyrosin and Tryptophan hydroxylase. CONCLUSIONS These results suggest that 3×Tg-AD mice exhibit changes in depression-related behavior involving aminergic neurotrasmitters and provide an animal model for investigating AD with depression.
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Affiliation(s)
- Adele Romano
- * These authors contributed equally as first authors
| | - Lorenzo Pace
- * These authors contributed equally as first authors
| | | | | | | | | | | | | | | | | | | | - Tommaso Cassano
- Department of Physiology and Pharmacology, Sapienza University of Rome, Italy (Drs Romano, Tempesta, Lavecchia, Bedse, and Gaetani); Department of Clinical and Experimental Medicine, University of Foggia, Italy (Drs Pace, Macheda, and Cassano); Puglia and Basilicata Experimental Zooprophylactic Institute, Foggia, Italy (Dr Petrella); School of Pharmacy, Pharmacology Unit, University of Camerino, Italy (Dr Cifani); Department of Medical and Surgical Sciences, University of Foggia, Italy (Drs Serviddio and Vendemiale).
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Theeke LA, Mallow JA. The Development of LISTEN: A Novel Intervention for Loneliness. ACTA ACUST UNITED AC 2015; 5:136-143. [PMID: 26229740 DOI: 10.4236/ojn.2015.52016] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
PURPOSE The purpose of this paper is to present the development of LISTEN (Loneliness Intervention using Story Theory to Enhance Nursing-sensitive outcomes), a new intervention for loneliness. METHODS LISTEN was developed using the Medical Research Council (MRC) framework for intervention development. Extensive literature review revealed that belonging, relating, placing in community, challenges, and meanings of coping were concepts significant to loneliness. Past interventions were limited but it was determined from a recent meta-analysis that enhanced effectiveness might result from interventions that targeted the poorly adapted cognitive processes of loneliness. These processes include social undesirability, stigma, and negative thoughts about self in relation to others. LISTEN is designed to be delivered in a determined logical sequence of 5 sessions, each focusing on the concepts relevant to loneliness as derived from the literature. For each session, intervention delivery is guided by the concepts from story theory (including intentional dialogue, nurse as listener, examination of self in relation to others and community, synthesizing concerns and patterns, and identifying messages) and the principles of cognitive restructuring (self-assessment of maladaptive cognitions, emotions, and behaviors, identifying challenges of changing, reconceptualization of self, new skill acquisition through group interaction, and identifying patterns of meaning in loneliness). RESULTS LISTEN is developed and the first randomized trial is complete with a sample of 27 lonely, chronically ill, community dwelling, and older adults. LISTEN was evaluated as feasible to deliver by the study team and acceptable for significantly diminishing loneliness by participants of the LISTEN groups who were compared to attention control groups (p < 0.5). CONCLUSIONS LISTEN has the potential to enhance health by diminishing loneliness which could result in improving the long-term negative known sequelae of loneliness. Future longitudinal randomized trials are needed in varied populations to assess long term health and healthcare system benefit of using LISTEN to treat loneliness.
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Affiliation(s)
- Laurie A Theeke
- Department of Adult Health, School of Nursing, West Virginia University, Morgantown, USA
| | - Jennifer A Mallow
- Department of Adult Health, School of Nursing, West Virginia University, Morgantown, USA
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Gitlin LN, Szanton SL, Huang J, Roth DL. Factors mediating the effects of a depression intervention on functional disability in older African Americans. J Am Geriatr Soc 2014; 62:2280-7. [PMID: 25516024 PMCID: PMC4415989 DOI: 10.1111/jgs.13156] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVES To determine factors mediating the effects of a depression intervention for older African Americans on functional disability and, secondarily, whether functional improvements mediate intervention effects on depressive symptoms. DESIGN Structural equation modeling to examine mediators in a secondary analysis of a randomized trial with 4-month follow-up. SETTING Philadelphia region. PARTICIPANTS Community-dwelling African Americans (≥55) with depressive symptoms living in an urban area (N = 208). INTERVENTION Up to 10 one-hour sessions over 4 months conducted by licensed social workers who provided care management, referrals and linkages, stress reduction techniques, depression knowledge and symptom recognition, and behavioral activation techniques. MEASUREMENTS Main outcome was self-reported functional difficulty level for 18 basic activities. Mediators included depression severity (Patient Health Questionnaire), depression knowledge and symptom recognition, behavioral activation, and anxiety. RESULTS At 4 months, the intervention had positive effects on functional difficulty and all mediators (P < .001). Separate structural equation models indicated that two factors (reduced depressive symptoms (23.5% mediated) and improved depression knowledge and symptom recognition (52.9% mediated)) significantly mediated the intervention's effect on functional disability. Enhancing behavioral activation and decreasing anxiety were not found to mediate improvements in functional disability. The two significant mediators jointly explained 62.5% of the intervention's total effect on functional disability. Functional improvement was not found to mediate the intervention's effect on depressive symptoms. CONCLUSION This multicomponent depression intervention for African Americans has an effect on functional disability that is driven primarily by enhancing symptom recognition and decreasing depressive symptoms. Reduction of functional difficulties did not account for improvements in depressive symptoms. Nonpharmacological treatments for depressive symptoms that enhance symptom recognition in older African Americans can also reduce their functional difficulties with daily living activities.
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Affiliation(s)
- Laura N. Gitlin
- Corresponding Author: Laura N. Gitlin, Ph.D., Professor/Director, Center for Innovative Care in Aging, Johns Hopkins University, 525 North Wolfe Street Suite 316, Baltimore, MD 21205, [[], T: 410-955-7539, F: 410-614-6873
| | - Sarah L. Szanton
- Associate Professor, Johns Hopkins University School of Nursing, Principal Faculty, Center for Innovative Care in Aging, 525 N Wolfe Street Suite 424, Baltimore, MD 21205 [], T: 410-502-2605, F:410-955-7463
| | - Jin Huang
- Biostatistician, Center on Aging and Health, Division of Geriatric Medicine and Gerontology, Johns Hopkins University.2024 E. Monument Street, Suite 2-700, Baltimore, MD 21205 []
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Gitlin LN, Roth DL, Huang J. Mediators of the impact of a home-based intervention (beat the blues) on depressive symptoms among older African Americans. Psychol Aging 2014; 29:601-11. [PMID: 25244479 DOI: 10.1037/a0036784] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Older African Americans (N = 208) with depressive symptoms were randomly assigned to a home-based nonpharmacologic intervention (Beat the Blues, or BTB) or wait-list control group. BTB was delivered by licensed social workers and involved up to 10 home visits focused on care management, referral and linkage, depression knowledge and efficacy in symptom recognition, instruction in stress reduction techniques, and behavioral activation through identification of personal goals and action plans for achieving them. Structured interviews by assessors masked to study assignment were used to assess changes in depressive symptoms (main trial endpoint), behavioral activation, depression knowledge, formal care service utilization, and anxiety (mediators) at baseline and 4 months. At 4 months, the intervention had a positive effect on depressive symptoms and all mediators except formal care service utilization. Structural equation models indicated that increased activation, enhanced depression knowledge, and decreased anxiety each independently mediated a significant proportion of the intervention's impact on depressive symptoms as assessed with 2 different measures (PHQ-9 and CES-D). These 3 factors also jointly explained over 60% of the intervention's total effect on both indicators of depressive symptoms. Our findings suggest that most of the impact of BTB on depressive symptoms is driven by enhancing activation or becoming active, reducing anxiety, and improving depression knowledge/efficacy. The intervention components appear to work in concert and may be mutually necessary for maximal benefits from treatment to occur. Implications for designing tailored interventions to address depressive symptoms among older African Americans are discussed.
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Affiliation(s)
- Laura N Gitlin
- School of Nursing Center for Innovative Care in Aging, Johns Hopkins University
| | - David L Roth
- Center on Aging and Health, Division of Geriatric Medicine and Gerontology, Johns Hopkins University
| | - Jin Huang
- Center on Aging and Health, Division of Geriatric Medicine and Gerontology, Johns Hopkins University
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Abstract
Older adults with Diabetes Mellitus (DM) experience greater risk for comorbid depression compared to those who do not have DM. Undetected, untreated or under-treated depression impinges an individual's ability to manage their DM successfully, hinders their adherence to treatment regime, and undermines provider-patient relationships. Thus, in the context of caring for older adults with DM, comorbid depression presents special challenges and opportunities for clinicians. In this article, we summarize the clinical presentation of late-life depression, potential mechanisms of comorbidity of depression and DM, importance of depression in the successful management of DM, and available best practice models for depression treatment.
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Affiliation(s)
- Mijung Park
- Department of Health and Community Systems, University of Pittsburgh, School of Nursing, 3500 Victoria Street, 421 Victoria Building, Pittsburgh, PA 15213, USA.
| | - Charles F Reynolds
- NIMH Center of Excellence in Late Life Depression Prevention and Treatment, Hartford Center of Excellence in Geriatric Psychiatry, Aging Institute of UPMC Senior Services and University of Pittsburgh, 3811 O'Hara Street, Pittsburgh, PA 15213-2582, USA
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Jayasekara R, Procter N, Harrison J, Skelton K, Hampel S, Draper R, Deuter K. Cognitive behavioural therapy for older adults with depression: a review. J Ment Health 2014; 24:168-71. [DOI: 10.3109/09638237.2014.971143] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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Holmes HM, Min LC, Yee M, Varadhan R, Basran J, Dale W, Boyd CM. Rationalizing prescribing for older patients with multimorbidity: considering time to benefit. Drugs Aging 2014; 30:655-66. [PMID: 23749475 DOI: 10.1007/s40266-013-0095-7] [Citation(s) in RCA: 98] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Given the growing number of older adults with multimorbidity who are prescribed multiple medications, clinicians need to prioritize which medications are most likely to benefit and least likely to harm an individual patient. The concept of time to benefit (TTB) is increasingly discussed in addition to other measures of drug effectiveness in order to understand and contextualize the benefits and harms of a therapy to an individual patient. However, how to glean this information from available evidence is not well established. The lack of such information for clinicians highlights a critical need in the design and reporting of clinical trials to provide information most relevant to decision making for older adults with multimorbidity. We define TTB as the time until a statistically significant benefit is observed in trials of people taking a therapy compared to a control group not taking the therapy. Similarly, time to harm (TTH) is the time until a statistically significant adverse effect is seen in a trial for the treatment group compared to the control group. To determine both TTB and TTH, it is critical that we also clearly define the benefit or harm under consideration. Well-defined benefits or harms are clinically meaningful, measurable outcomes that are desired (or shunned) by patients. In this conceptual review, we illustrate concepts of TTB in randomized controlled trials (RCTs) of statins for the primary prevention of cardiovascular disease. Using published results, we estimate probable TTB for statins with the future goal of using such information to improve prescribing decisions for individual patients. Knowing the relative TTBs and TTHs associated with a patient's medications could be immensely useful to a clinician in decision making for their older patients with multimorbidity. We describe the challenges in defining and determining TTB and TTH, and discuss possible ways of analyzing and reporting trial results that would add more information about this aspect of drug effectiveness to the clinician's evidence base.
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Affiliation(s)
- Holly M Holmes
- Department of General Internal Medicine, UT MD Anderson Cancer Center, Houston, TX 77030, USA.
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Cuijpers P, Karyotaki E, Pot AM, Park M, Reynolds CF. Managing depression in older age: psychological interventions. Maturitas 2014; 79:160-9. [PMID: 24973043 DOI: 10.1016/j.maturitas.2014.05.027] [Citation(s) in RCA: 90] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2014] [Revised: 05/27/2014] [Accepted: 05/28/2014] [Indexed: 01/16/2023]
Abstract
The number of studies on psychological treatments of depression in older adults has increased considerably in the past years. Therefore, we conducted an updated meta-analysis of these studies. A total of 44 studies comparing psychotherapies to control groups, other therapies or pharmacotherapy could be included. The overall effect size indicating the difference between psychotherapy and control groups was g=0.64 (95% CI: 0.47-0.80), which corresponds with a NNT of 3. These effects were maintained at 6 months or longer post randomization (g=0.27; 95%CI: 0.16-0.37). Specific types of psychotherapies that were found to be effective included cognitive behavior therapy (g=0.45; 95% CI: 0.29-0.60), life review therapy (g=0.59; 95% CI: 0.36-0.82) and problem-solving therapy (g=0.46; 95% CI: 0.18-0.74). Treatment compared to waiting list control groups resulted in larger effect sizes than treatments compared to care-as-usual and other control groups (p<0.05). Studies with lower quality resulted in higher effect sizes than high-quality studies (p<0.05). Direct comparisons between different types of psychotherapy suggested that cognitive behavior therapy and problem-solving therapy may be more effective than non-directive counseling and other psychotherapies may be less effective than other therapies. This should be considered with caution, however, because of the small number of studies. There were not enough studies to examine the long-term effects of psychotherapies and to compare psychotherapy with pharmacotherapy or combined treatments. We conclude that it is safe to assume that psychological therapies in general are effective in late-life depression, and this is especially well-established for cognitive behavior therapy and problem-solving therapy.
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Affiliation(s)
- Pim Cuijpers
- Department of Clinical Psychology, VU University Amsterdam, The Netherlands; EMGO Institute for Health and Care Research, The Netherlands.
| | - Eirini Karyotaki
- Department of Clinical Psychology, VU University Amsterdam, The Netherlands; EMGO Institute for Health and Care Research, The Netherlands
| | - Anne Margriet Pot
- Department of Clinical Psychology, VU University Amsterdam, The Netherlands; EMGO Institute for Health and Care Research, The Netherlands; Trimbos Institute, Netherlands Institute of Mental Health and Addiction, The Netherlands; School of Psychology, University of Queensland, Australia
| | - Mijung Park
- University of Pittsburgh School of Nursing, United States
| | - Charles F Reynolds
- University of Pittsburgh Schools of Medicine and Graduate School of Public Health, United States
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Adapting manualized Behavioural Activation treatment for older adults with depression. COGNITIVE BEHAVIOUR THERAPIST 2014. [DOI: 10.1017/s1754470x14000038] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractThere is growing evidence that Behavioural Activation is an effective treatment for older adults with depression. However, there is a lack of detail given in studies about any adaptations made to interventions or efforts made to remove treatment barriers. Factors such as co-morbid physical health problems, cognitive impairment and problems with social support suggest there may be specific treatment considerations when developing interventions for this group. This article aims to describe adaptations made to a general adult Behavioural Activation manual using literature on treatment factors for older adults as an organizational framework. This information may be of use to mental health workers delivering behavioural interventions to older adults with depression and documents the initial phase of developing a complex intervention.
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Abstract
BACKGROUND The prescription of antidepressants in nursing homes has increased markedly since the introduction of SSRIs, while at the same time depressive symptoms often go unrecognized and untreated. The aim of this study was to examine whether depression among residents in nursing homes is treated adequately. METHODS A sample of 429 participants from 11 Swedish nursing homes was selected and was assessed with the Cornell Scale for Depression in Dementia (CSDD) and using medical records and drug prescription data. For 256 participants a follow-up assessment was performed after 12 months. RESULTS The prevalence of depression, according to medical records, was 9.1%, and the prevalence of CSDD score of ≥8 was 7.5%. Depression persisted in more than 50% of cases at the 12-month follow-up. Antidepressants were prescribed to 33% of the participants without a depression diagnosis or with a CSDD score of <8. 46.2% of all participants were prescribed antidepressants. 14% of the participants without a depression diagnosis or with a CSDD score of <8 had psychotropic polypharmacy. 15.2% of all participants had psychotropic polypharmacy, which persisted at the 12-month follow-up in three-quarters of cases. CONCLUSION The prescription of antidepressants in frail elderly individuals is extensive and may be without clear indication. The clinical implication is that there is a need for systematic drug reviews at nursing homes, paying special attention to the subjects which are on antidepressants.
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Ghio L, Vaggi M, Amore M, Ferrannini L, Natta W. Unmet needs and research challenges for late-life mood disorders. Aging Clin Exp Res 2014; 26:101-14. [PMID: 24078460 DOI: 10.1007/s40520-013-0149-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2013] [Accepted: 09/18/2013] [Indexed: 10/26/2022]
Abstract
Mood disorders are common and often under-recognised in older people whereby, together with the general ageing of the population, they are becoming a significant and growing public health problem worldwide. However, the need to address the problem of late life mood disorders in a real-world setting is met with a surprising lack of strong evidence in this field. Randomised clinical trials which focus on elderly mood disorders are not very common and the majority of them focus on pharmacological treatment of major depression. The aim of this study was to review first the main unmet needs and research challenges in late-life mood disorders as a basis to then review the state of the art evidence resulting from randomised clinical trials and the main critical aspects of their implementation. Comorbidity as well as polypharmacy, cognitive decline, unpredictable placebo response, and uncertainty on optimal duration of trials are some of the challenges the investigator has to address. Moreover, some methodological limitations of randomised clinical trials reduce the applicability of the results of such studies to common clinical practices and have encouraged some authors to investigate the existence of possible alternative research designs such as pragmatic randomised clinical trials.
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Orgeta V, Qazi A, Spector AE, Orrell M. Psychological treatments for depression and anxiety in dementia and mild cognitive impairment. Cochrane Database Syst Rev 2014; 2014:CD009125. [PMID: 24449085 PMCID: PMC6465082 DOI: 10.1002/14651858.cd009125.pub2] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Experiencing anxiety and depression is very common in people with dementia and mild cognitive impairment (MCI). Psychological interventions have been suggested as a potential treatment for these populations. Current research suggests that people with dementia and MCI have limited opportunities for psychological treatments aimed at improving their well-being. A systematic review of the evidence on their effectiveness is likely to be useful in terms of improving outcomes for patients and for future recommendations for practice. OBJECTIVES The main objective of this review was to assess the effectiveness of psychological interventions in reducing anxiety and depression in people with dementia or mild cognitive impairment (MCI). SEARCH METHODS We searched the Cochrane Dementia and Cognitive Improvement Group Specialized Register and additional sources for both published and unpublished data. SELECTION CRITERIA We included randomised controlled trials (RCTs) comparing a psychological intervention with usual care or a placebo intervention (social contact control) in people with dementia or MCI. DATA COLLECTION AND ANALYSIS Two review authors worked independently to select trials, extract data and assess studies for risk of bias, using a data extraction form. We contacted authors when further information was not available from the published articles. MAIN RESULTS Six RCTs involving 439 participants with dementia were included in the review, but no studies of participants with MCI were identified. The studies included people with dementia living in the community or in nursing home care and were carried out in several countries. Only one of the studies was classified as low risk of bias. Five studies were at unclear or high risk of bias due to uncertainties around randomisation, blinding and selective reporting of results. The studies used the different psychological approaches of cognitive behavioural therapy (CBT), interpersonal therapy and counselling. Two studies were of multimodal interventions including a specific psychological therapy. The comparison groups received either usual care, attention-control educational programs, diagnostic feedback or services slightly above usual care.Meta-analysis showed a positive effect of psychological treatments on depression (6 trials, 439 participants, standardised mean difference (SMD) -0.22; 95% confidence interval (CI) -0.41 to -0.03, moderate quality evidence) and on clinician-rated anxiety (2 trials, 65 participants, mean difference (MD) -4.57; 95% CI -7.81 to -1.32, low quality evidence), but not on self-rated anxiety (2 trials, SMD 0.05; 95% CI -0.44 to 0.54) or carer-rated anxiety (1 trial, MD -2.40; 95% CI -4.96 to 0.16). Results were compatible with both benefit and harm on the secondary outcomes of patient quality of life, activities of daily living (ADLs), neuropsychiatric symptoms and cognition, or on carers' self-rated depressive symptoms, but most of the studies did not measure these outcomes. There were no reports of adverse events. AUTHORS' CONCLUSIONS We found evidence that psychological interventions added to usual care can reduce symptoms of depression and clinician-rated anxiety for people with dementia. We conclude that psychological interventions have the potential to improve patient well-being. Further high quality studies are needed to investigate which treatments are most effective and to evaluate the effect of psychological interventions in people with MCI.
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Affiliation(s)
- Vasiliki Orgeta
- University College LondonMental Health Sciences Unit67‐73 Riding House Street, 2nd FloorCharles Bell HouseLondonUKW1W 7EJ
| | - Afifa Qazi
- North East London Foundation TrustGoodmayes HospitalAdmin Block, Mascalls ParkMascalls LaneBrentwood, EssexUKCM13 2JU
| | - Aimee E Spector
- University College, LondonResearch Department of Clinical, Educational and Health PsychologyGower StreetLondonUKWC1E 6BT
| | - Martin Orrell
- University College LondonMental Health Sciences Unit67‐73 Riding House Street, 2nd FloorCharles Bell HouseLondonUKW1W 7EJ
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Abstract
This article summarizes the following psychological interventions for late-life depression: cognitive and behavioral therapy, problem-solving therapy, reminiscence and life review therapy, brief psychodynamic therapy, and interpersonal therapy. Results indicate that all psychological interventions reviewed were effective in reducing depressive symptoms in older adults. Future research should include larger sample sizes and focus on moderators of treatment such as age, depression severity, medical illness, and cognitive impairment.
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Affiliation(s)
- Jennifer L Francis
- Department of Psychiatry, University of Illinois at Chicago, 912 South Wood Street (M/C 913), Chicago, IL 60622, USA.
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McMurchie W, Macleod F, Power K, Laidlaw K, Prentice N. Computerised cognitive behavioural therapy for depression and anxiety with older people: a pilot study to examine patient acceptability and treatment outcome. Int J Geriatr Psychiatry 2013; 28:1147-56. [PMID: 23495124 DOI: 10.1002/gps.3935] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2012] [Revised: 01/04/2013] [Accepted: 01/22/2013] [Indexed: 11/11/2022]
Abstract
OBJECTIVE The study objective was to determine the acceptability and treatment outcome of using Beating the Blues (BTB) with older people (6 + years). Specific aims included identifying the treatment uptake and drop-out rate, and describing the role of basic demographics in therapy uptake. METHOD Fifty-eight participants, experiencing symptoms of depression, were given a free choice of receiving treatment as usual (TAU) plus BTB (TAU + BTB) or TAU alone. All participants completed demographic questionnaires and a range of outcome measures at baseline, 2 months after baseline (end of treatment) and 3 months after baseline (follow-up). RESULTS Thirty-three participants (56.9%) opted to receive BTB and reported having more experience and confidence using a computer than those who declined BTB. Twenty-four participants (72.7%) went on to complete all eight BTB sessions. Statistical analysis found significant differences between the two treatment groups, with the TAU + BTB group showing greater improvements in their symptoms of depression and anxiety than the TAU group by the end of treatment and at follow-up. Furthermore, the TAU+ BTB group had a significantly higher percentage of participants who met criteria for clinically significant improvement in their symptoms of depression by the end of treatment and at follow-up. CONCLUSION Although further research is required, including a randomised controlled trial, the results of this initial pilot study provide evidence that BTB may offer an acceptable and effective treatment option for older people.
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Affiliation(s)
- William McMurchie
- NHS Tayside, Clinical Psychology to General Adult Psychiatry, The Alloway Centre, Dundee, UK
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Karlin BE, Walser RD, Yesavage J, Zhang A, Trockel M, Taylor CB. Effectiveness of acceptance and commitment therapy for depression: comparison among older and younger veterans. Aging Ment Health 2013; 17:555-63. [PMID: 23607328 DOI: 10.1080/13607863.2013.789002] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVES Limited data exist on outcomes of older adults receiving psychotherapy for depression in real-world settings. Acceptance and Commitment Therapy for depression (ACT-D) offers potential utility for older individuals who may experience issues of loss, reduced control, and other life changes. The present article examines and compares outcomes of older and younger Veterans receiving ACT-D nationally in the U.S. Department of Veterans Affairs health care system. METHOD Patient outcomes were assessed using the Beck Depression Inventory-Second Edition and the World Health Organization Quality of Life-BREF. Therapeutic alliance was assessed using the Working Alliance Inventory-Short Revised. RESULTS Six hundred fifty-five Veterans aged 18-64 and 76 Veterans aged 65+ received ACT-D. Seventy-eight percent of older and 67% of younger patients completed all sessions or finished early. Mean depression scores declined from 28.4 (SD = 11.4) to 17.5 (SD = 12.0) in the older group and 30.3 (SD = 10.6) to 19.1 (SD = 14.3) in the younger group. Within-group effect sizes were d = .95 and d = 1.06 for the two age groups, respectively. Quality of life and therapeutic alliance also increased during treatment. CONCLUSION The findings suggest that ACT-D is an effective and acceptable treatment for older Veterans treated in routine clinical settings, including those with high levels of depression.
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Affiliation(s)
- Bradley E Karlin
- Mental Health Services, U.S. Department of Veterans Affairs Central Office, Washington, DC, United States.
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Churchill R, Moore THM, Furukawa TA, Caldwell DM, Davies P, Jones H, Shinohara K, Imai H, Lewis G, Hunot V. 'Third wave' cognitive and behavioural therapies versus treatment as usual for depression. Cochrane Database Syst Rev 2013:CD008705. [PMID: 24142810 DOI: 10.1002/14651858.cd008705.pub2] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND So-called 'third wave' cognitive and behavioural therapies represent a new generation of psychological therapies that are increasingly being used in the treatment of psychological problems. However, the effectiveness and acceptability of third-wave cognitive and behavioural therapy (CBT) approaches as treatment for acute depression remain unclear. OBJECTIVES 1. To examine the effects of all third wave CBT approaches compared with treatment as usual/waiting list/attention placebo/psychological placebo control conditions for acute depression.2. To examine the effects of different third wave CBT approaches (ACT, compassionate mind training, functional analytic psychotherapy, dialectical behaviour therapy, MBCT, extended behavioural activation and metacognitive therapy) compared with treatment as usual/waiting list/attention placebo/psychological placebo control conditions for acute depression.3. To examine the effects of all third wave CBT approaches compared with different types of comparators (treatment as usual, no treatment, waiting list, attention placebo, psychological placebo) for acute depression. SEARCH METHODS We searched the Cochrane Depression Anxiety and Neurosis Group Trials Specialised Register (CCDANCTR to 01/01/12), which includes relevant randomised controlled trials from The Cochrane Library (all years), EMBASE, (1974-), MEDLINE (1950-) and PsycINFO (1967-). We also searched CINAHL (May 2010) and PSYNDEX (June 2010) and reference lists of the included studies and relevant reviews for additional published and unpublished studies. An updated search of CCDANCTR restricted to search terms relevant to third wave CBT therapies was conducted in March 2013 (CCDANCTR to 01/02/13). SELECTION CRITERIA Randomised controlled trials that compared third wave CBT therapies with control conditions for acute depression in adults. DATA COLLECTION AND ANALYSIS Two review authors independently identified studies, assessed trial quality and extracted data. Study authors were contacted for additional information when required. We rated the quality of evidence using GRADE methods. MAIN RESULTS Four small studies (224 participants) were included in the review. Little information was provided about the process of allocating participants to groups. None of the studies used independent outcome assessors, and evidence suggested researcher allegiance towards the active treatments. The four studies examined a diversity of third wave CBT approaches (extended behavioural activation, acceptance and commitment therapy and competitive memory training) and control conditions. None of the studies conducted follow-up assessments. The results showed a significant difference in clinical response rates in favour of third wave CBT when compared with treatment as usual (TAU) conditions (three studies, 170 participants, risk ratio (RR) 0.51, 95% confidence interval (CI) 0.27 to 0.95; very low quality). No significant difference in treatment acceptability based on dropout rates was found between third wave CBT approaches and TAU (four studies, 224 participants, RR 1.01, 95% CI 0.08 to 12.30; very low quality). Both analyses showed substantial statistical heterogeneity. AUTHORS' CONCLUSIONS Very low quality evidence suggests that third wave CBT approaches appear to be more effective than treatment as usual in the treatment of acute depression. The very small number of available studies and the diverse types of interventions and control comparators, together with methodological limitations, limit the ability to draw any conclusions on their effect in the short term or over a longer term. The increasing popularity of third wave CBT approaches in clinical practice underscores the importance of completing further studies of third wave CBT approaches in the treatment of acute depression, on a short- and long-term basis, to provide evidence of their effectiveness to policy-makers, clinicians and users of services.
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Affiliation(s)
- Rachel Churchill
- Centre for Academic Mental Health, School of Social and Community Medicine, University of Bristol, Oakfield House, Oakfield Grove, Bristol, UK, BS8 2BN
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Hunot V, Moore THM, Caldwell DM, Furukawa TA, Davies P, Jones H, Honyashiki M, Chen P, Lewis G, Churchill R. 'Third wave' cognitive and behavioural therapies versus other psychological therapies for depression. Cochrane Database Syst Rev 2013:CD008704. [PMID: 24142844 DOI: 10.1002/14651858.cd008704.pub2] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND So-called 'third wave' cognitive and behavioural therapies represents a new generation of psychological therapies that are increasingly being used in the treatment of psychological problems. However, the effectiveness and acceptability of third wave cognitive and behavioural therapy (CBT) approaches as a treatment for depression compared with other psychological therapies remain unclear. OBJECTIVES 1. To examine the effects of all third wave CBT approaches compared with all other psychological therapy approaches for acute depression.2. To examine the effects of different third wave CBT approaches (ACT, compassionate mind training, functional analytic psychotherapy, extended behavioural activation and metacognitive therapy) compared with all other psychological therapy approaches for acute depression.3. To examine the effects of all third wave CBT approaches compared with different psychological therapy approaches (psychodynamic, behavioural, humanistic, integrative, cognitive-behavioural) for acute depression. SEARCH METHODS We searched the Cochrane Depression, Anxiety and Neurosis Group Specialised Register (CCDANCTR to 01/01/12), which includes relevant randomised controlled trials from The Cochrane Library (all years), EMBASE (1974-), MEDLINE (1950-) and PsycINFO (1967-). We also searched CINAHL (May 2010) and PSYNDEX (June 2010) and reference lists of the included studies and relevant reviews for additional published and unpublished studies. An updated search of CCDANCTR restricted to search terms relevant to third wave CBT was conducted in March 2013 (CCDANCTR to 01/02/13). SELECTION CRITERIA Randomised controlled trials that compared various third wave CBT with other psychological therapies for acute depression in adults. DATA COLLECTION AND ANALYSIS Two review authors independently identified studies, assessed trial quality and extracted data. Study authors were contacted for additional information where required. We rated the quality of evidence using GRADE methods. MAIN RESULTS A total of three studies involving 144 eligible participants were included in the review. Two of the studies (56 participants) compared an early version of acceptance and commitment therapy (ACT) with CBT, and one study (88 eligible participants) compared extended behavioural activation with CBT. No other studies of third wave CBT were identified. The two ACT studies were assessed as being at high risk of performance bias and researcher allegiance. Post-treatment results, which were based on dropout rates, showed no evidence of any difference between third wave CBT and other psychological therapies for the primary outcomes of efficacy (risk ratio (RR) of clinical response 1.14, 95% confidence interval (CI) 0.79 to 1.64; very low quality) and acceptability. Results at two-month follow-up showed no evidence of any difference between third wave CBT and other psychological therapies for clinical response (2 studies, 56 participants, RR 0.22, 95% CI 0.04 to 1.15). Moderate statistical heterogeneity was indicated in the acceptability analyses (I(2) = 41%). AUTHORS' CONCLUSIONS Very low quality evidence suggests that third wave CBT and CBT approaches are equally effective and acceptable in the treatment of acute depression. Evidence is limited in quantity, quality and breadth of available studies, precluding us from drawing any conclusions as to their short- or longer-term equivalence. The increasing popularity of third wave CBT approaches in clinical practice underscores the importance of completing further studies to compare various third wave CBT approaches with other psychological therapy approaches to inform clinicians and policymakers on the most effective forms of psychological therapy in treating depression.
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Affiliation(s)
- Vivien Hunot
- Centre for Academic Mental Health, School of Social and Community Medicine, University of Bristol, Oakfield House, Oakfield Grove, Bristol, Avon, UK, BS8 2BN
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Shinohara K, Honyashiki M, Imai H, Hunot V, Caldwell DM, Davies P, Moore THM, Furukawa TA, Churchill R. Behavioural therapies versus other psychological therapies for depression. Cochrane Database Syst Rev 2013; 2013:CD008696. [PMID: 24129886 PMCID: PMC7433301 DOI: 10.1002/14651858.cd008696.pub2] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Behavioural therapies represent one of several categories of psychological therapies that are currently used in the treatment of depression. However, the effectiveness and acceptability of behavioural therapies for depression compared with other psychological therapies remain unclear. OBJECTIVES 1. To examine the effects of all BT approaches compared with all other psychological therapy approaches for acute depression.2. To examine the effects of different BT approaches (behavioural therapy, behavioural activation, social skills training and relaxation training) compared with all other psychological therapy approaches for acute depression.3. To examine the effects of all BT approaches compared with different psychological therapy approaches (CBT, third wave CBT, psychodynamic, humanistic and integrative psychological therapies) for acute depression. SEARCH METHODS We searched the Cochrane Depression Anxiety and Neurosis Group Trials Specialised Register (CCDANCTR, 31/07/2013), which includes relevant randomised controlled trials from The Cochrane Library (all years), EMBASE, (1974-), MEDLINE (1950-) and PsycINFO (1967-). We also searched CINAHL (May 2010) and PSYNDEX (June 2010) and reference lists of the included studies and relevant reviews for additional published and unpublished studies. SELECTION CRITERIA Randomised controlled trials that compared behavioural therapies with other psychological therapies for acute depression in adults. DATA COLLECTION AND ANALYSIS Two or more review authors independently identified studies, assessed trial quality and extracted data. We contacted study authors for additional information. MAIN RESULTS Twenty-five trials involving 955 participants compared behavioural therapies with one or more of five other major categories of psychological therapies (cognitive-behavioural, third wave cognitive-behavioural, psychodynamic, humanistic and integrative therapies). Most studies had a small sample size and were assessed as being at unclear or high risk of bias. Compared with all other psychological therapies together, behavioural therapies showed no significant difference in response rate (18 studies, 690 participants, risk ratio (RR) 0.97, 95% confidence interval (CI) 0.86 to 1.09) or in acceptability (15 studies, 495 participants, RR of total dropout rate 1.02, 95% CI 0.65 to 1.61). Similarly, in comparison with each of the other classes of psychological therapies, low-quality evidence showed better response to cognitive-behavioural therapies than to behavioural therapies (15 studies, 544 participants, RR 0.93, 95% CI 0.83 to 1.05) and low-quality evidence of better response to behavioural therapies over psychodynamic therapies (2 studies, 110 participants, RR 1.24, 95% CI 0.84 to 1.82).When compared with integrative therapies and humanistic therapies, only one study was included in each comparison, and the analysis showed no significant difference between behavioural therapies and integrative or humanistic therapies. AUTHORS' CONCLUSIONS We found low- to moderate-quality evidence that behavioural therapies and other psychological therapies are equally effective. The current evidence base that evaluates the relative benefits and harms of behavioural therapies is very weak. This limits our confidence in both the size of the effect and its precision for our key outcomes related to response and withdrawal. Studies recruiting larger samples with improved reporting of design and fidelity to treatment would improve the quality of evidence in this review.
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Affiliation(s)
- Kiyomi Shinohara
- Kyoto University Graduate School of Medicine / School of Public HealthDepartment of Health Promotion and Human BehaviorYoshida Konoe‐cho, Sakyo‐kuKyotoJapan601‐8501
| | - Mina Honyashiki
- Kyoto University Graduate School of Medicine / School of Public HealthDepartment of Health Promotion and Human BehaviorYoshida Konoe‐cho, Sakyo‐kuKyotoJapan601‐8501
| | - Hissei Imai
- Kyoto University Graduate School of Medicine / School of Public HealthDepartment of Field MedicineKyotoJapan
| | - Vivien Hunot
- University of BristolCentre for Academic Mental Health, School of Social and Community MedicineOakfield HouseOakfield GroveBristolAvonUKBS8 2BN
| | - Deborah M Caldwell
- University of BristolSchool of Social and Community MedicineCanynge Hall, 39 Whatley RoadBristolAvonUKBS8 2PS
| | - Philippa Davies
- University of BristolSchool of Social and Community MedicineCanynge Hall, 39 Whatley RoadBristolAvonUKBS8 2PS
| | - Theresa HM Moore
- University of BristolSchool of Social and Community MedicineCanynge Hall, 39 Whatley RoadBristolAvonUKBS8 2PS
| | - Toshi A Furukawa
- Kyoto University Graduate School of Medicine / School of Public HealthDepartments of Health Promotion and Behavior Change and of Clinical EpidemiologyYoshida Konoe‐cho, Sakyo‐ku,KyotoJapan601‐8501
| | - Rachel Churchill
- University of BristolCentre for Academic Mental Health, School of Social and Community MedicineOakfield HouseOakfield GroveBristolAvonUKBS8 2BN
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Dowrick C, Chew-Graham C, Lovell K, Lamb J, Aseem S, Beatty S, Bower P, Burroughs H, Clarke P, Edwards S, Gabbay M, Gravenhorst K, Hammond J, Hibbert D, Kovandžić M, Lloyd-Williams M, Waheed W, Gask L. Increasing equity of access to high-quality mental health services in primary care: a mixed-methods study. PROGRAMME GRANTS FOR APPLIED RESEARCH 2013. [DOI: 10.3310/pgfar01020] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BackgroundEvidence-based interventions exist for common mental health problems. However, many people are unable to access effective care because it is not available to them or because interactions with caregivers do not address their needs. Current policy initiatives focus on supply-side factors, with less consideration of demand.Aim and objectivesOur aim was to increase equity of access to high-quality primary mental health care for underserved groups. Our objectives were to clarify the mental health needs of people from underserved groups; identify relevant evidence-based services and barriers to, and facilitators of, access to such services; develop and evaluate interventions that are acceptable to underserved groups; establish effective dissemination strategies; and begin to integrate effective and acceptable interventions into primary care.Methods and resultsExamination of evidence from seven sources brought forward a better understanding of dimensions of access, including how people from underserved groups formulate (mental) health problems and the factors limiting access to existing psychosocial interventions. This informed a multifaceted model with three elements to improve access: community engagement, primary care quality and tailored psychosocial interventions. Using a quasi-experimental design with a no-intervention comparator for each element, we tested the model in four disadvantaged localities, focusing on older people and minority ethnic populations. Community engagement involved information gathering, community champions and focus groups, and a community working group. There was strong engagement with third-sector organisations and variable engagement with health practitioners and commissioners. Outputs included innovative ways to improve health literacy. With regard to primary care, we offered an interactive training package to 8 of 16 practices, including knowledge transfer, systems review and active linking, and seven agreed to participate. Ethnographic observation identified complexity in the role of receptionists in negotiating access. Engagement was facilitated by prior knowledge, the presence of a practice champion and a sense of coproduction of the training. We developed a culturally sensitive well-being intervention with individual, group and signposting elements and tested its feasibility and acceptability for ethnic minority and older people in an exploratory randomised trial. We recruited 57 patients (57% of target) with high levels of unmet need, mainly through general practitioners (GPs). Although recruitment was problematic, qualitative data suggested that patients found the content and delivery of the intervention acceptable. Quantitative analysis suggested that patients in groups receiving the well-being intervention improved compared with the group receiving usual care. The combined effects of the model included enhanced awareness of the psychosocial intervention among community organisations and increased referral by GPs. Primary care practitioners valued community information gathering and access to the Improving Access to Mental Health in Primary Care (AMP) psychosocial intervention. We consequently initiated educational, policy and service developments, including a dedicated website.ConclusionsFurther research is needed to test the generalisability of our model. Mental health expertise exists in communities but needs to be nurtured. Primary care is one point of access to high-quality mental health care. Psychosocial interventions can be adapted to meet the needs of underserved groups. A multilevel intervention to increase access to high-quality mental health care in primary care can be greater than the sum of its parts.Study registrationCurrent Controlled Trials ISRCTN68572159.FundingThe National Institute for Health Research Programme Grants for Applied Research programme.
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Affiliation(s)
- C Dowrick
- Institute of Psychology, Health and Society, University of Liverpool, Liverpool, UK
| | - C Chew-Graham
- Institute of Population Health, University of Manchester, Manchester, UK
- Institute of Primary Care and Health Sciences, Keele University, Keele, UK
| | - K Lovell
- Institute of Population Health, University of Manchester, Manchester, UK
| | - J Lamb
- Institute of Population Health, University of Manchester, Manchester, UK
| | - S Aseem
- Institute of Population Health, University of Manchester, Manchester, UK
| | - S Beatty
- Institute of Population Health, University of Manchester, Manchester, UK
| | - P Bower
- Institute of Population Health, University of Manchester, Manchester, UK
| | - H Burroughs
- Institute of Population Health, University of Manchester, Manchester, UK
- Institute of Primary Care and Health Sciences, Keele University, Keele, UK
| | - P Clarke
- Institute of Psychology, Health and Society, University of Liverpool, Liverpool, UK
| | - S Edwards
- Institute of Psychology, Health and Society, University of Liverpool, Liverpool, UK
- College of Medicine, Swansea University, Swansea, UK
| | - M Gabbay
- Institute of Psychology, Health and Society, University of Liverpool, Liverpool, UK
| | - K Gravenhorst
- Institute of Psychology, Health and Society, University of Liverpool, Liverpool, UK
| | - J Hammond
- Institute of Population Health, University of Manchester, Manchester, UK
| | - D Hibbert
- Institute of Psychology, Health and Society, University of Liverpool, Liverpool, UK
| | - M Kovandžić
- Institute of Psychology, Health and Society, University of Liverpool, Liverpool, UK
| | - M Lloyd-Williams
- Institute of Psychology, Health and Society, University of Liverpool, Liverpool, UK
| | - W Waheed
- Institute of Population Health, University of Manchester, Manchester, UK
| | - L Gask
- Institute of Population Health, University of Manchester, Manchester, UK
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Corcoran J, Brown E, Davis M, Pineda M, Kadolph J, Bell H. Depression in older adults: a meta-synthesis. JOURNAL OF GERONTOLOGICAL SOCIAL WORK 2013; 56:509-534. [PMID: 23869566 DOI: 10.1080/01634372.2013.811144] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Depression in older adults is often overlooked and dismissed as a part of aging. A body of knowledge-both quantitative and qualitative-has developed on the topic of depression in older adults. Meta-analyses and systematic reviews have been used to synthesize the quantitative findings of studies, and our research seeks to synthesize the qualitative studies that have been conducted on elders' experience with depression. Thirteen studies met inclusion criteria, and 4 major themes were extracted: experiences, causes, recovery, and barriers to treatment. These themes are detailed and their implications for practice are explored.
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Affiliation(s)
- Jacqueline Corcoran
- School of Social Work, Virginia Commonwealth University, Richmond, VA 23284, USA.
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Abstract
OBJECTIVE To be used in conjunction with 'Pharmacological management of unipolar depression' [Malhi et al. Acta Psychiatr Scand 2013;127(Suppl. 443):6-23] and 'Lifestyle management of unipolar depression' [Berk et al. Acta Psychiatr Scand 2013;127(Suppl. 443):38-54]. To provide clinically relevant recommendations for the use of psychological treatments in depression derived from a literature review. METHOD Medical databases including MEDLINE and PubMed were searched for pertinent literature, with an emphasis on recent publications. RESULTS Structured psychological treatments such as cognitive behaviour therapy and interpersonal therapy (IPT) have a robust evidence base for efficacy in treating depression, even in severe cases of depression. However, they may not offer benefit as quickly as antidepressants, and maximal efficacy requires well-trained and experienced therapists. These therapies are effective across the lifespan and may be preferred where it is desired to avoid pharmacotherapy. In some instances, combination with pharmacotherapy may enhance outcome. Psychological therapy may have more enduring protective effects than medication and be effective in relapse prevention. Newer structured psychological therapies such as mindfulness-based cognitive therapy and acceptance and commitment therapy lack an extensive outcome literature, but the few published studies yielding positive outcomes suggest they should be considered options for treatment. CONCLUSION Cognitive behaviour therapy and IPT can be effective in alleviating acute depression for all levels of severity and in maintaining improvement. Psychological treatments for depression have demonstrated efficacy across the lifespan and may present a preferred treatment option in some groups, for example, children and adolescents and women who are pregnant or postnatal.
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Affiliation(s)
- L Lampe
- CADE Clinic, Department of Psychiatry, Royal North Shore Hospital, Sydney, NSW, Australia.
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Peñaranda APB, Valencia JG, Guarín MR, Borrero ÁEA, Díaz SMC, de la Hoz Bradford AM, Riveros PM, Jaramillo LE, Brito E, Acosta CAP, Pedraza RS, González-Pacheco J, Gómez-Restrepo C. [Integral Care Guide for Early Detection and Diagnosis of Depressive Episodes and Recurrent Depressive Disorder in Adults. Integral Attention of Adults with a Diagnosis of Depressive Episodes and Recurrent Depressive Disorder: Part II: General Aspects of Treatment, Management of the Acute Phase, Continuation and Maintenance of Patients with a Depression Diagnosis]. ACTA ACUST UNITED AC 2012; 41:740-73. [PMID: 26572264 DOI: 10.1016/s0034-7450(14)60045-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2012] [Accepted: 11/06/2012] [Indexed: 12/28/2022]
Abstract
INTRODUCTION This article presents recommendations based on evidence gathered to answer a series of clinical questions concerning the depressive episode and the recurrent depressive disorder, with emphasis on general treatment aspects, treatment in the acute phase and management of the continuation/maintenance, all intended to grant health care parameters based on the best and more updated available evidence for achieving minimum quality standards with adult patients thus diagnosed. METHODOLOGY A practical clinical guide was elaborated according to standards of the Methodological Guide of the Ministry of Social Protection. Recommendation from NICE90 and CANMAT guides were adopted and updated so as to answer the questions posed while de novo questions were developed. RESULTS Recommendations 5-22 corresponding to management of depression are presented.
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Affiliation(s)
- Adriana Patricia Bohórquez Peñaranda
- Médica psiquiatra, MSc Epidemiología Clínica, profesora Departamento de Psiquiatría y Salud Mental, Pontificia Universidad Javeriana, Coordinadora GAI Depresión, Bogotá, Colombia.
| | - Jenny García Valencia
- Médica psiquiatra, MSc PhD Epidemiología, profesora Departamento de Psiquiatría, Universidad de Antioquia, Medellín, Colombia
| | - Maritza Rodríguez Guarín
- Médica psiquiatra, MSc Epidemiología Clínica, profesora Departamento de Psiquiatría y Salud Mental, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Álvaro Enrique Arenas Borrero
- Médico psiquiatra, Maestrando Epidemiología Clínica, Departamento de Epidemiología Clínica y Bioestadística, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Sergio Mario Castro Díaz
- Médico residente psiquiatría, asistente de investigación, Departamento de Psiquiatría y Salud Mental, Epidemiología Clínica y Bioestadística, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Ana María de la Hoz Bradford
- Médica MSc Epidemiología Clínica, Departamento de Epidemiología Clínica y Bioestadística, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Patricia Maldonado Riveros
- Médica rural, asistente de investigación, Departamento de Epidemiología Clínica y Bioestadística, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Luis Eduardo Jaramillo
- Médico psiquiatra, MSc Farmacología, profesor titular Departamento de Psiquiatría, Universidad Nacional de Colombia, delegado Asociación Colombiana de Psiquiatría, Bogotá, Colombia
| | - Enrique Brito
- Médico psiquiatra, delegado Asociación Colombiana de Psiquiatría, Bogotá, Colombia
| | - Carlos Alberto Palacio Acosta
- Médico psiquiatra, MSc Epidemiología Clínica, profesor titular Departamento de Psiquiatría, Universidad de Antioquia, Medellín, Colombia
| | - Ricardo Sánchez Pedraza
- Médico psiquiatra, MSc Epidemiología Clínica, profesor titular Departamento de Psiquiatría, Universidad Nacional de Colombia, Bogotá, Colombia
| | - Juan González-Pacheco
- Médico psiquiatra, profesor y director Departamento de Psiquiatría y Salud Mental, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Carlos Gómez-Restrepo
- Médico psiquiatra, MSc Epidemiología Clínica, Psiquiatra de Enlace, Psicoanalista, profesor titular Departamento de Psiquiatría y Salud Mental, director Departamento de Epidemiología Clínica y Bioestadística, Pontificia Universidad Javeriana, Director GAI Depresión, codirector CINETS, Bogotá, Colombia
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Sharpe L, Gittins CB, Correia HM, Meade T, Nicholas MK, Raue PJ, McDonald S, Areán PA. Problem-solving versus cognitive restructuring of medically ill seniors with depression (PROMISE-D trial): study protocol and design. BMC Psychiatry 2012; 12:207. [PMID: 23173830 PMCID: PMC3561282 DOI: 10.1186/1471-244x-12-207] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2012] [Accepted: 11/07/2012] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND With an ageing population in most Western countries, people are living longer but often with one or more chronic physical health problems. Older people in physically poor health are at greater risk of developing clinical depression. Cognitive Behavioural Therapy (CBT) and Problem Solving Therapy (PST) have both been found to be efficacious in treating late-life depression, however patients with "multi-morbidity" (i.e. more than one chronic condition) are often excluded from these trials. The aim of this study is to compare the efficacy of CBT and PST in treating older adults who have one or more chronic physical health conditions and a diagnosable depressive disorder. This study will be the first to explicitly target the treatment of depression in older people in primary care settings presenting with a range of health problems using behavioural interventions. METHODS/DESIGN The PROMISE-D study is a randomised controlled trial of two evidence-based treatments for late-life major or minor depression for patients who also have at least one co-morbid chronic health problem. Participants will be randomised to two active interventions (PST or CBT) or enhanced treatment-as-usual (E-TAU). Primary outcomes will be depression diagnostic status and severity of depression (according to the Hamilton Depression Rating Scale and the Geriatric Depression Scale). Secondary outcomes will be anxiety severity, quality of life and health care utilisation. Assessments will be conducted by a researcher who remains blind to the patient's treatment allocation and will be conducted pre and post-treatment and at six and 12 months follow-up. Health care utilisation will be assessed throughout a two year period following entry to the trial. Executive function, rumination and emotion regulation will also be measured to determine the impact of these factors on treatment response in two treatment groups. DISCUSSION Multi-morbidity, the experience of two or more chronic health problems, is becoming an increasing problem internationally, particularly amongst the elderly. Evidence-based psychological treatments exist for late-life depression and these have been shown to be effective for participants with individual health problems and depression. However, there are no studies that have compared the two leading psychotherapies shown to be effective in the treatment of late-life depression. In addition, many trials of psychotherapy with older adults exclude those with multi-morbidity. Hence, this trial will confirm whether CBT and PST are efficacious in the treatment of depression in the context of complex medical needs and determine which of these two interventions is most efficacious. TRIAL REGISTRATION ACTRN12612000854831.
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Affiliation(s)
- Louise Sharpe
- School of Psychology, University of Sydney, Sydney, Australia
| | | | | | - Tanya Meade
- School of Psychology, University of Western Sydney, Sydney, Australia
- School of Medicine, University of Sydney, Sydney, Australia
| | - Michael K Nicholas
- Pain Management Research Institute, University of Sydney at Royal North Shore Hospital, Sydney, Australia
| | - Patrick J Raue
- Weill Medical College, Cornell University, New York, USA
| | - Sarah McDonald
- School of Psychology, University of Sydney, Sydney, Australia
| | - Patricia A Areán
- Department of Psychiatry, University of California, San Francisco, USA
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Abstract
BACKGROUND Depressive illness in older people causes significant suffering and health service utilisation. Relapse and recurrence rates are high. OBJECTIVES To examine the efficacy of antidepressants and psychological therapies in preventing the relapse and recurrence of depression in older people. SEARCH METHODS Search of the Cochrane Depression, Anxiety and Neurosis Review Group's specialized register (the CCDANCTR) up to 22 June 2012. The CCDANCTR includes relevant randomised controlled trials from the following bibliographic databases: The Cochrane Library (all years), EMBASE, (1974 to date) MEDLINE (1950 to date) and PsycINFO (1967 to date). We handsearched relevant journals, contacted experts in the field and examined reference lists, conference proceedings and bibliographies. SELECTION CRITERIA Both review authors independently selected studies. We included randomised controlled trials (RCTs) involving people aged 60 and over successfully treated for an episode of depression and randomised to receive continuation and maintenance treatment with antidepressants, psychological therapies, or combination. DATA COLLECTION AND ANALYSIS Data were extracted independently by the two authors.The primary outcome was relapse/recurrence rate of depression (reaching a cut-off on any depression rating scale) at six-monthly intervals. Secondary outcomes included global impression of change, social functioning, and deaths. Meta-analysis was performed using risk ratio for dichotomous outcomes and mean differences (MD) for continuous outcomes, with 95% confidence intervals. MAIN RESULTS Seven studies met the inclusion criteria (803 participants). Six compared antidepressant medication with placebo; two involved psychological therapies. There was marked heterogeneity between the studies.Comparing antidepressants with placebo, at six months follow-up there was no significant difference. At 12 months follow-up there was a statistically significant difference favouring antidepressants in reducing recurrence compared with placebo (three RCTs, N = 247, RR = 0.67, 95% CI 0.55 to 0.82; NNTB = five). At 24 months there was no significant difference for antidepressants overall, however, for the subgroup of tricyclic antidepressants there was significant benefit (three RCTs, N = 169, RR = 0.70, 95% CI 0.50 to 0.99; NNTB = five). At 36 months there was no significant difference for antidepressants overall. There was no difference in treatment acceptability or death rates between antidepressant and placebo.There was no significant difference between psychological treatment and antidepressant in recurrence rates at 12, 24, and 36 months (one RCT, N = 53) or between combination and antidepressant alone.Overall, the included studies were at low risk of bias. AUTHORS' CONCLUSIONS The long-term benefits of continuing antidepressant medication in the prevention of recurrence of depression in older people are not clear and no firm treatment recommendations can be made on the basis of this review. Continuing antidepressant medication for 12 months appears to be helpful but this is based on only three small studies with relatively few participants using differing classes of antidepressants in clinically heterogeneous populations. Comparisons at other time points did not reach statistical significance. Data on psychological therapies and combined treatments are too limited to draw any conclusions.
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75
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Depression interventions among racial and ethnic minority older adults: a systematic review across 20 years. Am J Geriatr Psychiatry 2012; 20:915-31. [PMID: 22828202 PMCID: PMC3479358 DOI: 10.1097/jgp.0b013e31825d091a] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
While there is strong evidence in support of geriatric depression treatments, much less is available with regard to older U.S. racial and ethnic minorities. The objectives of this review are to identify and appraise depression treatment studies tested with samples of U.S. racial and ethnic minority older adults. We include an appraisal of sociocultural adaptations made to the depression treatments in studies meeting our final criteria. Systematic search methods were utilized to identify research published between 1990 and 2010 that describe depression treatment outcomes for older adults by racial/ethnic group, or for samples of older adults who are primarily (i.e., >50%) racial/ethnic minorities. Twenty-three unduplicated articles included older adults and seven met all inclusion criteria. Favorable depression treatment effects were observed for older minorities across five studies that took place in different types of settings and with varying levels of sociocultural adaptations. The effectiveness of depression care remains mixed, although collaborative or integrated care shows promise for African Americans and Latinos. The degree to which the findings generalize to non-English-speaking, low acculturated, and low-income older persons, and to other older minority groups (i.e., Asian and Pacific Islanders, and American Indian and Alaska Natives), remains unclear. Given the high disease burden among older minorities with depression, it is imperative to provide timely, accessible, and effective depression treatments. Increasing their participation in behavioral health research should be a national priority.
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76
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Abstract
Depression is a common, disabling, and costly condition encountered in older patients. Effective strategies for detection and treatment of late-life depression are summarized based on a case of a 69-year-old woman who struggled with prolonged depression. Clinicians should screen older patients for depression using a standard rating scale, initiate treatment such as antidepressant medications or evidence-based psychotherapy, and monitor depression symptoms. Patients who are not improving should be considered for psychiatric consultation and treatment changes including electroconvulsive therapy. Several changes in treatment approaches are usually needed before patients achieve complete remission. Maintenance treatment and relapse-prevention planning (summarization of early warning signs for depression, maintenance treatments such as medications, and other strategies to reduce the risk of relapse [eg, regular physical activity or pleasant activities]) can reduce the risk of relapse. Collaborative programs, in which primary care clinicians work closely with mental health specialists following a measurement-based treatment-to-target approach, are significantly more effective than typical primary care treatment.
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Affiliation(s)
- Jürgen Unützer
- Psychiatry and Behavioral Sciences Chief of Psychiatry, University of Washington Medical Center Director, UW AIMS Center (http://uwaims.org) Director, IMPACT Implementation Program (http://impact-uw.org) 1959 NE Pacific Street Box 356560 Seattle, Washington 98195-6560
| | - Mijung Park
- Postdoctoral fellow of Geriatric Mental Health Services Research Department of Psychiatry and Behavioral Sciences University of Washington
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77
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Messinger-Rapport BJ, Cruz-Oliver DM, Thomas DR, Morley JE. Clinical Update on Nursing Home Medicine: 2012. J Am Med Dir Assoc 2012; 13:581-94. [DOI: 10.1016/j.jamda.2012.06.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2012] [Accepted: 06/08/2012] [Indexed: 01/24/2023]
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78
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Abstract
Cognitive behavioral therapy (CBT) refers to a popular therapeutic approach that has been applied to a variety of problems. The goal of this review was to provide a comprehensive survey of meta-analyses examining the efficacy of CBT. We identified 269 meta-analytic studies and reviewed of those a representative sample of 106 meta-analyses examining CBT for the following problems: substance use disorder, schizophrenia and other psychotic disorders, depression and dysthymia, bipolar disorder, anxiety disorders, somatoform disorders, eating disorders, insomnia, personality disorders, anger and aggression, criminal behaviors, general stress, distress due to general medical conditions, chronic pain and fatigue, distress related to pregnancy complications and female hormonal conditions. Additional meta-analytic reviews examined the efficacy of CBT for various problems in children and elderly adults. The strongest support exists for CBT of anxiety disorders, somatoform disorders, bulimia, anger control problems, and general stress. Eleven studies compared response rates between CBT and other treatments or control conditions. CBT showed higher response rates than the comparison conditions in 7 of these reviews and only one review reported that CBT had lower response rates than comparison treatments. In general, the evidence-base of CBT is very strong. However, additional research is needed to examine the efficacy of CBT for randomized-controlled studies. Moreover, except for children and elderly populations, no meta-analytic studies of CBT have been reported on specific subgroups, such as ethnic minorities and low income samples.
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79
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Meekums B, Karkou V, Nelson EA. Dance movement therapy for depression. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2012. [DOI: 10.1002/14651858.cd009895] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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80
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Andreescu C, Reynolds CF. Late-life depression: evidence-based treatment and promising new directions for research and clinical practice. Psychiatr Clin North Am 2011; 34:335-55, vii-iii. [PMID: 21536162 PMCID: PMC8442985 DOI: 10.1016/j.psc.2011.02.005] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
As the population ages, successive cohorts of older adults will experience depressive disorders. Late-life depression (LLD) carries additional risk for suicide, medical comorbidity, disability, and family caregiving burden. Although response and remission rates to pharmacotherapy and electroconvulsive therapy are comparable with those in midlife depression, relapse rates are higher, underscoring the challenge to achieve and maintain wellness. This article reviews the evidence base for LLD treatment options and provides an analysis of treatment options for difficult-to-treat LLD variants (eg, psychotic depression, vascular depression). Treatment algorithms are also reviewed based on predictors of response and promising novel treatment options.
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Affiliation(s)
- Carmen Andreescu
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh, 3811 O’Hara Street, 247 Sterling Plaza, Pittsburgh, PA 15213, USA
| | - Charles F. Reynolds
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh, 3811 O’Hara Street, 758 Bellefield Towers, Pittsburgh, PA 15213, USA,Corresponding author.
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81
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Psychosocial interventions for late-life major depression: evidence-based treatments, predictors of treatment outcomes, and moderators of treatment effects. Psychiatr Clin North Am 2011; 34:377-401, viii. [PMID: 21536164 PMCID: PMC3099466 DOI: 10.1016/j.psc.2011.03.001] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
This systematic review evaluates the efficacy of psychosocial interventions for the acute treatment of late-life depression and identifies predictors of treatment outcomes and moderators of treatment effects. Problem-solving therapy, cognitive behavioral therapy, and treatment initiation and participation program have supportive evidence of efficacy, pending replication. Although the data on predictors of treatment outcomes and moderators of treatment effects are preliminary, it appears that baseline anxiety and stress level, personality disorders, endogenous depression, and reduced self-rated health predict worse depression outcomes. Future research may examine the moderating effects of baseline depression severity and identify other clinical or demographic moderators.
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82
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McKenna G, Hevey D, Martin E. Patients' and providers' perspectives on bibliotherapy in primary care. Clin Psychol Psychother 2011; 17:497-509. [PMID: 20146202 DOI: 10.1002/cpp.679] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Bibliotherapy is a form of self-administered treatment in which structured materials provide a means to alleviate distress. Although the treatment has evidence of effectiveness, evaluations of bibliotherapy have typically focused on outcomes, and the perspectives of both the client and the service provider have been understudied. In the present study, eleven users of a bibliotherapy scheme were interviewed regarding their experiences of bibliotherapy. In addition, five referring practitioners to the scheme were also interviewed. Thematic analyses revealed three super-ordinate themes in the transcripts: participants' personal experiences of the bibliotherapy scheme factors that facilitate change and the influence of the professionals involved. The implications of these findings for bibliotherapy schemes are considered.
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Affiliation(s)
- Grainne McKenna
- School of Psychology, Trinity College Dublin, Dublin, Ireland
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83
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Welch T, Welch M, Baer J, Dias J, Gurney C, Van Dale B, Lockie M, Millar K, Noon J, Psiurski S. Removed But Not Out of Reach: Seniors with Depression in Smaller Center, Rural, and Remote Communities. Psychiatr Ann 2010. [DOI: 10.3928/00485713-20101123-05] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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84
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Churchill R, Caldwell D, Moore THM, Davies P, Jones H, Lewis G, Hunot V. Behavioural therapies versus other psychological therapies for depression. Cochrane Database Syst Rev 2010:CD008696. [PMID: 25067905 PMCID: PMC4110712 DOI: 10.1002/14651858.cd008696] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
This is the protocol for a review and there is no abstract. The objectives are as follows: To examine the effectiveness and acceptability of all BT approaches compared with all other psychological therapy approaches for acute depressionTo examine the effectiveness and acceptability of different BT approaches (behavioural therapy, behavioural activation, social skills training and relaxation training) compared with all other psychological therapy approaches for acute depression.To examine the effectiveness and acceptability of all BT approaches compared with different psychological therapy approaches (psychodynamic, humanistic, integrative, cognitive-behavioural and third wave CBT) for acute depression.
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Affiliation(s)
- Rachel Churchill
- Academic Unit of Psychiatry, School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Deborah Caldwell
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Theresa HM Moore
- Academic Unit of Psychiatry, School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Philippa Davies
- Academic Unit of Psychiatry, School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Hannah Jones
- Cochrane Schizophrenia Group, The University of Nottingham, Nottingham, UK
| | - Glyn Lewis
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Vivien Hunot
- Academic Unit of Psychiatry, School of Social and Community Medicine, University of Bristol, Bristol, UK
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85
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Churchill R, Davies P, Caldwell D, Moore THM, Jones H, Lewis G, Hunot V. Humanistic therapies versus other psychological therapies for depression. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2010. [DOI: 10.1002/14651858.cd008700] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Rachel Churchill
- University of Bristol; Academic Unit of Psychiatry, School of Social and Community Medicine; Oakfield House Oakfield Grove Bristol UK BS8 2BN
| | - Philippa Davies
- University of Bristol; Academic Unit of Psychiatry, School of Social and Community Medicine; Oakfield House Oakfield Grove Bristol UK BS8 2BN
| | - Deborah Caldwell
- University of Bristol; School of Social and Community Medicine; Cotham House, Cotham Hill Bristol Avon UK BS6 6JL
| | - Theresa HM Moore
- University of Bristol; Academic Unit of Psychiatry, School of Social and Community Medicine; Oakfield House Oakfield Grove Bristol UK BS8 2BN
| | - Hannah Jones
- The University of Nottingham; Cochrane Schizophrenia Group; Institute of Mental Health, Sir Colin Campbell Building University of Nottingham Innovation Park, Triumph Road, Nottingham UK NG7 2TU
| | - Glyn Lewis
- University of Bristol; School of Social and Community Medicine; Cotham House, Cotham Hill Bristol Avon UK BS6 6JL
| | - Vivien Hunot
- University of Bristol; Academic Unit of Psychiatry, School of Social and Community Medicine; Oakfield House Oakfield Grove Bristol UK BS8 2BN
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86
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Churchill R, Moore THM, Davies P, Caldwell D, Jones H, Lewis G, Hunot V. Mindfulness-based 'third wave' cognitive and behavioural therapies versus treatment as usual for depression. Cochrane Database Syst Rev 2010:CD008705. [PMID: 25067907 PMCID: PMC4110888 DOI: 10.1002/14651858.cd008705] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
This is the protocol for a review and there is no abstract. The objectives are as follows: To examine the effectiveness and acceptability of all third wave CBT approaches compared with treatment as usual/waiting list/attention placebo control conditions for acute depression.To examine the effectiveness and acceptability of different third wave CBT approaches (ACT, compassionate mind training, functional analytic psychotherapy, meta-cognitive therapy, dialectical behaviour therapy, MBCT, extended behavioural activation and meta-cognitive therapy) compared with treatment as usual/waiting list/attention placebo control conditions for acute depression.To examine the effectiveness and acceptability of all third wave CBT approaches compared with different types of comparator (standard care, no treatment, waiting list, attention placebo) for acute depression.
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Affiliation(s)
- Rachel Churchill
- Academic Unit of Psychiatry, School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Theresa HM Moore
- Academic Unit of Psychiatry, School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Philippa Davies
- Academic Unit of Psychiatry, School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Deborah Caldwell
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Hannah Jones
- Cochrane Schizophrenia Group, The University of Nottingham, Nottingham, UK
| | - Glyn Lewis
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Vivien Hunot
- Academic Unit of Psychiatry, School of Social and Community Medicine, University of Bristol, Bristol, UK
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87
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Hunot V, Moore THM, Caldwell D, Davies P, Jones H, Lewis G, Churchill R. Mindfulness-based 'third wave' cognitive and behavioural therapies versus other psychological therapies for depression. Cochrane Database Syst Rev 2010:CD008704. [PMID: 25067906 PMCID: PMC4110713 DOI: 10.1002/14651858.cd008704] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
This is the protocol for a review and there is no abstract. The objectives are as follows: To examine the effectiveness and acceptability of all third wave CBT approaches compared with all other psychological therapy approaches for acute depression.To examine the effectiveness and acceptability of different third wave CBT approaches (ACT,compassionate mind training, functional analytic psychotherapy, extended behavioural activation and meta-cognitive therapy) compared with all other psychological therapy approaches for acute depression.To examine the effectiveness and acceptability of all third wave CBT approaches compared with different psychological therapy approaches (psychodynamic, behavioural, humanistic, integrative, cognitive-behavioural) for acute depression.
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Affiliation(s)
- Vivien Hunot
- Academic Unit of Psychiatry, School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Theresa HM Moore
- Academic Unit of Psychiatry, School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Deborah Caldwell
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Philippa Davies
- Academic Unit of Psychiatry, School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Hannah Jones
- Cochrane Schizophrenia Group, The University of Nottingham, Nottingham, UK
| | - Glyn Lewis
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Rachel Churchill
- Academic Unit of Psychiatry, School of Social and Community Medicine, University of Bristol, Bristol, UK
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88
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Broomfield NM, Laidlaw K, Hickabottom E, Murray MF, Pendrey R, Whittick JE, Gillespie DC. Post-stroke depression: the case for augmented, individually tailored cognitive behavioural therapy. Clin Psychol Psychother 2010; 18:202-17. [DOI: 10.1002/cpp.711] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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89
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Abstract
BACKGROUND We developed an indicated preventive life-review course, "Looking for Meaning", based on the assumption that reminiscence styles influence coping with depressive symptoms. This study describes the impact of this course in a pragmatic randomized controlled trial. METHODS Inclusion criteria were >50 years, a score of 5 or higher on the Center for Epidemiological Studies Depression Scale (CES-D), and no depressive disorder or psychotropic or psychological treatment. Participants were randomized and stratified by gender: the experimental group (N = 83) was offered the course and the comparison group (N = 88) a movie. There were three measurements: pre-treatment, post-treatment and 6 months after post-treatment. Depressive symptoms constituted the primary outcome. Secondary outcomes were anxiety symptoms, satisfaction with life, mastery and reminiscence styles. All analyses were conducted according to the intention-to-treat principle. Missing values were replaced by regression imputation. RESULTS The course reduced depressive symptoms, a decrease that was retained during follow-up. A significant between-group effect size was found (d = 0.58). There was also a reduction in symptoms of anxiety; however, the comparison group showed the same reduction, resulting in a small between-group effect size. Gender and level of depressive symptoms were found to be prognostic factors for the change in depressive symptoms; age was not. Post hoc analyses showed significant between-group effect sizes for females and those with a score above the cut-off of the CES-D. CONCLUSION The course "Looking for Meaning" can be recommended for people aged over 50 years, females and older adults with a clinically relevant level of depressive symptoms (above cut-off) in particular.
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90
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Smith JM. Clinical implications of treating depressed older adults with SSRIs: possible risk of hyponatremia. J Gerontol Nurs 2010; 36:22-7; quiz 28-9. [PMID: 20180497 DOI: 10.3928/00989134-20100202-04] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2009] [Accepted: 09/03/2009] [Indexed: 11/20/2022]
Abstract
Depression is a serious mental health problem in older adults. Some of the symptoms of depression include depressed mood, significant change in weight or appetite, changes in sleep patterns, a decrease in concentration and energy, and possible suicide. However, depression is a treatable illness, especially with the newer class of antidepressant agents, the selective serotonin reuptake inhibitors (SSRIs). One side effect of SSRI use includes hyponatremia, which is becoming an increasingly serious complication that may have harmful clinical ramifications. Older adults are especially at risk for hyponatremia and could experience serious consequences if left untreated. The purpose of this article is to use an individual example to demonstrate the clinical importance of detecting hyponatremia in older adults receiving SSRI treatment.
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Affiliation(s)
- Judith M Smith
- Goldfarb School of Nursing, Barnes-Jewish College, St Louis, Missouri 63110, USA.
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91
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Davidson KW, Rieckmann N, Clemow L, Schwartz JE, Shimbo D, Medina V, Albanese G, Kronish I, Hegel M, Burg MM. Enhanced depression care for patients with acute coronary syndrome and persistent depressive symptoms: coronary psychosocial evaluation studies randomized controlled trial. ARCHIVES OF INTERNAL MEDICINE 2010; 170:600-8. [PMID: 20386003 PMCID: PMC2882253 DOI: 10.1001/archinternmed.2010.29] [Citation(s) in RCA: 244] [Impact Index Per Article: 17.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND Depressive symptoms are an established predictor of mortality and major adverse cardiac events (defined as nonfatal myocardial infarction or hospitalization for unstable angina or urgent/emergency revascularizations) in patients with acute coronary syndrome (ACS). This study was conducted to determine the acceptability and efficacy of enhanced depression treatment in patients with ACS. METHODS A 3-month observation period to identify patients with ACS and persistent depressive symptoms was followed by a 6-month randomized controlled trial. From January 1, 2005, through February 29, 2008, 237 patients with ACS from 5 hospitals were enrolled, including 157 persistently depressed patients randomized to intervention (initial patient preference for problem-solving therapy and/or pharmacotherapy, then a stepped-care approach; 80 patients) or usual care (77 patients) and 80 nondepressed patients who underwent observational evaluation. The primary outcome was patient satisfaction with depression care. Secondary outcomes were depressive symptom changes (assessed with the Beck Depression Inventory), major adverse cardiac events, and death. RESULTS At the end of the trial, the proportion of patients who were satisfied with their depression care was higher in the intervention group (54% of 80) than in the usual care group (19% of 77) (odds ratio, 5.4; 95% confidence interval [CI], 2.2-12.9 [P < .001]). The Beck Depression Inventory score decreased significantly more (t(155) = 2.85 [P = .005]) for intervention patients (change, -5.7; 95% CI, -7.6 to -3.8; df = 155) than for usual care patients (change, -1.9; 95% CI, -3.8 to -0.1; df = 155); the depression effect size was 0.59 of the standard deviation. At the end of the trial, 3 intervention patients and 10 usual care patients had experienced major adverse cardiac events (4% and 13%, respectively; log-rank test, chi(2)(1) = 3.93 [P = .047]), as well as 5 nondepressed patients (6%) (for the intervention vs nondepressed cohort, chi(2)(1) = 0.48 [P = .49]). CONCLUSION Enhanced depression care for patients with ACS was associated with greater satisfaction, a greater reduction in depressive symptoms, and a promising improvement in prognosis. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT00158054.
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Affiliation(s)
- Karina W Davidson
- Department of Medicine, Columbia University College of Physicians and Surgeons, PH9 Center, 622 W 168th St, Room 948, New York, NY 10032, USA.
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92
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Satterfield JM, Crabb R. Cognitive-Behavioral Therapy for Depression in an Older Gay Man: A Clinical Case Study. COGNITIVE AND BEHAVIORAL PRACTICE 2010; 17:45-55. [PMID: 23144559 PMCID: PMC3494402 DOI: 10.1016/j.cbpra.2009.04.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Although strong evidence supports cognitive-behavioral therapy for late-life depression and depression in racial and ethnic minorities, there are no empirical studies on the treatment of depression in older sexual minorities. Three distinct literatures were tapped to create a depression treatment protocol for an older gay male. Interventions were deduced from the late-life depression literature, culturally adapted CBT protocols for racial minorities, and the emerging social and developmental psychological theories for lesbian, gay, and bisexual populations. Specific treatment interventions, processes, and outcomes are described to illustrate how these literatures may be used to provide more culturally appropriate and effective health care for the growing, older sexual minority population.
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93
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Churchill R, Moore THM, Caldwell D, Davies P, Jones H, Furukawa TA, Lewis G, Hunot V. Cognitive behavioural therapies versus other psychological therapies for depression. Cochrane Database Syst Rev 2010:CD008698. [PMID: 25411559 PMCID: PMC4234083 DOI: 10.1002/14651858.cd008698] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
This is the protocol for a review and there is no abstract. The objectives are as follows: To examine the effectiveness and acceptability of all CBT approaches compared with all other psychological therapy approaches for acute depressionTo examine the effectiveness and acceptability of different CBT approaches (cognitive therapy, rational emotive behaviour therapy, problem-solving therapy, self-control therapy and Coping with Depression course) compared with all other psychological therapy approaches for acute depression.To examine the effectiveness and acceptability of all CBT approaches compared with different psychological therapy approaches (psychodynamic, behavioural, humanistic, integrative, third wave CBT) for acute depression.
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Affiliation(s)
- Rachel Churchill
- Academic Unit of Psychiatry, School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Theresa HM Moore
- Academic Unit of Psychiatry, School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Deborah Caldwell
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Philippa Davies
- Academic Unit of Psychiatry, School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Hannah Jones
- Cochrane Schizophrenia Group, The University of Nottingham, Nottingham, UK
| | - Toshi A Furukawa
- Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine/School of Public Health, Kyoto, Japan
| | - Glyn Lewis
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Vivien Hunot
- Academic Unit of Psychiatry, School of Social and Community Medicine, University of Bristol, Bristol, UK
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94
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Churchill R, Davies P, Caldwell D, Moore THM, Jones H, Lewis G, Hunot V. Humanistic therapies versus other psychological therapies for depression. Cochrane Database Syst Rev 2010; 2010:CD008700. [PMID: 25278809 PMCID: PMC4179874 DOI: 10.1002/14651858.cd007800] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
This is the protocol for a review and there is no abstract. The objectives are as follows: To examine the effectiveness and acceptability of all humanistic therapies compared with all other psychological therapy approaches for acute depression.To examine the effectiveness and acceptability of different humanistic therapy models (person-centred, gestalt, process-experiential, transactional analysis, existential and non-directive therapies) compared with all other psychological therapy approaches for acute depression.To examine the effectiveness and acceptability of all humanistic therapies compared with different psychological therapy approaches (psychodynamic, behavioural, humanistic, integrative, cognitive-behavioural) for acute depression.
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Affiliation(s)
- Rachel Churchill
- Academic Unit of Psychiatry, School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Philippa Davies
- Academic Unit of Psychiatry, School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Deborah Caldwell
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Theresa HM Moore
- Academic Unit of Psychiatry, School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Hannah Jones
- Cochrane Schizophrenia Group, The University of Nottingham, Nottingham, UK
| | - Glyn Lewis
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Vivien Hunot
- Academic Unit of Psychiatry, School of Social and Community Medicine, University of Bristol, Bristol, UK
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95
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Caldwell D, Hunot V, Moore THM, Davies P, Jones H, Lewis G, Churchill R. Behavioural therapies versus treatment as usual for depression. Cochrane Database Syst Rev 2010:CD008697. [PMID: 25411561 PMCID: PMC4234087 DOI: 10.1002/14651858.cd008697] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
This is the protocol for a review and there is no abstract. The objectives are as follows: To examine the effectiveness and acceptability of all BT approaches compared with treatment as usual/waiting list/attention placebo control conditions for acute depression.To examine the effectiveness and acceptability of different BT approaches (behavioural therapy, behavioural activation, social skills training and relaxation training) compared with treatment as usual/waiting list/attention placebo control conditions for acute depression.To examine the effectiveness and acceptability of all BT approaches compared with different types of comparator (standard care, no treatment, waiting list, attention placebo) for acute depression.
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Affiliation(s)
- Deborah Caldwell
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Vivien Hunot
- Academic Unit of Psychiatry, School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Theresa HM Moore
- Academic Unit of Psychiatry, School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Philippa Davies
- Academic Unit of Psychiatry, School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Hannah Jones
- Cochrane Schizophrenia Group, The University of Nottingham, Nottingham, UK
| | - Glyn Lewis
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Rachel Churchill
- Academic Unit of Psychiatry, School of Social and Community Medicine, University of Bristol, Bristol, UK
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96
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Davies P, Hunot V, Moore THM, Caldwell D, Jones H, Lewis G, Churchill R. Humanistic therapies versus treatment as usual for depression. Cochrane Database Syst Rev 2010:CD008701. [PMID: 25408624 PMCID: PMC4233123 DOI: 10.1002/14651858.cd008701] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
This is the protocol for a review and there is no abstract. The objectives are as follows: To examine the effectiveness and acceptability of all humanistic therapies compared with treatment as usual/waiting list/attention placebo control conditions for acute depression.To examine the effectiveness and acceptability of different humanistic therapy models (person-centred, gestalt, process-experiential, transactional analysis, existential and non-directive therapies) compared with treatment as usual/waiting list/attention placebo control conditions for acute depression.To examine the effectiveness and acceptability of all humanistic therapies compared with different types of comparator (standard care, no treatment, waiting list, attention placebo) for acute depression.
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Affiliation(s)
- Philippa Davies
- Academic Unit of Psychiatry, School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Vivien Hunot
- Academic Unit of Psychiatry, School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Theresa HM Moore
- Academic Unit of Psychiatry, School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Deborah Caldwell
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Hannah Jones
- Cochrane Schizophrenia Group, The University of Nottingham, Nottingham, UK
| | - Glyn Lewis
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Rachel Churchill
- Academic Unit of Psychiatry, School of Social and Community Medicine, University of Bristol, Bristol, UK
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97
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Hunot V, Moore THM, Caldwell D, Davies P, Jones H, Lewis G, Churchill R. Interpersonal, cognitive analytic and other integrative therapies versus other psychological therapies for depression. Cochrane Database Syst Rev 2010:CD008702. [PMID: 25408623 PMCID: PMC4233115 DOI: 10.1002/14651858.cd008702] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
This is the protocol for a review and there is no abstract. The objectives are as follows: To examine the effectiveness and acceptability of all integrative therapies compared with all other psychological therapy approaches for acute depression.To examine the effectiveness and acceptability of different integrative therapy models (IPT, CAT, psychodynamic-interpersonal therapy, CBASP, counselling) compared with all other psychological therapy approaches for acute depression.To examine the effectiveness and acceptability of all integrative therapies compared with different psychological therapy approaches (psychodynamic, behavioural, humanistic, cognitive-behavioural, third wave CBT) for acute depression.
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Affiliation(s)
- Vivien Hunot
- Academic Unit of Psychiatry, School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Theresa HM Moore
- Academic Unit of Psychiatry, School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Deborah Caldwell
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Philippa Davies
- Academic Unit of Psychiatry, School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Hannah Jones
- Cochrane Schizophrenia Group, The University of Nottingham, Nottingham, UK
| | - Glyn Lewis
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Rachel Churchill
- Academic Unit of Psychiatry, School of Social and Community Medicine, University of Bristol, Bristol, UK
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98
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Churchill R, Moore THM, Davies P, Caldwell D, Jones H, Lewis G, Hunot V. Psychodynamic therapies versus other psychological therapies for depression. Cochrane Database Syst Rev 2010:CD008706. [PMID: 25267905 PMCID: PMC4176678 DOI: 10.1002/14651858.cd008706] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
This is the protocol for a review and there is no abstract. The objectives are as follows: To examine the effectiveness and acceptability of all psychodynamic therapy approaches compared with all other psychological therapy approaches for acute depression.To examine the effectiveness and acceptability of different psychodynamic therapy approaches (drive/structural, relational and integrative analytic models) compared with all other psychological therapy approaches for acute depression.To examine the effectiveness and acceptability of all psychodynamic therapy approaches compared with different psychological therapy approaches (behavioural, humanistic, integrative, cognitive-behavioural, 'third-wave' CBT) for acute depression.
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Affiliation(s)
- Rachel Churchill
- Academic Unit of Psychiatry, School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Theresa HM Moore
- Academic Unit of Psychiatry, School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Philippa Davies
- Academic Unit of Psychiatry, School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Deborah Caldwell
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Hannah Jones
- Cochrane Schizophrenia Group, The University of Nottingham, Nottingham, UK
| | - Glyn Lewis
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Vivien Hunot
- Academic Unit of Psychiatry, School of Social and Community Medicine, University of Bristol, Bristol, UK
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99
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Churchill R, Davies P, Caldwell D, Moore THM, Jones H, Lewis G, Hunot V. Interpersonal, cognitive analytic and other integrative therapies versus treatment as usual for depression. Cochrane Database Syst Rev 2010:CD008703. [PMID: 25411560 PMCID: PMC4234086 DOI: 10.1002/14651858.cd008703] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
This is the protocol for a review and there is no abstract. The objectives are as follows: To examine the effectiveness and acceptability of all integrative therapies compared with treatment as usual/waiting list/attention placebo control conditions for acute depression.To examine the effectiveness and acceptability of different integrative therapies (IPT, CAT, psychodynamic-interpersonal therapy, cognitive behavioural analysis system of psychotherapy and counselling) compared with treatment as usual/waiting list/attention placebo control conditions for acute depression.To examine the effectiveness and acceptability of all integrative therapies compared with different types of comparator (standard care, no treatment, waiting list, attention placebo) for acute depression.
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Affiliation(s)
- Rachel Churchill
- Academic Unit of Psychiatry, School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Philippa Davies
- Academic Unit of Psychiatry, School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Deborah Caldwell
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Theresa HM Moore
- Academic Unit of Psychiatry, School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Hannah Jones
- Cochrane Schizophrenia Group, The University of Nottingham, Nottingham, UK
| | - Glyn Lewis
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Vivien Hunot
- Academic Unit of Psychiatry, School of Social and Community Medicine, University of Bristol, Bristol, UK
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100
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Moore THM, Hunot V, Davies P, Caldwell D, Jones H, Lewis G, Churchill R. Psychodynamic therapies versus treatment as usual for depression. Cochrane Database Syst Rev 2010:CD008707. [PMID: 25267906 PMCID: PMC4176682 DOI: 10.1002/14651858.cd008707] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
This is the protocol for a review and there is no abstract. The objectives are as follows: To examine the effectiveness and acceptability of all psychodynamic therapies compared with treatment as usual/waiting list/attention placebo control conditions for acute depression.To examine the effectiveness and acceptability of different psychodynamic therapy models (drive/structural, relational and integrative analytic models) compared with treatment as usual/waiting list/attention placebo control conditions for acute depression.To examine the effectiveness and acceptability of all psychodynamic therapies compared with different types of comparator (standard care, no treatment, waiting list, attention placebo) for acute depression.
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Affiliation(s)
- Theresa HM Moore
- Academic Unit of Psychiatry, School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Vivien Hunot
- Academic Unit of Psychiatry, School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Philippa Davies
- Academic Unit of Psychiatry, School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Deborah Caldwell
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Hannah Jones
- Cochrane Schizophrenia Group, The University of Nottingham, Nottingham, UK
| | - Glyn Lewis
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Rachel Churchill
- Academic Unit of Psychiatry, School of Social and Community Medicine, University of Bristol, Bristol, UK
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