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James Vibin A, Niharika N, Valliappan V, Lamo P, Parajuli N, Jat M, Lama S, Agarwal A, Sagar R, Sharma G. Effect of Integrated Yoga as an add-on therapy in adults with clinical depression - A randomized controlled trial. Int J Soc Psychiatry 2024; 70:709-719. [PMID: 38279599 DOI: 10.1177/00207640231223431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2024]
Abstract
BACKGROUND Depression is a leading cause of disability and the conventional management has several limitations. Recent studies demonstrated the benefits of yoga in psychological disorders. AIMS To evaluate the efficacy of the Integrated Yoga Module (IYM) to standard care with added yogic education on lifestyle modification (YELM) in patients with clinical depression. METHODS A PROBE trial was conducted at a single tertiary care hospital in India. Adults aged 18 to 64 with clinical depression were randomized to either an IYM or an active control group using a computer-generated mixed block randomization sequence. Both groups received YELM in addition to standard care and the intervention group practiced IYM, for 8 weeks. The primary outcome was the reduction in depression symptoms assessed using the Beck Depression Inventory (BDI-II), and secondary outcomes involved self-compassion, brief resilience, positive and negative experiences, and quality of life, evaluated at 8 weeks. RESULTS The mean ± SD age of participants was 32.2 ± 10.0 and 54.3% were females. The IYM group showed statistically significant improvements in BDI-II scores β = -6.7 (95% CI [-10.8, -2.5]; p = .001), resilience β = 0.4 (95% CI [0.02, 0.80]; p = .037), physical health domain of WHOQOL - BREF β = 10.1 (95% CI [0.7, 19.5]; p = .035) and negative emotions (SPANE-N) β = 2.8 (95% CI [0.1, 5.4]; p = .037). However, no significant differences were found in SCS-SF β = -0.3 (95% CI [-0.7, 0.0]; p = .053). CONCLUSIONS IYM as an adjunct is superior to conventional medical management in reducing symptoms and improving positive psychological resources in clinical depression.
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Affiliation(s)
- Anu James Vibin
- Centre for Integrative Medicine and Research, All India Institute of Medical Sciences, New Delhi, India
| | - Niharika Niharika
- Centre for Integrative Medicine and Research, All India Institute of Medical Sciences, New Delhi, India
| | - Varun Valliappan
- Centre for Integrative Medicine and Research, All India Institute of Medical Sciences, New Delhi, India
| | - Pasang Lamo
- Centre for Integrative Medicine and Research, All India Institute of Medical Sciences, New Delhi, India
| | - Niranjan Parajuli
- Centre for Integrative Medicine and Research, All India Institute of Medical Sciences, New Delhi, India
| | - Mansingh Jat
- Centre for Integrative Medicine and Research, All India Institute of Medical Sciences, New Delhi, India
| | - Sudha Lama
- Centre for Integrative Medicine and Research, All India Institute of Medical Sciences, New Delhi, India
| | - Aman Agarwal
- Centre for Integrative Medicine and Research, All India Institute of Medical Sciences, New Delhi, India
| | - Rajesh Sagar
- Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, India
| | - Gautam Sharma
- Centre for Integrative Medicine and Research, All India Institute of Medical Sciences, New Delhi, India
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India
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Ji M, Feng J, Liu G. Efficacy and safety of aripiprazole or bupropion augmentation and switching in patients with treatment-resistant depression or major depressive disorder: A systematic review and meta-analysis of randomized controlled trials. PLoS One 2024; 19:e0299020. [PMID: 38669232 PMCID: PMC11051639 DOI: 10.1371/journal.pone.0299020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 02/03/2024] [Indexed: 04/28/2024] Open
Abstract
OBJECTIVES To report the first and largest systematic review and meta-analysis of randomized controlled trials (RCT) to evaluate the efficacy and safety of aripiprazole or bupropion augmentation and switching in patients with treatment-resistant depression (TRD) or major depressive disorder(MDD). METHODS We conducted a systematic literature retrieval via PubMed, Embase, Web of Science, and Cochrane until April 2023 for RCT, which evaluated the efficacy and safety of aripiprazole or bupropion augmentation and switching for patients with TRD or MDD. Outcomes measured were changes in the Montgomery-Asberg Depression Rating Scale (MADRS), response and remission rate, and serious adverse events. RESULTS Five RCTs, including 4480 patients, were included for meta-analysis. Among them, two RCTs were rated as "high risk" in three aspects (allocation concealment, blinding of participants and personnel and blinding of outcome assessment) because of the non-blind method, and the quality evaluation of the remaining works of literature was "low risk". Augmentation treatment with Aripiprazole (A-ARI) was associated with a significant higher response rate compared with augmentation treatment with bupropion (A-BUP) (RR: 1.15; 95% CI: 1.05, 1.25; P = 0.0007; I2 = 23%). Besides, A-ARI had a significant higher remission rate compared with switching to bupropion (S-BUP) (RR: 1.22; 95% CI: 1.00, 1.49; P = 0.05; I2 = 59%) and A-BUP had a significant higher remission rate compared with S-BUP (RR: 1.20; 95% CI: 1.06, 1.36; P = 0.0004; I2 = 0%). In addition, there was no significant difference in remission rate(RR: 1.05; 95% CI: 0.94, 1.17; P = 0.42; I2 = 33%), improvement of MADRS(WMD: -2.07; 95% CI: -5.84, 1.70; P = 0.28; I2 = 70%) between A-ARI and A-BUP. No significant difference was observed in adverse events and serious adverse events among the three treatment strategies. CONCLUSIONS A-ARI may be a better comprehensive antidepressant treatment strategy than A-BUP or S-BUP for patients with TRD or MDD. More large-scale, multi-center, double-blind RCTs are needed to further evaluated the efficacy and safety of aripiprazole or bupropion augmentation and switching treatment strategies.
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Affiliation(s)
- Mengjia Ji
- Department of Traditional Chinese Medicine, Shandong University of Traditional Chinese Medicine, Jinan, Shandong Province, China
| | - Junfei Feng
- Department of Traditional Chinese Medicine, Shandong Wendeng Osteopath Hospital, Weihai, Shandong Province, China
| | - Guirong Liu
- Department of Traditional Chinese Medicine, Shandong University of Traditional Chinese Medicine, Jinan, Shandong Province, China
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Fossa AJ, D'Souza J, Bergmans R, Zivin K, Adar SD. Residential greenspace and major depression among older adults living in urban and suburban areas with different climates across the United States. ENVIRONMENTAL RESEARCH 2024; 243:117844. [PMID: 38061587 DOI: 10.1016/j.envres.2023.117844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Revised: 11/04/2023] [Accepted: 11/30/2023] [Indexed: 12/22/2023]
Abstract
BACKGROUND AND AIM Residential greenspace could alleviate depression - a leading cause of disability. Fewer studies of depression and greenspace have considered major depression, and, to our knowledge, none have considered how climate, which determines vegetation abundance and type, may change the impacts of greenspace. Our aim was to investigate whether residential greenspace is associated with major depression among older adults and explore effect modification by climate. METHODS We used biennial interviews between 2008 and 2016 from the Health and Retirement Study. We calculated greenness within walking distance of home addresses as the maximum NDVI for the year of each participant interview averaged within a 1 km buffer. Reflecting clinical criteria, a score of ≥5 on the CIDI-SF indicated major depression in the preceding 12-months. We characterized climate using Köppen-Geiger classifications. To estimate prevalence ratios, we used Poisson regression. Our models adjusted for sociodemographic characteristics, geography, annual sunshine, and bluespace. RESULTS The 21,611 eligible participants were 65 ± 10 years old on average, 55% female, 81% White, 12% Black, 10% Hispanic/Latino, and 31% had at least a 4-year college degree. The 12-month prevalence of a major depression was 8%. In adjusted models, more residential greenspace was associated with a lower prevalence of major depression (prevalence ratio per IQR, 0.91; 95% CI, 0.84 to 0.98). There was evidence of effect modification by climate (P forinteraction, 0.062). We observed stronger associations in tropical (prevalence ratio per IQR 0.69; 95% CI, 0.47 to 1.01) and cold (prevalence ratio per IQR, 0.83; 95% CI, 0.74 to 0.93) climates compared to arid (prevalence ratio per IQR 0.99; 95% CI, 0.90 to 1.09) and temperate (prevalence ratio per IQR 0.98; 95% CI, 0.86 to 1.11) climates. CONCLUSIONS Residential greenspace may help reduce major depression. However, climate may influence how people benefit from greenspace.
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Affiliation(s)
- Alan J Fossa
- University of Michigan School of Public Health, Department of Epidemiology, Ann Arbor, MI, United States.
| | - Jennifer D'Souza
- University of Michigan School of Public Health, Department of Epidemiology, Ann Arbor, MI, United States
| | - Rachel Bergmans
- University of Michigan, Medical School, Department of Anesthesiology, Ann Arbor, MI, United States
| | - Kara Zivin
- University of Michigan Medical School, Department of Psychiatry, Ann Arbor, MI, United States; VA Ann Arbor Healthcare System, Center for Clinical Management Research, Ann Arbor, MI, United States
| | - Sara D Adar
- University of Michigan School of Public Health, Department of Epidemiology, Ann Arbor, MI, United States
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Owens M, Bunce H. The effect of brief exposure to virtual nature on mental wellbeing in adolescents. Sci Rep 2023; 13:17769. [PMID: 37853074 PMCID: PMC10584913 DOI: 10.1038/s41598-023-44717-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 10/11/2023] [Indexed: 10/20/2023] Open
Abstract
Adolescence is a time of multiple transitions and a vulnerability period for mental health difficulties. There are many barriers to the treatment of mental health conditions which is one reason for developing alternatives to help improve efficacy in treatment and prevention. One approach is to use nature-based interventions (NBIs) to improve mental wellbeing. In this experimental proof-of-principle intervention study, we randomly allocated a sample of adolescents to brief exposure (6 min) to either a virtual woodland nature video or a busy train journey and tested the effect on mental wellbeing. Results showed beneficial effects in the nature condition on several self-reported outcomes including stress, relaxation, affect, mood, attention, nature connection and nature spirituality. The intervention was mainly acceptable and feasible to do suggesting that overall brief virtual nature interventions may have utility in a range of mental health contexts for adolescents including as self-help universal or targeted prevention strategies, adjunct to psychological therapy and as preparation for more intensive NBIs. Additionally, brief virtual nature interventions support accessibility for those who may be limited on time, unable to access real-life nature or who may be more biophobic.
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Affiliation(s)
- Matthew Owens
- Department of Psychology, The Mood Disorders Centre, University of Exeter, Exeter, EX4 4QQ, UK.
- The ROWAN Group, Exeter, UK.
| | - Hannah Bunce
- The ROWAN Group, Exeter, UK
- Somerset Foundation Trust NHS, Taunton, TA1 5DA, UK
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Simonsson O, Carlbring P, Carhart-Harris R, Davis AK, Nutt DJ, Griffiths RR, Erritzoe D, Goldberg SB. Assessing the risk of symptom worsening in psilocybin-assisted therapy for depression: A systematic review and individual participant data meta-analysis. Psychiatry Res 2023; 327:115349. [PMID: 37523886 PMCID: PMC10528683 DOI: 10.1016/j.psychres.2023.115349] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 07/09/2023] [Accepted: 07/16/2023] [Indexed: 08/02/2023]
Abstract
We conducted a meta-analysis using individual participant data from three, two-dose psilocybin trials for depression (N = 102) with the aim of assessing the risk of symptom worsening. Clinically significant symptom worsening occurred for a minority of participants in the psilocybin and escitalopram conditions (∼10%) and for a majority of participants in the waitlist condition (63.6%). Using data from the two trials with control arms, the psilocybin arm showed a lower likelihood of symptom worsening versus waitlist, and no difference in the likelihood of symptom worsening versus escitalopram. The limitation of a relatively small sample size should be addressed in future studies.
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Affiliation(s)
- Otto Simonsson
- Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Norra Stationsgatan 69, Stockholm 113 64, Sweden; Department of Sociology, University of Oxford, Oxford, United Kingdom.
| | - Per Carlbring
- Department of Psychology, Stockholm University, Stockholm, Sweden
| | - Robin Carhart-Harris
- Neuroscape Psychedelics Division, Department of Neurology, University of California San Francisco, San Francisco, CA, United States; Centre for Psychedelic Research, Imperial College London, London, United Kingdom
| | - Alan K Davis
- Center for Psychedelic Drug Research and Education, College of Social Work, The Ohio State University, Columbus, OH, United States; Department of Psychiatry, The Ohio State University, Columbus, OH, United States; Center for Psychedelic and Consciousness Research, Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD, United States
| | - David J Nutt
- Centre for Psychedelic Research, Imperial College London, London, United Kingdom
| | - Roland R Griffiths
- Center for Psychedelic and Consciousness Research, Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD, United States; Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD 21205, United States; Department of Neuroscience, Johns Hopkins University School of Medicine, Baltimore, MD 21205, United States
| | - David Erritzoe
- Centre for Psychedelic Research, Imperial College London, London, United Kingdom
| | - Simon B Goldberg
- Department of Counseling Psychology, University of Wisconsin, Madison, WI, United States
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Koenig LJ, Khurana N, Islam MH, Gopalappa C, Farnham PG. Closing the gaps in the continuum of depression care for persons with HIV: modeling the impact on viral suppression in the United States. AIDS 2023; 37:1147-1156. [PMID: 36927810 PMCID: PMC10986188 DOI: 10.1097/qad.0000000000003536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
Abstract
OBJECTIVE Depression is prevalent among persons with HIV (PWH) and is associated with poorer adherence and lack of viral load suppression (VLS). When treated for depression, PWH are more likely to stay in HIV care and adhere to medications; however, for many PWH, depression is not adequately diagnosed or treated. We adapted Progression and Transmission of HIV (PATH 3.0), a U.S. agent-based dynamic stochastic simulation model, by incorporating a continuum of depression care and estimating the impact on VLS of an enhanced depression diagnosis and care scenario (EDC). METHODS We compared EDC - whereby every PWH is assessed for depression, gets treatment if diagnosed, and of those, half achieve remission - to a status quo scenario (SQ) on VLS. Based on published findings, assumptions for SQ were: 34.7% depressed, 45% diagnosed, 55.3% treated and 33% of treated achieving remission. Compared to PWH without depression, we assumed the probability of being non-virally suppressed increased by 1.57 times for PWH with depression (PWH-D), and by 0.95 times for PWH with remitted depression. RESULTS There was an average increase of 14.6% (11.5-18.5) in the proportion of PWH-D who achieved VLS in EDC compared to SQ. Among all PWH, there was a 4.7% (3.4-6.0) increase in the proportion who achieved VLS in EDC compared to SQ. CONCLUSIONS Fully diagnosing and adequately treating depression would improve health and quality of life for a substantial proportion of PWH-D and result in a nearly 5% increase in expected rates of VLS in the United States, supporting national prevention goals.
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Affiliation(s)
- Linda J Koenig
- Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Nidhi Khurana
- Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Md Hafizul Islam
- Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Chaitra Gopalappa
- Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
- University of Massachusetts-Amherst, Amherst, Massachusetts, USA
| | - Paul G Farnham
- Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
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Dawood Hristova JJ, Pérez-Jover V. Psychotherapy with Psilocybin for Depression: Systematic Review. Behav Sci (Basel) 2023; 13:bs13040297. [PMID: 37102811 PMCID: PMC10135952 DOI: 10.3390/bs13040297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 03/22/2023] [Accepted: 03/30/2023] [Indexed: 04/03/2023] Open
Abstract
Depression is a common mental health issue that affects 280 million people in the world with a high mortality rate, as well as being a leading cause of disability. Psychopharmacological therapies with psychedelics, particularly those with psilocybin, are showing promising potential for the treatment of depression, among other conditions. Some of their benefits include a rapid and exponential improvement in depressive symptoms and an increased sense of well-being that can last for months after the treatment, as well as a greater development of introspective capacity. The aim of this project was to provide experimental evidence about therapeutic procedures along with psilocybin for the treatment of major depressive disorder. The project highlights eight studies that examined this condition. Some of them dealt with treatment-resistant depression while others dealt with depression due to a life-threatening disease such as cancer. These publications affirm the efficiency of the psilocybin therapy for depression, with only one or two doses in conjunction with psychological support during the process.
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McCartney AM, McGovern HT, De Foe A. Psychedelic assisted therapy for major depressive disorder: Recent work and clinical directions. JOURNAL OF PSYCHEDELIC STUDIES 2022. [DOI: 10.1556/2054.2022.00211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Abstract
Psychedelic substances such as psilocybin and ketamine may represent the future of antidepressant treatment, due to their rapid and prolonged effects on mood and cognition. The current body of psychedelic research has focused on administration and treatment within a psychiatric context. Here, instead, we put to the test the contention that it is necessary to evaluate the current state of this literature from a broader biopsychosocial perspective. Examining these arguably neglected social and psychological aspects of psychedelic treatment can provide a more holistic understanding of the interplay between the interconnected domains. This review of six major clinical trials applies a biopsychosocial model to evaluate the antidepressant effects of psilocybin and ketamine assisted therapy. We conclude that combination psychedelic treatment and psychotherapy facilitate more enduring and profound antidepressant effects than produced by ketamine or psilocybin alone. Emphasising the advantages of therapeutic intervention will encourage those who may attempt to self-medicate with psychedelics to instead seek a framework of psychological support, minimising associated risks of unregulated use.
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Affiliation(s)
| | | | - Alexander De Foe
- The Royal Melbourne Institute of Technology, Melbourne, Australia
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Zisook S, Planeta B, Hicks PB, Chen P, Davis LL, Villarreal G, Sapra M, Johnson GR, Mohamed S. Childhood adversity and adulthood major depressive disorder. Gen Hosp Psychiatry 2022; 76:36-44. [PMID: 35366613 DOI: 10.1016/j.genhosppsych.2022.03.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 03/18/2022] [Accepted: 03/20/2022] [Indexed: 02/08/2023]
Abstract
OBJECTIVE Examine how specific types of childhood adversity are associated with clinical features and treatment in adults with Major Depressive Disorder (MDD). METHOD This is a secondary analysis of the 35-site VA Augmentation and Switching Treatments for Improving Depression Outcomes study. A 10-item Adverse Childhood Events (ACE) survey was administered at baseline. RESULTS 83% experienced at least one of the 10 ACEs and 20.7% experienced 6 or more. Participants with childhood adversities were more likely to be younger, female, unemployed, single or divorced, and to have had more severe depression and anxiety, more lifetime episodes, a younger age of first diagnosed MDD, more comorbid PTSD, worse quality of life, and more suicidal ideation than those no or fewer adversities. Neither the overall number nor any of the specific types of adversities were associated with lower remission rates after administration of standard "next-step" treatment strategies, while histories of different specific types were associated with lower depression severity, better quality of life, and less suicidal ideation post-treatment. CONCLUSIONS Attention to different forms of childhood adversity and to diverse clinical outcomes beyond remission and relapse are important considerations when treating individuals with MDD with histories of childhood maltreatment. CLINICALTRIALS gov identifier: NCT01421342.
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Affiliation(s)
- Sidney Zisook
- Department of Psychiatry, UC San Diego, 9350 Campus Point Drive, La Jolla, CA 92037, United States of America.
| | - Beata Planeta
- Cooperative Studies Program Coordinating Center, VA Connecticut Healthcare System, West Haven, United States of America.
| | - Paul B Hicks
- Department of Psychiatry, Baylor Scott & White Health, Temple, TX, United States of America; Department of Psychiatry, Texas A&M College of Medicine, Temple, TX, United States of America.
| | - Peijun Chen
- Department of Psychiatry, Geriatric Research, Education, and Clinical Center, VA Northeast Ohio Health System Cleveland VA Medical Center, United States of America; Case Western Reserve University School of Medicine, Cleveland, OH, United States of America.
| | - Lori L Davis
- Tuscaloosa VA Medical Center, Research Service, Tuscaloosa, AL, United States of America; University of Alabama Heersink School of Medicine, Birmingham, AL, United States of America.
| | - Gerardo Villarreal
- New Mexico VA Healthcare System, United States of America; University of New Mexico School of Medicine, Albuquerque, NM, United States of America.
| | - Mamta Sapra
- Veteran Affairs Medical Center, Salem, VA, United States of America; Department of Psychiatry and Behavioral Medicine, Virginia Tech Carilion School of Medicine, United States of America.
| | - Gary R Johnson
- Cooperative Studies Program Coordinating Center, VA Connecticut Healthcare System, West Haven, United States of America.
| | - Somaia Mohamed
- Veterans Affairs (VA) New England Mental Illness Research, Education, and Clinical Center, VA Connecticut Healthcare System, West Haven, CT, United States of America; Yale Medical School, New Haven, CT, United States of America.
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Batterham PJ, Christensen H, Calear AL, Werner-Seidler A, Kazan D. Rates and Predictors of Deterioration in a Trial of Internet-Delivered Cognitive Behavioral Therapy for Reducing Suicidal Thoughts. Arch Suicide Res 2022; 26:937-947. [PMID: 33215554 DOI: 10.1080/13811118.2020.1848671] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE It is necessary for suicide prevention interventions to demonstrate safety. One important aspect of safety is evidence that deterioration rates are low. No studies have examined deterioration of suicidal ideation in the context of an internet-based cognitive behavioral therapy (CBT) intervention to reduce suicidal ideation. A secondary analysis of the outcomes of an online trial was conducted to determine rates of deterioration in a CBT intervention called Living with Deadly Thoughts, relative to an attention control condition, and to identify factors associated with deterioration. METHOD The randomized controlled trial included 418 adults with suicidal ideation at baseline (77% females, mean age 40.6 years). Deterioration was defined in two ways: a reliable increase in Suicidal Ideation Attributes Scale (SIDAS score) of ≥6.0 units; or triggering the safety protocol during the trial as determined by high levels of suicidality. Analyses were repeated with multiply imputed data. Predictors of deterioration were identified using logistic regression analysis. RESULTS 30 (14%) participants in the control group and 15 (7%) in the intervention group met criteria for reliable deterioration (Fisher's exact p = 0.027). In a fully adjusted logistic regression model, greater initial severity of suicidal thinking was associated with lower odds of deterioration, while intervention condition, demographics, psychological factors and mental health factors had no significant association with deterioration. CONCLUSIONS Participation in an online suicide prevention intervention was associated with lower prevalence of reliable deterioration than participation in an attention-control intervention, providing further evidence that internet-based CBT interventions do not cause harm.HighlightsFirst study to assess deterioration in an internet suicide prevention interventionRates of reliable deterioration were higher in control (14%) than intervention (7%)No psychological or demographic factors were robustly associated with deteriorationFindings provide further evidence that internet based CBT programs are not harmful.
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Owens M, Bunce HLI. The Potential for Outdoor Nature-Based Interventions in the Treatment and Prevention of Depression. Front Psychol 2022; 13:740210. [PMID: 35401311 PMCID: PMC8984301 DOI: 10.3389/fpsyg.2022.740210] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 02/15/2022] [Indexed: 01/05/2023] Open
Abstract
There is growing interest in nature-based interventions (NBI) to improve human health and wellbeing. An important nascent area is exploring the potential of outdoor therapies to treat and prevent common mental health problems like depression. In this conceptual analysis on the nature-depression nexus, we distil some of the main issues for consideration when NBIs for depression are being developed. We argue that understanding the mechanisms, or 'active ingredients' in NBIs is crucial to understand what works and for whom. Successfully identifying modifiable mediating intervention targets will pave the way for interventions with increased efficacy. We highlight a non-exhaustive list of five clinically relevant putative, candidate mechanisms which may underly the beneficial effects of NBIs on depression: stress, rumination, mindfulness, sleep and exercise. We also make the case that when developing NBIs it is important to not neglect young people, explore personalised approaches and focus on both treatment and prevention approaches. To achieve these aims methodologically rigorous programmes of clinical research are needed that include well-powered and controlled experimental designs including randomised controlled trials, qualitative research, longitudinal studies and large prospective cohorts.
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Affiliation(s)
- Matthew Owens
- Department of Psychology, The Mood Disorders Centre, University of Exeter, Exeter, United Kingdom
| | - Hannah L. I. Bunce
- CEDAR, University of Exeter and Somerset Foundation Trust NHS, Taunton, United Kingdom
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Fugger G, Bartova L, Dold M, Fabbri C, Fanelli G, Zanardi R, Kautzky A, Zohar J, Souery D, Mendlewicz J, Montgomery S, Rujescu D, Serretti A, Kasper S. Evidence on sociodemographic and clinical correlates of antidepressant combination or augmentation with second-generation antipsychotics in major depressive disorder. Prog Neuropsychopharmacol Biol Psychiatry 2022; 114:110480. [PMID: 34826558 DOI: 10.1016/j.pnpbp.2021.110480] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 11/04/2021] [Accepted: 11/21/2021] [Indexed: 11/25/2022]
Abstract
About two thirds of the patients with major depressive disorder (MDD) do not sufficiently respond to monotherapy with antidepressants (ADs) which makes them reliant on further treatment approaches. Hereby, combination of different ADs and augmentation with second-generation antipsychotics (SGAs) are widely used and recommended psychopharmacotherapeutic strategies. The present secondary analyses are based on an international, naturalistic, cross-sectional multicenter study conducted by the European Group for the Study of Resistant Depression. Comparing socio-demographic and clinical characteristics of 436 adult MDD patients receiving either SGAs (N = 191, 43.8%) or ADs (N = 245, 56.2%), that were additionally administered to their first-line AD psychopharmacotherapy, we aimed to identify possible trajectories of decision-making for clinicians regarding which treatment option to prefer in individual patients. Our most robust findings represent an association of SGA augmentation with the presence of psychotic symptoms, longer mean duration of lifetime psychiatric hospitalizations, employment of further augmentation strategies with mood-stabilizers and benzodiazepines, and a trend towards higher mean daily dosages of their first-line ADs and current suicidal risk. Treatment outcome was not significantly different between patients receiving either SGA augmentation or AD combination. Being aware of limitations inherent to the cross-sectional study design and the lack of randomization, more severe and rather chronic conditions in MDD seemed to encourage clinicians to choose SGA augmentation over AD combination. The fact that mood-stabilizers and/or benzodiazepines were more frequently co-administered with SGAs may represent a requirement of an overall refined psychopharmacotherapy including additional fast-acting agents with potent AD, tranquilizing and anti-suicidal effects in MDD patients experiencing challenging clinical manifestations. New glutamatergic substances seem to be promising in this regard.
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Affiliation(s)
- Gernot Fugger
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria; Department of Biomedical and NeuroMotor Sciences, University of Bologna, Bologna, Italy
| | - Lucie Bartova
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria; Department of Biomedical and NeuroMotor Sciences, University of Bologna, Bologna, Italy
| | - Markus Dold
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria; Department of Biomedical and NeuroMotor Sciences, University of Bologna, Bologna, Italy
| | - Chiara Fabbri
- Department of Biomedical and NeuroMotor Sciences, University of Bologna, Bologna, Italy; Social, Genetic & Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - Giuseppe Fanelli
- Department of Biomedical and NeuroMotor Sciences, University of Bologna, Bologna, Italy; Department of Human Genetics, Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, the Netherlands
| | - Raffaella Zanardi
- Vita-Salute San Raffaele University, Milano, Italy; Mood Disorders Unit, IRCCS Scientific Institute Ospedale San Raffaele, Milano, Italy
| | - Alexander Kautzky
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Joseph Zohar
- Psychiatric Division, Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Daniel Souery
- School of Medicine, Free University of Brussels, Brussels, Belgium; Psy Pluriel - European Centre of Psychological Medicine, Brussels, Belgium
| | | | - Stuart Montgomery
- Imperial College School of Medicine, University of London, London, United Kingdom
| | - Dan Rujescu
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Alessandro Serretti
- Department of Biomedical and NeuroMotor Sciences, University of Bologna, Bologna, Italy
| | - Siegfried Kasper
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria; Center for Brain Research, Medical University of Vienna, Vienna, Austria.
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13
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Use of Spirituality in the Treatment of Depression: Systematic Literature Review. Psychiatr Q 2022; 93:255-269. [PMID: 35226252 DOI: 10.1007/s11126-020-09881-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/12/2020] [Indexed: 10/19/2022]
Abstract
Spirituality has been gaining recognition as a potential treatment modality. Our paper aimed to provide a systematic overview of existing research examining the use of spirituality as a treatment method for depression. All articles published between 2000 and 2018 that scientifically evaluated therapeutic interventions with elements of spirituality were included in the review. Ten studies met the inclusion criteria. Their analysis showed that there were elements of spirituality-based treatments that were repeatedly mentioned, including gratitude, forgiveness, self-acceptance, and compassion. Most often, spirituality was used together with psychotherapy. The review also noted the emergence of digital interventions.
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14
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"Supporting Wellness": A depression and bipolar support alliance mixed-methods investigation of lived experience perspectives and priorities for mood disorder treatment. J Affect Disord 2022; 299:575-584. [PMID: 34942220 DOI: 10.1016/j.jad.2021.12.032] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 11/08/2021] [Accepted: 12/12/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND The lived experience of people with mood disorders may be leveraged to inform priorities for research, define key treatment outcomes, and support decision-making in clinical care. The aim of this mixed-methods project was to provide insight into how people with depression and bipolar disorder experience the impact of symptoms, their treatment preferences, and their definitions of wellness. METHODS The project was implemented in two phases. In Phase 1, community-based participatory research was used to develop a web-based survey enquiring about living with a mood disorder, treatment experiences, and wellness priorities. In Phase 2, a series of focus groups were conducted to explore aspects of wellness in greater detail. RESULTS Respondents (n= 6153) described the symptoms of mood disorders as having a significant, chronic impact on their lives. A holistic approach to treatment was desired by participants, but not necessarily experienced. Qualitative findings were used to further describe four highly ranked wellness priorities identified in the survey: ability to act independently or according to my own will; purpose in life; getting through the day; and contentment. LIMITATIONS Experience of a mood disorder was self-reported, and no formal confirmation of diagnosis occurred. Although the survey could not incorporate all possible wellness definitions, this was supplemented by qualitative focus groups. CONCLUSION The present findings provide important insights from the perspectives of individuals with lived experience of mood disorders. Implications of this for research and clinical practice are discussed, particularly with regards to measurement-based care and use of wellness-oriented clinical outcome assessments.
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15
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Leichsenring F, Steinert C, Rabung S, Ioannidis JP. The efficacy of psychotherapies and pharmacotherapies for mental disorders in adults: an umbrella review and meta-analytic evaluation of recent meta-analyses. World Psychiatry 2022; 21:133-145. [PMID: 35015359 PMCID: PMC8751557 DOI: 10.1002/wps.20941] [Citation(s) in RCA: 137] [Impact Index Per Article: 68.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Mental disorders represent a worldwide public health concern. Psychotherapies and pharmacotherapies are recommended as first line treatments. However, evidence has emerged that their efficacy may be overestimated, due to a variety of shortcomings in clinical trials (e.g., publication bias, weak control conditions such as waiting list). We performed an umbrella review of recent meta-analyses of randomized controlled trials (RCTs) of psychotherapies and pharmacotherapies for the main mental disorders in adults. We selected meta-analyses that formally assessed risk of bias or quality of studies, excluded weak comparators, and used effect sizes for target symptoms as primary outcome. We searched PubMed and PsycINFO and individual records of the Cochrane Library for meta-analyses published between January 2014 and March 2021 comparing psychotherapies or pharmacotherapies with placebo or treatment-as-usual (TAU), or psychotherapies vs. pharmacotherapies head-to-head, or the combination of psychotherapy with pharmacotherapy to either monotherapy. One hundred and two meta-analyses, encompassing 3,782 RCTs and 650,514 patients, were included, covering depressive disorders, anxiety disorders, post-traumatic stress disorder, obsessive-compulsive disorder, somatoform disorders, eating disorders, attention-deficit/hyperactivity disorder, substance use disorders, insomnia, schizophrenia spectrum disorders, and bipolar disorder. Across disorders and treatments, the majority of effect sizes for target symptoms were small. A random effect meta-analytic evaluation of the effect sizes reported by the largest meta-analyses per disorder yielded a standardized mean difference (SMD) of 0.34 (95% CI: 0.26-0.42) for psychotherapies and 0.36 (95% CI: 0.32-0.41) for pharmacotherapies compared with placebo or TAU. The SMD for head-to-head comparisons of psychotherapies vs. pharmacotherapies was 0.11 (95% CI: -0.05 to 0.26). The SMD for the combined treatment compared with either monotherapy was 0.31 (95% CI: 0.19-0.44). Risk of bias was often high. After more than half a century of research, thousands of RCTs and millions of invested funds, the effect sizes of psychotherapies and pharmacotherapies for mental disorders are limited, suggesting a ceiling effect for treatment research as presently conducted. A paradigm shift in research seems to be required to achieve further progress.
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Affiliation(s)
- Falk Leichsenring
- Department of Psychosomatics and PsychotherapyUniversity of GiessenGiessenGermany,Department of Psychosomatics and PsychotherapyUniversity of RostockRostockGermany
| | - Christiane Steinert
- Department of Psychosomatics and PsychotherapyUniversity of GiessenGiessenGermany,International Psychoanalytic UniversityBerlinGermany
| | - Sven Rabung
- Department of PsychologyUniversity of KlagenfurtKlagenfurtAustria
| | - John P.A. Ioannidis
- Department of MedicineStanford University School of MedicineStanfordCAUSA,Department of Epidemiology and Population HealthStanford University School of MedicineStanfordCAUSA,Department of Biomedical Data ScienceStanford University School of MedicineStanfordCAUSA
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16
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Gukasyan N, Davis AK, Barrett FS, Cosimano MP, Sepeda ND, Johnson MW, Griffiths RR. Efficacy and safety of psilocybin-assisted treatment for major depressive disorder: Prospective 12-month follow-up. J Psychopharmacol 2022; 36:151-158. [PMID: 35166158 PMCID: PMC8864328 DOI: 10.1177/02698811211073759] [Citation(s) in RCA: 133] [Impact Index Per Article: 66.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Preliminary data suggest that psilocybin-assisted treatment produces substantial and rapid antidepressant effects in patients with major depressive disorder (MDD), but little is known about long-term outcomes. AIMS This study sought to examine the efficacy and safety of psilocybin through 12 months in participants with moderate to severe MDD who received psilocybin. METHODS This randomized, waiting-list controlled study enrolled 27 patients aged 21-75 with moderate to severe unipolar depression (GRID-Hamilton Depression Rating Scale (GRID-HAMD) ⩾ 17). Participants were randomized to an immediate or delayed (8 weeks) treatment condition in which they received two doses of psilocybin with supportive psychotherapy. Twenty-four participants completed both psilocybin sessions and were followed through 12 months following their second dose. RESULTS All 24 participants attended all follow-up visits through the 12-month timepoint. Large decreases from baseline in GRID-HAMD scores were observed at 1-, 3-, 6-, and 12-month follow-up (Cohen d = 2.3, 2.0, 2.6, and 2.4, respectively). Treatment response (⩾50% reduction in GRID-HAMD score from baseline) and remission were 75% and 58%, respectively, at 12 months. There were no serious adverse events judged to be related to psilocybin in the long-term follow-up period, and no participants reported psilocybin use outside of the context of the study. Participant ratings of personal meaning, spiritual experience, and mystical experience after sessions predicted increased well-being at 12 months, but did not predict improvement in depression. CONCLUSIONS These findings demonstrate that the substantial antidepressant effects of psilocybin-assisted therapy may be durable at least through 12 months following acute intervention in some patients.
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Affiliation(s)
- Natalie Gukasyan
- Center for Psychedelic and
Consciousness Research, Department of Psychiatry and Behavioral Sciences, Johns
Hopkins University School of Medicine, Baltimore, MD, USA,Natalie Gukasyan, Center for Psychedelic
and Consciousness Research, Department of Psychiatry and Behavioral Sciences,
Johns Hopkins University School of Medicine, 5510 Nathan Shock Drive, Baltimore,
MD 21224, USA.
| | - Alan K Davis
- Center for Psychedelic and
Consciousness Research, Department of Psychiatry and Behavioral Sciences, Johns
Hopkins University School of Medicine, Baltimore, MD, USA,College of Social Work, The Ohio State
University, Columbus, OH, USA
| | - Frederick S Barrett
- Center for Psychedelic and
Consciousness Research, Department of Psychiatry and Behavioral Sciences, Johns
Hopkins University School of Medicine, Baltimore, MD, USA
| | - Mary P Cosimano
- Center for Psychedelic and
Consciousness Research, Department of Psychiatry and Behavioral Sciences, Johns
Hopkins University School of Medicine, Baltimore, MD, USA
| | - Nathan D Sepeda
- Center for Psychedelic and
Consciousness Research, Department of Psychiatry and Behavioral Sciences, Johns
Hopkins University School of Medicine, Baltimore, MD, USA
| | - Matthew W Johnson
- Center for Psychedelic and
Consciousness Research, Department of Psychiatry and Behavioral Sciences, Johns
Hopkins University School of Medicine, Baltimore, MD, USA
| | - Roland R Griffiths
- Center for Psychedelic and
Consciousness Research, Department of Psychiatry and Behavioral Sciences, Johns
Hopkins University School of Medicine, Baltimore, MD, USA,Department of Neuroscience, Johns
Hopkins University School of Medicine, Baltimore, MD, USA,Roland R Griffiths, Center for Psychedelic
and Consciousness Research, Department of Psychiatry and Behavioral Sciences,
Johns Hopkins University School of Medicine, 5510 Nathan Shock Drive, Baltimore,
MD 21224, USA.
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17
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Fugger G, Bartova L, Fabbri C, Fanelli G, Dold M, Swoboda MMM, Kautzky A, Zohar J, Souery D, Mendlewicz J, Montgomery S, Rujescu D, Serretti A, Kasper S. The sociodemographic and clinical profile of patients with major depressive disorder receiving SSRIs as first-line antidepressant treatment in European countries. Eur Arch Psychiatry Clin Neurosci 2022; 272:715-727. [PMID: 34989830 PMCID: PMC9095529 DOI: 10.1007/s00406-021-01368-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Accepted: 11/29/2021] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Due to favorable antidepressant (AD) efficacy and tolerability, selective-serotonin reuptake inhibitors (SSRIs) are consistently recommended as substances of first choice for the treatment of major depressive disorder (MDD) in international guidelines. However, little is known about the real-world clinical correlates of patients primarily prescribed SSRIs in contrast to those receiving alternative first-line ADs. METHODS These secondary analyses are based on a naturalistic, multinational cross-sectional study conducted by the European Group for the Study of Resistant Depression at ten research sites. We compared the socio-demographic and clinical characteristics of 1410 patients with primary MDD, who were either prescribed SSRIs or alternative substances as first-line AD treatment, using chi-squared tests, analyses of covariance, and logistic regression analyses. RESULTS SSRIs were prescribed in 52.1% of MDD patients who showed lower odds for unemployment, current severity of depressive symptoms, melancholic features, suicidality, as well as current inpatient treatment compared to patients receiving alternative first-line ADs. Furthermore, patients prescribed SSRIs less likely received add-on therapies including AD combination and augmentation with antipsychotics, and exhibited a trend towards higher response rates. CONCLUSION A more favorable socio-demographic and clinical profile associated with SSRIs in contrast to alternative first-line ADs may have guided European psychiatrists' treatment choice for SSRIs, rather than any relevant pharmacological differences in mechanisms of action of the investigated ADs. Our results must be cautiously interpreted in light of predictable biases resulting from the open treatment selection, the possible allocation of less severely ill patients to SSRIs as well as the cross-sectional study design that does not allow to ascertain any causal conclusions.
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Affiliation(s)
- Gernot Fugger
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria ,Department of Biomedical and NeuroMotor Sciences, University of Bologna, Bologna, Italy
| | - Lucie Bartova
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria ,Department of Biomedical and NeuroMotor Sciences, University of Bologna, Bologna, Italy
| | - Chiara Fabbri
- Department of Biomedical and NeuroMotor Sciences, University of Bologna, Bologna, Italy ,Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Giuseppe Fanelli
- Department of Biomedical and NeuroMotor Sciences, University of Bologna, Bologna, Italy ,Department of Human Genetics, Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands
| | - Markus Dold
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | | | - Alexander Kautzky
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Joseph Zohar
- Psychiatric Division, Chaim Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
| | - Daniel Souery
- School of Medicine, Free University of Brussels, Brussels, Belgium ,Psy Pluriel-European Centre of Psychological Medicine, Brussels, Belgium
| | | | - Stuart Montgomery
- Imperial College School of Medicine, University of London, London, UK
| | - Dan Rujescu
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Alessandro Serretti
- Department of Biomedical and NeuroMotor Sciences, University of Bologna, Bologna, Italy
| | - Siegfried Kasper
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria. .,Center for Brain Research, Medical University of Vienna, Spitalgasse 4, 1090, Vienna, Austria.
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18
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van Bronswijk SC, van Dijk DA, van den Boogaard TM, Deen ML, Ruhé HG, Spijker J, Peeters FPML. Impact of Comorbid Personality Disorders on Depression Treatment in Routine Outpatient Care. Am J Psychother 2021; 74:150-156. [PMID: 34905935 DOI: 10.1176/appi.psychotherapy.202120200046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The impact of personality disorder on treatment effectiveness for depression has been debated, and study results have been inconsistent. However, studies that report a negative impact of personality disorders on depression treatment outcomes are often characterized by uncontrolled treatment designs. Within such contexts, individuals with depression and personality disorders are at risk to receive suboptimal treatment. The aim of this retrospective observational study was to investigate whether and to what extent comorbid personality disorders were associated with the type and amount of depression treatment received in routine outpatient care. METHODS Retrospectively extracted data from electronic records of 1,455 outpatients treated for depression at several sites of a nationwide mental health provider in the Netherlands were included. The type and number of treatment sessions and visits were analyzed by using regression models. RESULTS Individuals with depression and comorbid personality disorders received more psychotherapy sessions than individuals without personality disorders, irrespective of depression severity. The number of pharmacotherapy sessions and supportive and crisis visits did not differ between individuals with and without comorbid personality disorders. CONCLUSIONS Individuals with depression and personality disorders received more intensive treatment than individuals without comorbid personality disorders. These results conflict with treatment guidelines and recommendations from high-quality studies and may be indicative of overtreatment among this large group of patients.
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Affiliation(s)
- Suzanne C van Bronswijk
- Department of Clinical Psychological Science, Maastricht University, Maastrich, the Netherlands (van Bronswijk, van Dijk, Peeters); Department of Psychiatry and Psychology, Maastricht University Medical Center+, Maastricht, the Netherlands (van Bronswijk); Department of Mood Disorders, PsyQ Haaglanden, the Hague, the Netherlands (van Dijk, van den Boogaard); Parnassia Psychiatric Institute, the Hague (Deen); Institute of Psychology, Leiden University, Leiden, the Netherlands (Deen); Department of Psychiatry, Radboud University Medical Center, Nijmegen, the Netherlands (Ruhé); Donders Institute for Brain, Cognition and Behavior, Radboud University, Nijmegen (Ruhé); Pro Persona Mental Healthcare, and Behavourial Science Institute, Radboud University, Nijmegen (Spijker)
| | - Dyllis A van Dijk
- Department of Clinical Psychological Science, Maastricht University, Maastrich, the Netherlands (van Bronswijk, van Dijk, Peeters); Department of Psychiatry and Psychology, Maastricht University Medical Center+, Maastricht, the Netherlands (van Bronswijk); Department of Mood Disorders, PsyQ Haaglanden, the Hague, the Netherlands (van Dijk, van den Boogaard); Parnassia Psychiatric Institute, the Hague (Deen); Institute of Psychology, Leiden University, Leiden, the Netherlands (Deen); Department of Psychiatry, Radboud University Medical Center, Nijmegen, the Netherlands (Ruhé); Donders Institute for Brain, Cognition and Behavior, Radboud University, Nijmegen (Ruhé); Pro Persona Mental Healthcare, and Behavourial Science Institute, Radboud University, Nijmegen (Spijker)
| | - Th Michael van den Boogaard
- Department of Clinical Psychological Science, Maastricht University, Maastrich, the Netherlands (van Bronswijk, van Dijk, Peeters); Department of Psychiatry and Psychology, Maastricht University Medical Center+, Maastricht, the Netherlands (van Bronswijk); Department of Mood Disorders, PsyQ Haaglanden, the Hague, the Netherlands (van Dijk, van den Boogaard); Parnassia Psychiatric Institute, the Hague (Deen); Institute of Psychology, Leiden University, Leiden, the Netherlands (Deen); Department of Psychiatry, Radboud University Medical Center, Nijmegen, the Netherlands (Ruhé); Donders Institute for Brain, Cognition and Behavior, Radboud University, Nijmegen (Ruhé); Pro Persona Mental Healthcare, and Behavourial Science Institute, Radboud University, Nijmegen (Spijker)
| | - Mathijs L Deen
- Department of Clinical Psychological Science, Maastricht University, Maastrich, the Netherlands (van Bronswijk, van Dijk, Peeters); Department of Psychiatry and Psychology, Maastricht University Medical Center+, Maastricht, the Netherlands (van Bronswijk); Department of Mood Disorders, PsyQ Haaglanden, the Hague, the Netherlands (van Dijk, van den Boogaard); Parnassia Psychiatric Institute, the Hague (Deen); Institute of Psychology, Leiden University, Leiden, the Netherlands (Deen); Department of Psychiatry, Radboud University Medical Center, Nijmegen, the Netherlands (Ruhé); Donders Institute for Brain, Cognition and Behavior, Radboud University, Nijmegen (Ruhé); Pro Persona Mental Healthcare, and Behavourial Science Institute, Radboud University, Nijmegen (Spijker)
| | - Henricus G Ruhé
- Department of Clinical Psychological Science, Maastricht University, Maastrich, the Netherlands (van Bronswijk, van Dijk, Peeters); Department of Psychiatry and Psychology, Maastricht University Medical Center+, Maastricht, the Netherlands (van Bronswijk); Department of Mood Disorders, PsyQ Haaglanden, the Hague, the Netherlands (van Dijk, van den Boogaard); Parnassia Psychiatric Institute, the Hague (Deen); Institute of Psychology, Leiden University, Leiden, the Netherlands (Deen); Department of Psychiatry, Radboud University Medical Center, Nijmegen, the Netherlands (Ruhé); Donders Institute for Brain, Cognition and Behavior, Radboud University, Nijmegen (Ruhé); Pro Persona Mental Healthcare, and Behavourial Science Institute, Radboud University, Nijmegen (Spijker)
| | - Jan Spijker
- Department of Clinical Psychological Science, Maastricht University, Maastrich, the Netherlands (van Bronswijk, van Dijk, Peeters); Department of Psychiatry and Psychology, Maastricht University Medical Center+, Maastricht, the Netherlands (van Bronswijk); Department of Mood Disorders, PsyQ Haaglanden, the Hague, the Netherlands (van Dijk, van den Boogaard); Parnassia Psychiatric Institute, the Hague (Deen); Institute of Psychology, Leiden University, Leiden, the Netherlands (Deen); Department of Psychiatry, Radboud University Medical Center, Nijmegen, the Netherlands (Ruhé); Donders Institute for Brain, Cognition and Behavior, Radboud University, Nijmegen (Ruhé); Pro Persona Mental Healthcare, and Behavourial Science Institute, Radboud University, Nijmegen (Spijker)
| | - Frenk P M L Peeters
- Department of Clinical Psychological Science, Maastricht University, Maastrich, the Netherlands (van Bronswijk, van Dijk, Peeters); Department of Psychiatry and Psychology, Maastricht University Medical Center+, Maastricht, the Netherlands (van Bronswijk); Department of Mood Disorders, PsyQ Haaglanden, the Hague, the Netherlands (van Dijk, van den Boogaard); Parnassia Psychiatric Institute, the Hague (Deen); Institute of Psychology, Leiden University, Leiden, the Netherlands (Deen); Department of Psychiatry, Radboud University Medical Center, Nijmegen, the Netherlands (Ruhé); Donders Institute for Brain, Cognition and Behavior, Radboud University, Nijmegen (Ruhé); Pro Persona Mental Healthcare, and Behavourial Science Institute, Radboud University, Nijmegen (Spijker)
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19
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Bartova L, Fugger G, Dold M, Kautzky A, Swoboda MMM, Rujescu D, Zohar J, Souery D, Mendlewicz J, Montgomery S, Fabbri C, Serretti A, Kasper S. The Choice of Either Quetiapine or Aripiprazole as Augmentation Treatment in a European Naturalistic Sample of Patients With Major Depressive Disorder. Int J Neuropsychopharmacol 2021; 25:118-127. [PMID: 34637516 PMCID: PMC8832223 DOI: 10.1093/ijnp/pyab066] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Revised: 08/30/2021] [Accepted: 11/11/2021] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Augmentation with second-generation antipsychotics (SGAs) represents an evidence-based psychopharmacotherapeutic strategy recommended in case of insufficient response to the first-line antidepressant (AD) treatment in major depressive disorder (MDD). Comparative evidence regarding efficacy and prescription preferences of the individual SGAs is scarce. METHODS In the scope of this European, multi-site, naturalistic cross-sectional investigation with retrospective assessment of treatment outcome, we compared sociodemographic and clinical characteristics of 187 MDD patients receiving either quetiapine (n = 150) or aripiprazole (n = 37) as augmentation of their first-line AD psychopharmacotherapy. RESULTS Comorbid posttraumatic stress disorder and diabetes were significantly associated with aripiprazole augmentation in our primary and post-hoc binary logistic regression analyses. Furthermore, we identified an association between aripiprazole co-administration and the presence of additional psychotic features, higher rates of AD combination treatment, and a longer duration of psychiatric hospitalizations during the lifetime, which, however, lost significance after correcting for multiple comparisons. Regarding treatment outcome, we found a trend of higher response rates and greater reductions in severity of depressive symptoms in MDD patients dispensed quetiapine. CONCLUSIONS Factors associated with a more chronic and severe profile of MDD seem to encourage clinicians to choose aripiprazole over quetiapine, that was, however, administered in the majority of our MDD patients, which might reflect the current approval situation allowing to prescribe exclusively quetiapine as on-label augmentation in MDD in Europe. Given the retrospective assessment of treatment response, the markedly smaller proportion of patients receiving aripiprazole augmentation generally showing an unfavorable disease profile, and the partially heterogeneous statistical robustness of our findings, further studies are required to elaborate on our observation and to generate unambiguous recommendations regarding the choice of first-line SGA augmentation in MDD.
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Affiliation(s)
- Lucie Bartova
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna,Austria,Department of Biomedical and NeuroMotor Sciences, University of Bologna, Bologna,Italy
| | - Gernot Fugger
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna,Austria,Department of Biomedical and NeuroMotor Sciences, University of Bologna, Bologna,Italy
| | - Markus Dold
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna,Austria
| | - Alexander Kautzky
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna,Austria
| | | | - Dan Rujescu
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna,Austria
| | - Joseph Zohar
- Psychiatric Division, Chaim Sheba Medical Center, Tel Hashomer,Israel
| | - Daniel Souery
- School of Medicine, Free University of Brussels, Brussels,Belgium,Psy Pluriel - European Centre of Psychological Medicine, Brussels,Belgium
| | | | - Stuart Montgomery
- Imperial College School of Medicine, University of London, London,United Kingdom
| | - Chiara Fabbri
- Department of Biomedical and NeuroMotor Sciences, University of Bologna, Bologna,Italy,Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London,United Kingdom
| | - Alessandro Serretti
- Department of Biomedical and NeuroMotor Sciences, University of Bologna, Bologna,Italy
| | - Siegfried Kasper
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna,Austria,Center for Brain Research, Medical University of Vienna, Vienna,Austria,Correspondence: Siegfried Kasper, MD, Professor Emeritus, Center for Brain Research, Medical University of Vienna, Spitalgasse 4, A-1090 Vienna, Austria ()
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20
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van Bronswijk SC, van Dijk DA, van den Boogaard TM, Deen ML, Ruhé HG, Spijker J, Peeters FPML. Impact of Comorbid Personality Disorders on Depression Treatment in Routine Outpatient Care. Am J Psychother 2021:appipsychotherapy20200046. [PMID: 34134502 DOI: 10.1176/appi.psychotherapy.20200046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The impact of personality disorder on treatment effectiveness for depression has been debated, and study results have been inconsistent. However, studies that report a negative impact of personality disorders on depression treatment outcomes are often characterized by uncontrolled treatment designs. Within such contexts, individuals with depression and personality disorders are at risk to receive suboptimal treatment. The aim of this retrospective observational study was to investigate whether and to what extent comorbid personality disorders were associated with the type and amount of depression treatment received in routine outpatient care. METHODS Retrospectively extracted data from electronic records of 1,455 outpatients treated for depression at several sites of a nationwide mental health provider in the Netherlands were included. The type and number of treatment sessions and visits were analyzed by using regression models. RESULTS Individuals with depression and comorbid personality disorders received more psychotherapy sessions than individuals without personality disorders, irrespective of depression severity. The number of pharmacotherapy sessions and supportive and crisis visits did not differ between individuals with and without comorbid personality disorders. CONCLUSIONS Individuals with depression and personality disorders received more intensive treatment than individuals without comorbid personality disorders. These results conflict with treatment guidelines and recommendations from high-quality studies and may be indicative of overtreatment among this large group of patients.
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Affiliation(s)
- Suzanne C van Bronswijk
- Department of Clinical Psychological Science, Maastricht University, Maastrich, the Netherlands (van Bronswijk, van Dijk, Peeters); Department of Psychiatry and Psychology, Maastricht University Medical Center+, Maastricht, the Netherlands (van Bronswijk); Department of Mood Disorders, PsyQ Haaglanden, the Hague, the Netherlands (van Dijk, van den Boogaard); Parnassia Psychiatric Institute, the Hague (Deen); Institute of Psychology, Leiden University, Leiden, the Netherlands (Deen); Department of Psychiatry, Radboud University Medical Center, Nijmegen, the Netherlands (Ruhé); Donders Institute for Brain, Cognition and Behavior, Radboud University, Nijmegen (Ruhé); Pro Persona Mental Healthcare, and Behavourial Science Institute, Radboud University, Nijmegen (Spijker)
| | - Dyllis A van Dijk
- Department of Clinical Psychological Science, Maastricht University, Maastrich, the Netherlands (van Bronswijk, van Dijk, Peeters); Department of Psychiatry and Psychology, Maastricht University Medical Center+, Maastricht, the Netherlands (van Bronswijk); Department of Mood Disorders, PsyQ Haaglanden, the Hague, the Netherlands (van Dijk, van den Boogaard); Parnassia Psychiatric Institute, the Hague (Deen); Institute of Psychology, Leiden University, Leiden, the Netherlands (Deen); Department of Psychiatry, Radboud University Medical Center, Nijmegen, the Netherlands (Ruhé); Donders Institute for Brain, Cognition and Behavior, Radboud University, Nijmegen (Ruhé); Pro Persona Mental Healthcare, and Behavourial Science Institute, Radboud University, Nijmegen (Spijker)
| | - Th Michael van den Boogaard
- Department of Clinical Psychological Science, Maastricht University, Maastrich, the Netherlands (van Bronswijk, van Dijk, Peeters); Department of Psychiatry and Psychology, Maastricht University Medical Center+, Maastricht, the Netherlands (van Bronswijk); Department of Mood Disorders, PsyQ Haaglanden, the Hague, the Netherlands (van Dijk, van den Boogaard); Parnassia Psychiatric Institute, the Hague (Deen); Institute of Psychology, Leiden University, Leiden, the Netherlands (Deen); Department of Psychiatry, Radboud University Medical Center, Nijmegen, the Netherlands (Ruhé); Donders Institute for Brain, Cognition and Behavior, Radboud University, Nijmegen (Ruhé); Pro Persona Mental Healthcare, and Behavourial Science Institute, Radboud University, Nijmegen (Spijker)
| | - Mathijs L Deen
- Department of Clinical Psychological Science, Maastricht University, Maastrich, the Netherlands (van Bronswijk, van Dijk, Peeters); Department of Psychiatry and Psychology, Maastricht University Medical Center+, Maastricht, the Netherlands (van Bronswijk); Department of Mood Disorders, PsyQ Haaglanden, the Hague, the Netherlands (van Dijk, van den Boogaard); Parnassia Psychiatric Institute, the Hague (Deen); Institute of Psychology, Leiden University, Leiden, the Netherlands (Deen); Department of Psychiatry, Radboud University Medical Center, Nijmegen, the Netherlands (Ruhé); Donders Institute for Brain, Cognition and Behavior, Radboud University, Nijmegen (Ruhé); Pro Persona Mental Healthcare, and Behavourial Science Institute, Radboud University, Nijmegen (Spijker)
| | - Henricus G Ruhé
- Department of Clinical Psychological Science, Maastricht University, Maastrich, the Netherlands (van Bronswijk, van Dijk, Peeters); Department of Psychiatry and Psychology, Maastricht University Medical Center+, Maastricht, the Netherlands (van Bronswijk); Department of Mood Disorders, PsyQ Haaglanden, the Hague, the Netherlands (van Dijk, van den Boogaard); Parnassia Psychiatric Institute, the Hague (Deen); Institute of Psychology, Leiden University, Leiden, the Netherlands (Deen); Department of Psychiatry, Radboud University Medical Center, Nijmegen, the Netherlands (Ruhé); Donders Institute for Brain, Cognition and Behavior, Radboud University, Nijmegen (Ruhé); Pro Persona Mental Healthcare, and Behavourial Science Institute, Radboud University, Nijmegen (Spijker)
| | - Jan Spijker
- Department of Clinical Psychological Science, Maastricht University, Maastrich, the Netherlands (van Bronswijk, van Dijk, Peeters); Department of Psychiatry and Psychology, Maastricht University Medical Center+, Maastricht, the Netherlands (van Bronswijk); Department of Mood Disorders, PsyQ Haaglanden, the Hague, the Netherlands (van Dijk, van den Boogaard); Parnassia Psychiatric Institute, the Hague (Deen); Institute of Psychology, Leiden University, Leiden, the Netherlands (Deen); Department of Psychiatry, Radboud University Medical Center, Nijmegen, the Netherlands (Ruhé); Donders Institute for Brain, Cognition and Behavior, Radboud University, Nijmegen (Ruhé); Pro Persona Mental Healthcare, and Behavourial Science Institute, Radboud University, Nijmegen (Spijker)
| | - Frenk P M L Peeters
- Department of Clinical Psychological Science, Maastricht University, Maastrich, the Netherlands (van Bronswijk, van Dijk, Peeters); Department of Psychiatry and Psychology, Maastricht University Medical Center+, Maastricht, the Netherlands (van Bronswijk); Department of Mood Disorders, PsyQ Haaglanden, the Hague, the Netherlands (van Dijk, van den Boogaard); Parnassia Psychiatric Institute, the Hague (Deen); Institute of Psychology, Leiden University, Leiden, the Netherlands (Deen); Department of Psychiatry, Radboud University Medical Center, Nijmegen, the Netherlands (Ruhé); Donders Institute for Brain, Cognition and Behavior, Radboud University, Nijmegen (Ruhé); Pro Persona Mental Healthcare, and Behavourial Science Institute, Radboud University, Nijmegen (Spijker)
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21
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Piera-Jiménez J, Etzelmueller A, Kolovos S, Folkvord F, Lupiáñez-Villanueva F. Guided Internet-Based Cognitive Behavioral Therapy for Depression: Implementation Cost-Effectiveness Study. J Med Internet Res 2021; 23:e27410. [PMID: 33973857 PMCID: PMC8150403 DOI: 10.2196/27410] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Revised: 02/18/2021] [Accepted: 04/11/2021] [Indexed: 02/06/2023] Open
Abstract
Background Major depressive disorder is a chronic condition; its prevalence is expected to grow with the aging trend of high-income countries. Internet-based cognitive-behavioral therapy has proven efficacy in treating major depressive disorder. Objective The objective of this study was to assess the cost-effectiveness of implementing a community internet-based cognitive behavioral therapy intervention (Super@, the Spanish program for the MasterMind project) for treating major depressive disorder. Methods The cost-effectiveness of the Super@ program was assessed with the Monitoring and Assessment Framework for the European Innovation Partnership on Active and Healthy Ageing tool, using a 3-state Markov model. Data from the cost and effectiveness of the intervention were prospectively collected from the implementation of the program by a health care provider in Badalona, Spain; the corresponding data for usual care were gathered from the literature. The health states, transition probabilities, and utilities were computed using Patient Health Questionnaire–9 scores. Results The analysis was performed using data from 229 participants using the Super@ program. Results showed that the intervention was more costly than usual care; the discounted (3%) and nondiscounted incremental cost-effectiveness ratios were €29,367 and €26,484 per quality-adjusted life-year, respectively (approximately US $35,299 and $31,833, respectively). The intervention was cost-effective based on the €30,000 willingness-to-pay threshold typically applied in Spain (equivalent to approximately $36,060). According to the deterministic sensitivity analyses, the potential reduction of costs associated with intervention scale-up would reduce the incremental cost-effectiveness ratio of the intervention, although it remained more costly than usual care. A discount in the incremental effects up to 5% exceeded the willingness-to-pay threshold of €30,000. Conclusions The Super@ program, an internet-based cognitive behavioral therapy intervention for treating major depressive disorder, cost more than treatment as usual. Nevertheless, its implementation in Spain would be cost-effective from health care and societal perspectives, given the willingness-to-pay threshold of €30,000 compared with treatment as usual.
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Affiliation(s)
- Jordi Piera-Jiménez
- Open Evidence Research Group, Universitat Oberta de Catalunya, Barcelona, Spain.,Servei Català de la Salut, Barcelona, Spain.,Digitalization for the Sustainability of the Healthcare System, Sistema de Salut de Catalunya, Barcelona, Spain
| | | | - Spyros Kolovos
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom
| | - Frans Folkvord
- Open Evidence Research Group, Universitat Oberta de Catalunya, Barcelona, Spain.,Department of Communication and Cognition, Tilburg School of Humanities and Digital Sciences, Tilburg University, Tilburg, Netherlands
| | - Francisco Lupiáñez-Villanueva
- Open Evidence Research Group, Universitat Oberta de Catalunya, Barcelona, Spain.,Department of Information and Communication Sciences, Universitat Oberta de Catalunya, Barcelona, Spain
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22
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Davis AK, Barrett FS, May DG, Cosimano MP, Sepeda ND, Johnson MW, Finan PH, Griffiths RR. Effects of Psilocybin-Assisted Therapy on Major Depressive Disorder: A Randomized Clinical Trial. JAMA Psychiatry 2021; 78:481-489. [PMID: 33146667 PMCID: PMC7643046 DOI: 10.1001/jamapsychiatry.2020.3285] [Citation(s) in RCA: 536] [Impact Index Per Article: 178.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
IMPORTANCE Major depressive disorder (MDD) is a substantial public health burden, but current treatments have limited effectiveness and adherence. Recent evidence suggests that 1 or 2 administrations of psilocybin with psychological support produces antidepressant effects in patients with cancer and in those with treatment-resistant depression. OBJECTIVE To investigate the effect of psilocybin therapy in patients with MDD. DESIGN, SETTING, AND PARTICIPANTS This randomized, waiting list-controlled clinical trial was conducted at the Center for Psychedelic and Consciousness Research at Johns Hopkins Bayview Medical Center in Baltimore, Maryland. Adults aged 21 to 75 years with an MDD diagnosis, not currently using antidepressant medications, and without histories of psychotic disorder, serious suicide attempt, or hospitalization were eligible to participate. Enrollment occurred between August 2017 and April 2019, and the 4-week primary outcome assessments were completed in July 2019. A total of 27 participants were randomized to an immediate treatment condition group (n = 15) or delayed treatment condition group (waiting list control condition; n = 12). Data analysis was conducted from July 1, 2019, to July 31, 2020, and included participants who completed the intervention (evaluable population). INTERVENTIONS Two psilocybin sessions (session 1: 20 mg/70 kg; session 2: 30 mg/70 kg) were given (administered in opaque gelatin capsules with approximately 100 mL of water) in the context of supportive psychotherapy (approximately 11 hours). Participants were randomized to begin treatment immediately or after an 8-week delay. MAIN OUTCOMES AND MEASURES The primary outcome, depression severity was assessed with the GRID-Hamilton Depression Rating Scale (GRID-HAMD) scores at baseline (score of ≥17 required for enrollment) and weeks 5 and 8 after enrollment for the delayed treatment group, which corresponded to weeks 1 and 4 after the intervention for the immediate treatment group. Secondary outcomes included the Quick Inventory of Depressive Symptomatology-Self Rated (QIDS-SR). RESULTS Of the randomized participants, 24 of 27 (89%) completed the intervention and the week 1 and week 4 postsession assessments. This population had a mean (SD) age of 39.8 (12.2) years, was composed of 16 women (67%), and had a mean (SD) baseline GRID-HAMD score of 22.8 (3.9). The mean (SD) GRID-HAMD scores at weeks 1 and 4 (8.0 [7.1] and 8.5 [5.7]) in the immediate treatment group were statistically significantly lower than the scores at the comparable time points of weeks 5 and 8 (23.8 [5.4] and 23.5 [6.0]) in the delayed treatment group. The effect sizes were large at week 5 (Cohen d = 2.5; 95% CI, 1.4-3.5; P < .001) and week 8 (Cohen d = 2.6; 95% CI, 1.5-3.7; P < .001). The QIDS-SR documented a rapid decrease in mean (SD) depression score from baseline to day 1 after session 1 (16.7 [3.5] vs 6.3 [4.4]; Cohen d = 2.6; 95% CI, 1.8-3.5; P < .001), which remained statistically significantly reduced through the week 4 follow-up (6.0 [5.7]; Cohen d = 2.3; 95% CI, 1.5-3.0; P < .001). In the overall sample, 17 participants (71%) at week 1 and 17 (71%) at week 4 had a clinically significant response to the intervention (≥50% reduction in GRID-HAMD score), and 14 participants (58%) at week 1 and 13 participants (54%) at week 4 were in remission (≤7 GRID-HAMD score). CONCLUSIONS AND RELEVANCE Findings suggest that psilocybin with therapy is efficacious in treating MDD, thus extending the results of previous studies of this intervention in patients with cancer and depression and of a nonrandomized study in patients with treatment-resistant depression. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT03181529.
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Affiliation(s)
- Alan K. Davis
- Center for Psychedelic and Consciousness Research, Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland,College of Social Work, The Ohio State University, Columbus
| | - Frederick S. Barrett
- Center for Psychedelic and Consciousness Research, Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Darrick G. May
- Center for Psychedelic and Consciousness Research, Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Mary P. Cosimano
- Center for Psychedelic and Consciousness Research, Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Nathan D. Sepeda
- Center for Psychedelic and Consciousness Research, Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Matthew W. Johnson
- Center for Psychedelic and Consciousness Research, Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Patrick H. Finan
- Center for Psychedelic and Consciousness Research, Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Roland R. Griffiths
- Center for Psychedelic and Consciousness Research, Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland,Department of Neuroscience, Johns Hopkins School of Medicine, Baltimore, Maryland
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23
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Discovering Common Elements of Empirically Supported Self-Help Interventions for Depression in Primary Care: a Systematic Review. J Gen Intern Med 2021; 36:869-880. [PMID: 33564943 PMCID: PMC8042082 DOI: 10.1007/s11606-020-06449-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Accepted: 12/13/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Although the efficacy of self-help cognitive-behavioral therapy (CBT) for depression has been well established, its feasibility in primary care settings is limited because of time and resource constraints. The goal of this study was to identify common elements of empirically supported (i.e., proven effective in controlled research) self-help CBTs and frameworks for effective use in practice. METHODS Randomized controlled trials (RCTs) for self-help CBTs for depression in primary care were systematically identified in Pubmed, PsycINFO, and CENTRAL. The distillation and matching model approach was used to abstract commonly used self-help techniques (practice elements). Study contexts associated with unique combinations of intervention elements were explored, including total human support dose (total face-to-face, telephone, and personalized email contact time recommended by the protocol), effective symptom domain (depression vs. general psychological distress), and severity of depression targeted by the study. Relative contribution to intervention success was estimated for individual elements and human support by conditional probability (CP, proportion of the number of times each element appeared in a successful intervention to the number of times it was used in the interventions identified by the review). RESULTS Twenty-one interventions (12 successful) in 20 RCTs and 21 practice elements were identified. Cognitive restructuring, behavioral activation, and homework assignment were elements appearing in > 80% of successful interventions. The dose of human support was positively associated with the proportion of interventions that were successful in a significant linear fashion (CPs: interventions with no support, 0.20; 1-119 min of support, 0.60; 120 min of support, 0.83; p = 0.042). In addition, human support increased the probability of success for most of the extracted elements. Only social support activation, homework assignment, and interpersonal skills were highly successful (CPs ≥ 0.60) when minimal support was provided. DISCUSSION These findings suggest that human support is an important component in creating an evidence-informed brief self-help program compatible with primary care settings.
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24
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Predictors of Quality of Life Improvement with Escitalopram and Adjunctive Aripiprazole in Patients with Major Depressive Disorder: A CAN-BIND Study Report. CNS Drugs 2021; 35:439-450. [PMID: 33860922 DOI: 10.1007/s40263-021-00803-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/06/2021] [Indexed: 12/19/2022]
Abstract
BACKGROUND Non-response to first-line treatment for major depressive disorder (MDD) is common; for such individuals, quality of life (QoL) impairments can be severe. Identifying predictors of QoL changes may support the management of cases with persistent depressive symptoms despite adequate initial pharmacological/psychological treatment. OBJECTIVE The present study aimed to explore predictors of domain-specific QoL improvement following adjunctive aripiprazole treatment for inadequate response to initial antidepressant therapy. METHODS We evaluated secondary QoL outcomes from a CAN-BIND (Canadian Biomarker Integration Network in Depression) study in patients with MDD who did not respond to an initial 8 weeks of escitalopram and received a further 8 weeks of adjunctive aripiprazole (n = 96). Physical, psychological, social, and environmental QoL domains were assessed using the World Health Organization QoL Scale Brief Version (WHOQOL-BREF). Clinician-rated depressive symptoms were assessed using the Montgomery-Åsberg Depression Rating Scale (MADRS). Functioning was measured with the Sheehan Disability Scale (SDS). Satisfaction with medication was assessed with a single item from the Quality of Life Enjoyment and Satisfaction Questionnaire Short Form (Q-LES-Q-SF). Exploratory t-tests were used to describe domain score changes. A hierarchical linear regression was used to explore demographic, clinical, and treatment-related predictors of improvement. RESULTS Across domains, QoL improved with adjunctive aripiprazole treatment. Satisfaction with medication and MADRS and SDS scores similarly improved. Symptom reduction was a predictor for positive change to physical and psychological QoL; functioning improvements were predictive of increases to all QoL domains. Satisfaction with medication predicted improvements to physical and psychological domains, whereas number of medication trials was a predictor of worsening QoL in the physical domain. CONCLUSION The final model explained the most variance in psychological (68%) and physical (67%) QoL. Less variance was explained for environmental (43%) and social QoL (33%), highlighting a need for further exploration of predictors in these domains. Strategies such as functional remediation may have potential to support QoL for individuals with persistent depressive symptoms. CLINICAL TRIALS REGISTRY ClinicalTrials.gov identifier: NCT016557.
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25
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Morton E, Bhat V, Giacobbe P, Lou W, Michalak EE, Chakrabarty T, Frey BN, Milev RV, Müller DJ, Parikh SV, Rotzinger S, Kennedy SH, Lam RW. Impacts on Quality of Life with Escitalopram Monotherapy and Aripiprazole Augmentation in Patients with Major Depressive Disorder: A CAN-BIND Report. PHARMACOPSYCHIATRY 2021; 54:225-231. [PMID: 33652477 DOI: 10.1055/a-1385-0263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Many individuals with major depressive disorder (MDD) do not respond to initial antidepressant monotherapy. Adjunctive aripiprazole is recommended for treatment non-response; however, the impacts on quality of life (QoL) for individuals who receive this second-line treatment strategy have not been described. METHODS We evaluated secondary QoL outcomes in patients with MDD (n=179). After 8 weeks of escitalopram, non-responders (<50% decrease in clinician-rated depression) were treated with adjunctive aripiprazole for 8 weeks (n=97); responders continued escitalopram (n=82). A repeated-measures ANOVA evaluated change in Quality of Life Enjoyment and Satisfaction Short Form scores. QoL was described relative to normative benchmarks. RESULTS Escitalopram responders experienced the most QoL improvements in the first treatment phase. For non-responders, QoL improved with a large effect during adjunctive aripiprazole treatment. At the endpoint, 47% of patients achieving symptomatic remission still had impaired QoL. DISCUSSION Individuals who were treated with adjunctive aripiprazole after non-response to escitalopram experienced improved QoL, but a substantial degree of QoL impairment persisted. Since QoL deficits may predict MDD recurrence, attention to ways to support this outcome is required.
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Affiliation(s)
- Emma Morton
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Venkat Bhat
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Peter Giacobbe
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Wendy Lou
- Dalla Lane School of Public Health, University of Toronto, ON, Canada
| | - Erin E Michalak
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Trisha Chakrabarty
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Benicio N Frey
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
| | - Roumen V Milev
- Departments of Psychiatry and Psychology, Queen's University, Kingston, ON, Canada
| | - Daniel J Müller
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Sagar V Parikh
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan, USA
| | - Susan Rotzinger
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Sidney H Kennedy
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Raymond W Lam
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
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26
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Cuijpers P, Quero S, Papola D, Cristea IA, Karyotaki E. Care-as-usual control groups across different settings in randomized trials on psychotherapy for adult depression: a meta-analysis. Psychol Med 2021; 51:634-644. [PMID: 31843031 DOI: 10.1017/s0033291719003581] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Care-as-usual (CAU) is often used as a control condition in psychotherapy research, but it may vary considerably what that entails, ranging from no treatment, to routine treatment in primary care, general medical care, perinatal care, and specialized mental health care. METHODS We conducted a meta-analysis of trials comparing psychotherapy for depression to CAU, with a focus on the different categories of CAU and countries where the studies were conducted. We used an existing database of randomized trials on psychotherapy for depression that is updated every year. RESULTS A total of 140 studies with 15 419 patients were included. We found no significant differences in effects between categories of CAU (effect sizes ranging from g = 0.43 for CAU in primary care to g = 0.73 for no treatment), but heterogeneity was high in all CAU categories. After stratifying effects across specific countries (within CAU categories) we found that heterogeneity was considerably lower and there were several significant differences between countries. Overall, effects were larger in non-Western countries (g = 0.84 to 1.28) compared to those in Western countries (g = 0.52; p for difference = 0.002). Effects were smaller in studies with risk of bias (p = 0.01). CONCLUSIONS There are no significant differences between major categories of CAU when compared to psychotherapy conditions in randomized trials. However, effects of psychotherapy differ considerably across CAU conditions in specific countries. CAU therefore is a heterogeneous control condition in psychotherapy research.
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Affiliation(s)
- Pim Cuijpers
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health research institute, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Soledad Quero
- Department of Basic, Clinical Psychology, and Psychobiology, Universitat Jaume I, Castellón, Spain
| | - Davide Papola
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health research institute, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
- Department of Neuroscience, Biomedicine and Movement Science, Section of Psychiatry, WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, University of Verona, Verona, Italy
| | - Ioana A Cristea
- Department of Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Eirini Karyotaki
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health research institute, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
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27
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Jacobs M, Pradier MF, McCoy TH, Perlis RH, Doshi-Velez F, Gajos KZ. How machine-learning recommendations influence clinician treatment selections: the example of the antidepressant selection. Transl Psychiatry 2021; 11:108. [PMID: 33542191 PMCID: PMC7862671 DOI: 10.1038/s41398-021-01224-x] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 01/11/2021] [Accepted: 01/18/2021] [Indexed: 02/06/2023] Open
Abstract
Decision support systems embodying machine learning models offer the promise of an improved standard of care for major depressive disorder, but little is known about how clinicians' treatment decisions will be influenced by machine learning recommendations and explanations. We used a within-subject factorial experiment to present 220 clinicians with patient vignettes, each with or without a machine-learning (ML) recommendation and one of the multiple forms of explanation. We found that interacting with ML recommendations did not significantly improve clinicians' treatment selection accuracy, assessed as concordance with expert psychopharmacologist consensus, compared to baseline scenarios in which clinicians made treatment decisions independently. Interacting with incorrect recommendations paired with explanations that included limited but easily interpretable information did lead to a significant reduction in treatment selection accuracy compared to baseline questions. These results suggest that incorrect ML recommendations may adversely impact clinician treatment selections and that explanations are insufficient for addressing overreliance on imperfect ML algorithms. More generally, our findings challenge the common assumption that clinicians interacting with ML tools will perform better than either clinicians or ML algorithms individually.
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Affiliation(s)
- Maia Jacobs
- Department of Computer Science, Harvard University, 29 Oxford Street, Cambridge, MA, 02138, USA
| | - Melanie F Pradier
- Department of Computer Science, Harvard University, 29 Oxford Street, Cambridge, MA, 02138, USA
| | - Thomas H McCoy
- Center for Quantitative Health, Massachusetts General Hospital, 185 Cambridge Street, Boston, MA, 02114, USA
- Harvard Medical School, 25 Shattuck Street, Boston, MA, 02115, USA
| | - Roy H Perlis
- Center for Quantitative Health, Massachusetts General Hospital, 185 Cambridge Street, Boston, MA, 02114, USA
- Harvard Medical School, 25 Shattuck Street, Boston, MA, 02115, USA
| | - Finale Doshi-Velez
- Department of Computer Science, Harvard University, 29 Oxford Street, Cambridge, MA, 02138, USA
| | - Krzysztof Z Gajos
- Department of Computer Science, Harvard University, 29 Oxford Street, Cambridge, MA, 02138, USA.
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28
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Dai D, Lacadie CM, Holmes SE, Cool R, Anticevic A, Averill C, Abdallah C, Esterlis I. Ketamine Normalizes the Structural Alterations of Inferior Frontal Gyrus in Depression. CHRONIC STRESS 2021; 4:2470547020980681. [PMID: 33426409 PMCID: PMC7758564 DOI: 10.1177/2470547020980681] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 11/20/2020] [Indexed: 12/20/2022]
Abstract
Background Ketamine is a novel fast-acting antidepressant. Acute ketamine treatment can reverse microstructure deficits and normalize functional alterations in the brain, but little is known about the impacts of ketamine on brain volumes in individuals with depression. Methods We used 3 T magnetic resonance imaging (MRI) and tensorbased morphological methods to investigate the regional volume differences for 29 healthy control (HC) subjects and 21 subjects with major depressive disorder (MDD), including 10 subjects with comorbid post-traumatic stress disorder (PTSD). All the subjects participated in MRI scanning before and 24 h post intravenous ketamine infusion. The effects of acute ketamine administration on HC, MDD, and MDD/PTSD groups were examined separately by whole-brain voxel-wise t-tests. Results Our data showed smaller volume of inferior frontal gyrus (IFG, opercular part) in MDD and MDD/PTSD subjects compared to HC, and a significant correlation between opercular IFG volume and depressive severity in MDD subjects only. Ketamine administration normalized the structural alterations of opercular IFG in both MDD and MDD/PTSD groups, and significantly improved depressive and PTSD symptoms. Twenty-four hours after a single ketamine infusion, there were two clusters of voxels with volume changes in MDD subjects, including significantly increased volumes of opercular IFG. No significant structural alterations were found in the MDD/PTSD or HC groups. Conclusion These findings provide direct evidence that acute ketamine administration can normalize structural alterations associated with depression and highlight the importance of IFG in the guidance of future therapeutic targets.
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Affiliation(s)
- Dan Dai
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut
| | - Cheryl M Lacadie
- Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, Connecticut
| | - Sophie E Holmes
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut
| | - Ryan Cool
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut
| | - Alan Anticevic
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut.,Department of Psychology, Yale University School of Medicine, New Haven, Connecticut
| | - Chris Averill
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut.,Clinical Neurosciences Division, National Center for PTSD, US Department of Veterans Affairs, West Haven, Connecticut
| | - Chadi Abdallah
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut.,Clinical Neurosciences Division, National Center for PTSD, US Department of Veterans Affairs, West Haven, Connecticut.,Michael E. DeBakey, VA Medical Center, Houston, Texas.,Menninger Department of Psychiatry, Baylor College of Medicine, Houston, Texas
| | - Irina Esterlis
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut.,Department of Psychology, Yale University School of Medicine, New Haven, Connecticut.,Clinical Neurosciences Division, National Center for PTSD, US Department of Veterans Affairs, West Haven, Connecticut
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Kopf-Beck J, Zimmermann P, Egli S, Rein M, Kappelmann N, Fietz J, Tamm J, Rek K, Lucae S, Brem AK, Sämann P, Schilbach L, Keck ME. Schema therapy versus cognitive behavioral therapy versus individual supportive therapy for depression in an inpatient and day clinic setting: study protocol of the OPTIMA-RCT. BMC Psychiatry 2020; 20:506. [PMID: 33054737 PMCID: PMC7557007 DOI: 10.1186/s12888-020-02880-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 09/19/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Major depressive disorder represents (MDD) a major cause of disability and disease burden. Beside antidepressant medication, psychotherapy is a key approach of treatment. Schema therapy has been shown to be effective in the treatment of psychiatric disorders, especially personality disorders, in a variety of settings and patient groups. Nevertheless, there is no evidence on its effectiveness for MDD in an inpatient nor day clinic setting and little is known about the factors that drive treatment response in such a target group. METHODS In the current protocol, we outline OPTIMA (OPtimized Treatment Identification at the MAx Planck Institute): a single-center randomized controlled trial of schema therapy as a treatment approach for MDD in an inpatient and day clinic setting. Over the course of 7 weeks, we compare schema therapy with cognitive behavioral therapy and individual supportive therapy, conducted in individual and group sessions and with no restrictions regarding concurrent antidepressant medication, thus approximating real-life treatment conditions. N = 300 depressed patients are included. All study therapists undergo a specific training and supervision and therapy adherence is assessed. Primary outcome is depressive symptom severity as self-assessment (Beck Depression Inventory-II) and secondary outcomes are clinical ratings of MDD (Montgomery-Asberg Depression Rating Scale), recovery rates after 7 weeks according to the Munich-Composite International Diagnostic Interview, general psychopathology (Brief Symptom Inventory), global functioning (World Health Organization Disability Assessment Schedule), and clinical parameters such as dropout rates. Further parameters on a behavioral, cognitive, psychophysiological, and biological level are measured before, during and after treatment and in 2 follow-up assessments after 6 and 24 months after end of treatment. DISCUSSION To our knowledge, the OPTIMA-Trial is the first to investigate the effectiveness of schema therapy as a treatment approach of MDD, to investigate mechanisms of change, and explore predictors of treatment response in an inpatient and day clinic setting by using such a wide range of parameters. Insights from OPTIMA will allow more integrative approaches of psychotherapy of MDD. Especially, the identification of intervention-specific markers of treatment response can improve evidence-based clinical decision for individualizing treatment. TRIAL REGISTRATION Identifier on clinicaltrials.gov : NCT03287362 ; September, 12, 2017.
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Affiliation(s)
- Johannes Kopf-Beck
- Max Planck Institute of Psychiatry, Kraepelinstraße 2-10, 80804, Munich, Germany.
| | - Petra Zimmermann
- Max Planck Institute of Psychiatry, Kraepelinstraße 2-10, 80804, Munich, Germany
| | - Samy Egli
- Max Planck Institute of Psychiatry, Kraepelinstraße 2-10, 80804, Munich, Germany
| | - Martin Rein
- Max Planck Institute of Psychiatry, Kraepelinstraße 2-10, 80804, Munich, Germany
| | - Nils Kappelmann
- Max Planck Institute of Psychiatry, Kraepelinstraße 2-10, 80804, Munich, Germany
- International Max Planck Research School for Translational Psychiatry (IMPRS-TP), Munich, Germany
| | - Julia Fietz
- Max Planck Institute of Psychiatry, Kraepelinstraße 2-10, 80804, Munich, Germany
- International Max Planck Research School for Translational Psychiatry (IMPRS-TP), Munich, Germany
| | - Jeanette Tamm
- Max Planck Institute of Psychiatry, Kraepelinstraße 2-10, 80804, Munich, Germany
| | - Katharina Rek
- Max Planck Institute of Psychiatry, Kraepelinstraße 2-10, 80804, Munich, Germany
- University of Kassel, Kassel, Germany
| | - Susanne Lucae
- Max Planck Institute of Psychiatry, Kraepelinstraße 2-10, 80804, Munich, Germany
| | - Anna-Katharine Brem
- Max Planck Institute of Psychiatry, Kraepelinstraße 2-10, 80804, Munich, Germany
- Berenson-Allen Center for Noninvasive Brain Stimulation, Division of Cognitive Neurology, Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
- University Hospital of Old Age Psychiatry, University of Bern, Bern, Switzerland
- Department of Neuropsychology, Lucerne Psychiatry, Lucerne, Switzerland
| | - Philipp Sämann
- Max Planck Institute of Psychiatry, Kraepelinstraße 2-10, 80804, Munich, Germany
| | - Leonhard Schilbach
- Max Planck Institute of Psychiatry, Kraepelinstraße 2-10, 80804, Munich, Germany
- Independent Max Planck Research Group for Social Neuroscience, München, Germany
- Ludwig-Maximilians-Universität, Munich, Germany
| | - Martin E Keck
- Max Planck Institute of Psychiatry, Kraepelinstraße 2-10, 80804, Munich, Germany
- Schmieder Hospital in Gailingen, Gailingen, Germany
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30
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Owens M, Watkins E, Bot M, Brouwer IA, Roca M, Kohls E, Penninx BWJH, Grootheest G, Hegerl U, Gili M, Visser M. Nutrition and depression: Summary of findings from the EU‐funded MooDFOOD depression prevention randomised controlled trial and a critical review of the literature. NUTR BULL 2020. [DOI: 10.1111/nbu.12447] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Affiliation(s)
- M. Owens
- Department of Psychology University of Exeter Exeter UK
| | - E. Watkins
- Department of Psychology University of Exeter Exeter UK
| | - M. Bot
- Amsterdam UMC Vrije Universiteit, Psychiatry Amsterdam Public Health Research Institute GGZ in Geest Specialized Mental Health Care Amsterdam The Netherlands
| | - I. A. Brouwer
- Department of Health Sciences Faculty of Science Amsterdam Public Health Research Institute Vrije Universiteit Amsterdam Amsterdam The Netherlands
| | - M. Roca
- Institut Universitari d’ Investigació en Ciències de la Salut (IUNICS/IDISBA) Rediapp University of Balearic Islands Palma de Mallorca Spain
| | - E. Kohls
- Department of Psychiatry and Psychotherapy Medical Faculty University Leipzig Leipzig Germany
| | - B. W. J. H. Penninx
- Amsterdam UMC Vrije Universiteit, Psychiatry Amsterdam Public Health Research Institute GGZ in Geest Specialized Mental Health Care Amsterdam The Netherlands
| | - G. Grootheest
- Amsterdam UMC Vrije Universiteit, Psychiatry Amsterdam Public Health Research Institute GGZ in Geest Specialized Mental Health Care Amsterdam The Netherlands
| | - U. Hegerl
- Department of Psychiatry, Psychosomatics and Psychotherapy Goethe‐University Frankfurt Germany
| | - M. Gili
- Institut Universitari d’ Investigació en Ciències de la Salut (IUNICS/IDISBA) Rediapp University of Balearic Islands Palma de Mallorca Spain
| | - M. Visser
- Department of Health Sciences Faculty of Science Amsterdam Public Health Research Institute Vrije Universiteit Amsterdam Amsterdam The Netherlands
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31
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Carey TA, Huddy V, Griffiths R. To Mix or Not To Mix? A Meta-Method Approach to Rethinking Evaluation Practices for Improved Effectiveness and Efficiency of Psychological Therapies Illustrated With the Application of Perceptual Control Theory. Front Psychol 2019; 10:1445. [PMID: 31297076 PMCID: PMC6607441 DOI: 10.3389/fpsyg.2019.01445] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Accepted: 06/05/2019] [Indexed: 11/24/2022] Open
Abstract
Progress in the development of more effective and efficient psychological therapies could be accelerated with innovative and nuanced approaches to research methodology. Therapy development has been dominated by a mono-methodology attitude with randomized controlled trials (RCTs) regarded as a “gold standard” despite the concept of a single methodology being ascribed gold standard status having been called into question. Rather than one particular methodology being considered superior to all others, the gold standard approach should be matching appropriate methodologies to important research questions. The way in which that matching should occur, however, is far from clear. Moving from a mono-methodological approach to mixed-method designs has not been straightforward. The ways in which methods should be mixed, to arrive at robust and persuasive answers to genuine research questions, is not entirely clear. In this paper, we argue that attention to the meta-methods underpinning all research designs will improve research precision and provide greater clarity about the contribution of any particular program of research to scientific progress in that field. From a meta-method perspective, the matter of what changed can be delineated from why or how these changes occurred. Different methods and different types of mixing can be justified for each meta question. A meta-method approach should make explicit the assumptions that guide the development of research designs and also promote the articulation of putative mechanisms that might be relevant. By paying greater attention to assumptions such as how causality occurs, and important mechanisms of change, the mixing of methodologies that are still not mainstream in this area such as routine outcome monitoring and evaluation and functional model building, can occur. By adopting methodologies that focus on learning about a program’s strengths and weaknesses rather than presiding over judgments of whether or not the program is deemed to be effective, we will move much closer to a position of being able to understand what programs under which conditions people find most helpful for their purposes.
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Affiliation(s)
- Timothy A Carey
- Centre for Remote Health, Flinders University, Alice Springs, NT, Australia
| | - Vyv Huddy
- Clinical Psychology Unit, University of Sheffield, Sheffield, United Kingdom
| | - Robert Griffiths
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, United Kingdom.,University of Manchester, Manchester, United Kingdom
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32
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Keating LE, Becker S, McCabe K, Whattam J, Garrick L, Frey BN, Sassi RB, McKinnon MC. Impact of a structured, group-based running programme on clinical, cognitive and social function in youth and adults with complex mood disorders: a 12-week pilot study. BMJ Open Sport Exerc Med 2019; 5:e000521. [PMID: 31191972 PMCID: PMC6539166 DOI: 10.1136/bmjsem-2019-000521] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/23/2019] [Indexed: 01/26/2023] Open
Abstract
Background Individuals with mood disorders often report lingering health-related quality of life (HRQOL) and social and cognitive impairments even after mood symptoms have improved. Exercise programmes improve mood symptoms in patients, but whether exercise improves functional outcomes in patients with difficult-to-treat mood disorders remains unknown. Design We evaluated the impact of a 12-week structured running programme on cognitive, social and quality-of-life outcomes in participants with difficult-to-treat mood disorders. Methods In a prospective, open-label study, patients referred to the St Joseph’s Healthcare Hamilton Team Unbreakable running programme for youth and adults with mood disorders completed a comprehensive assessment battery before and after the 12-week exercise intervention. Results We collected preintervention and postintervention data from 18 participants who improved on the general health, vitality, role of emotions, social functioning and mental health (all p≤0.01) HRQOL subscales. Performance improved on cognitive tests that assessed working memory and processing speed (p≤0.04); there were no improvements in complex executive functioning tasks. Regression analyses indicated that younger age, shorter illness duration and reduced bodily pain predicted social and cognitive outcomes. Conclusion Participation in a group-based, structured running programme was associated with improved HRQOL and social and cognitive function.
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Affiliation(s)
- Laura E Keating
- Neuroscience Graduate Program, McMaster University, Burlington, Ontario, Canada
| | - Suzanna Becker
- Psychology, Neuroscience and Behaviour, McMaster University, Hamilton, Ontario, Canada
| | - Katie McCabe
- Mood Disorders Program, St Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada.,Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | - Jeff Whattam
- Mood Disorders Program, St Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
| | - Laura Garrick
- Research Administration, St Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
| | - Benicio N Frey
- Mood Disorders Program, St Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada.,Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | - Roberto B Sassi
- Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada.,Child and Adolescent Psychiatry, St Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
| | - Margaret C McKinnon
- Mood Disorders Program, St Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada.,Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
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Massoudi B, Holvast F, Bockting CLH, Burger H, Blanker MH. The effectiveness and cost-effectiveness of e-health interventions for depression and anxiety in primary care: A systematic review and meta-analysis. J Affect Disord 2019; 245:728-743. [PMID: 30447572 DOI: 10.1016/j.jad.2018.11.050] [Citation(s) in RCA: 58] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Revised: 09/21/2018] [Accepted: 11/03/2018] [Indexed: 01/20/2023]
Abstract
PURPOSE Psychological interventions are labor-intensive and expensive, but e-health interventions may support them in primary care. In this study, we systematically reviewed the effectiveness and cost-effectiveness of e-health interventions for depressive and anxiety symptoms and disorders in primary care. METHODS We searched MEDLINE, Cochrane library, Embase, and PsychINFO until January 2018, for randomized controlled trials of e-health interventions for depression or anxiety in primary care. Two reviewers independently screened the identified publications, extracted data, and assessed risk of bias using the Cochrane Collaboration's tool. RESULTS Out of 3617 publications, we included 14 that compared 33 treatments in 4183 participants. Overall, the methodological quality was poor to fair. The pooled effect size of e-health interventions was small (standardized mean difference = -0.19, 95%CI -0.31 to -0.06) for depression compared to control groups in the short-term, but this was maintained in the long-term (standardized mean difference = -0.22, 95%CI -0.35 to -0.09). Further analysis showed that e-health for depression had a small effect compared to care as usual and a moderate effect compared to waiting lists. One trial on anxiety showed no significant results. Four trials reported on cost-effectiveness. LIMITATIONS The trials studied different types of e-health interventions and had several risks of bias. Moreover, only one study was included for anxiety. CONCLUSIONS E-health interventions for depression have a small effect in primary care, with a moderate effect compared to waiting lists. The approach also appeared to be cost-effective for depression. However, we found no evidence for its effectiveness for anxiety.
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Affiliation(s)
- Btissame Massoudi
- University of Groningen, University Medical Center Groningen, Department of General Practice, Groningen, the Netherlands.
| | - Floor Holvast
- University of Groningen, University Medical Center Groningen, Department of General Practice, Groningen, the Netherlands.
| | - Claudi L H Bockting
- University of Utrecht, Department of Clinical Psychology, Utrecht, the Netherlands; University of Groningen, Department of Clinical Psychology, Groningen, the Netherlands.
| | - Huibert Burger
- University of Groningen, University Medical Center Groningen, Department of General Practice, Groningen, the Netherlands.
| | - Marco H Blanker
- University of Groningen, University Medical Center Groningen, Department of General Practice, Groningen, the Netherlands.
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van Bronswijk S, Moopen N, Beijers L, Ruhe HG, Peeters F. Effectiveness of psychotherapy for treatment-resistant depression: a meta-analysis and meta-regression. Psychol Med 2019; 49:366-379. [PMID: 30139408 DOI: 10.1017/s003329171800199x] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Despite substantial advances in treatment and management strategies for major depression, less than 50% of patients respond to first-line antidepressant treatment or psychotherapy. Given the growing number of controlled studies of psychotherapy for treatment-resistant depression (TRD) and the preference for psychotherapy of depressed subjects as a treatment option, we conducted a meta-analysis and meta-regression analysis to investigate the effectiveness of psychotherapy for TRD. Seven different psychotherapies were studied in 21 trials that included a total of 25 comparisons. In three comparisons of psychotherapy v. treatment as usual (TAU) we found no evidence to conclude that there is a significant benefit of psychotherapy as compared with TAU. In 22 comparisons of add-on psychotherapy plus TAU v. TAU only, we found a moderate general effect size of 0.42 (95% CI 0.29-0.54) in favor of psychotherapy plus TAU. The meta-regression provided evidence for a positive association between baseline severity as well as group v. individual therapy format with the treatment effect. There was no evidence for publication bias. Most frequent investigated treatments were cognitive behavior therapy, interpersonal psychotherapy, mindfulness-based cognitive therapy, and cognitive behavioral analysis system of psychotherapy. Our meta-analysis provides evidence that, in addition to pharmacological and neurostimulatory treatments, the inclusion of add-on of psychotherapy to TAU in guidelines for the treatment of TRD is justified and will provide better outcomes for this difficult-to-treat population.
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Affiliation(s)
- Suzanne van Bronswijk
- Department of Psychiatry and Psychology,University Hospital Maastricht, School for Mental Health and Neuroscience, Faculty of Health, Medicine and Life Sciences, Maastricht University,P.O. Box 5800, 6202 AZ Maastricht,The Netherlands
| | - Neha Moopen
- School of Social and Behavioral Sciences, Tilburg University,Tilburg,The Netherlands
| | - Lian Beijers
- Department of Psychiatry,University of Groningen, University Medical Center Groningen, Interdisciplinary Center Psychopathology and Emotion regulation (ICPE),Groningen,The Netherlands
| | - Henricus G Ruhe
- Department of Psychiatry,Warneford Hospital, University of Oxford,Oxford,UK
| | - Frenk Peeters
- Department of Psychiatry and Psychology,University Hospital Maastricht, School for Mental Health and Neuroscience, Faculty of Health, Medicine and Life Sciences, Maastricht University,P.O. Box 5800, 6202 AZ Maastricht,The Netherlands
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Kamijima K, Yasuda M, Yamamura K, Fukuta Y. Real-world effectiveness and safety of aripiprazole augmentation therapy in patients with major depressive disorder. Curr Med Res Opin 2018; 34:2105-2112. [PMID: 30173568 DOI: 10.1080/03007995.2018.1519317] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
AIMS Augmentation therapy is an option for patients with major depressive disorder who do respond sufficiently to adequate dosages of selective serotonin reuptake inhibitors or serotonin-norepinephrine reuptake inhibitors, but little is known about application of this strategy in everyday practice. METHODS This prospective, multi-center, observational study investigated the effectiveness and safety of aripiprazole augmentation in Japanese patients with inadequate response to conventional antidepressant therapy in real-world clinical practice. The primary endpoint was mean change in the (Japanese version) Montgomery-Åsberg Depression Rating Scale (MADRS) total score from baseline to study end. Safety was assessed by monitoring adverse events. RESULTS There were 1103 patients in the safety population and 1090 patients in the effectiveness population. Mean change in the MADRS total score at study end was -14.9 ± 12.3 (p < .001 vs baseline). The remission rate increased from 34.5% at Month 6 to 43.3% at Month 12, suggesting additional benefit with continued treatment. The type of primary antidepressant (paroxetine, fluvoxamine, sertraline, milnacipran, duloxetine, mirtazapine, or escitalopram) had no influence on the effectiveness of aripiprazole augmentation therapy. A baseline MADRS total score of <33 points and an elapsed time of <176 days from an episode of depression to the start of aripiprazole treatment increased the likelihood of achieving remission; 24.8% of patients experienced at least one adverse event, but no new safety signals were identified. CONCLUSIONS Aripiprazole augmentation therapy appears to be effective and safe in Japanese patients with depression/depressive symptoms treated in everyday clinical practice, taking into account factors associated with achieving remission.
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Karyotaki E, Kemmeren L, Riper H, Twisk J, Hoogendoorn A, Kleiboer A, Mira A, Mackinnon A, Meyer B, Botella C, Littlewood E, Andersson G, Christensen H, Klein JP, Schröder J, Bretón-López J, Scheider J, Griffiths K, Farrer L, Huibers MJH, Phillips R, Gilbody S, Moritz S, Berger T, Pop V, Spek V, Cuijpers P. Is self-guided internet-based cognitive behavioural therapy (iCBT) harmful? An individual participant data meta-analysis. Psychol Med 2018; 48:2456-2466. [PMID: 29540243 PMCID: PMC6190066 DOI: 10.1017/s0033291718000648] [Citation(s) in RCA: 78] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Revised: 01/02/2018] [Accepted: 02/16/2018] [Indexed: 11/07/2022]
Abstract
BACKGROUND Little is known about potential harmful effects as a consequence of self-guided internet-based cognitive behaviour therapy (iCBT), such as symptom deterioration rates. Thus, safety concerns remain and hamper the implementation of self-guided iCBT into clinical practice. We aimed to conduct an individual participant data (IPD) meta-analysis to determine the prevalence of clinically significant deterioration (symptom worsening) in adults with depressive symptoms who received self-guided iCBT compared with control conditions. Several socio-demographic, clinical and study-level variables were tested as potential moderators of deterioration. METHODS Randomised controlled trials that reported results of self-guided iCBT compared with control conditions in adults with symptoms of depression were selected. Mixed effects models with participants nested within studies were used to examine possible clinically significant deterioration rates. RESULTS Thirteen out of 16 eligible trials were included in the present IPD meta-analysis. Of the 3805 participants analysed, 7.2% showed clinically significant deterioration (5.8% and 9.1% of participants in the intervention and control groups, respectively). Participants in self-guided iCBT were less likely to deteriorate (OR 0.62, p < 0.001) compared with control conditions. None of the examined participant- and study-level moderators were significantly associated with deterioration rates. CONCLUSIONS Self-guided iCBT has a lower rate of negative outcomes on symptoms than control conditions and could be a first step treatment approach for adult depression as well as an alternative to watchful waiting in general practice.
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Affiliation(s)
- Eirini Karyotaki
- Department of Clinical Psychology, VU Amsterdam and Institute for Public Health Research, Amsterdam, the Netherlands
| | - Lise Kemmeren
- Department of Psychiatry, GGZ inGeest and VU University Medical Centre, Amsterdam Public Health research institute, Amsterdam, the Netherlands
| | - Heleen Riper
- Department of Clinical Psychology, VU Amsterdam and Institute for Public Health Research, Amsterdam, the Netherlands
| | - Jos Twisk
- Department of Epidemiology and Biostatistics and Amsterdam Institute for Public Health Research, VU University Amsterdam, Amsterdam, the Netherlands
| | - Adriaan Hoogendoorn
- Department of Psychiatry, GGZ inGeest and VU University Medical Centre, Amsterdam Public Health research institute, Amsterdam, the Netherlands
| | - Annet Kleiboer
- Department of Clinical Psychology, VU Amsterdam and Institute for Public Health Research, Amsterdam, the Netherlands
| | - Adriana Mira
- Department of Psychology and Technology, Jaume University, Castellon, Spain
- CIBER Fisiopatología Obesidad y Nutrición (CIBERobn), Instituto Salud Carlos III, Spain
| | - Andrew Mackinnon
- Black Dog Institute and University of New South Wales, Prince of Wales Hospital, Sydney, Australia
- Center for Mental Health, University of Melbourne, Melbourne, Australia
| | - Björn Meyer
- Research Department, Germany and Department of Psychology, City University, Gaia AG, Hamburg, London, UK
| | - Cristina Botella
- Department of Psychology and Technology, Jaume University, Castellon, Spain
- CIBER Fisiopatología Obesidad y Nutrición (CIBERobn), Instituto Salud Carlos III, Spain
| | | | - Gerhard Andersson
- Department of Behavioural Sciences and Learning, Sweden Institute for Disability Research, Linköping University, Linköping, Sweden
- Department of Clinical Neuroscience, Psychiatry Section, Karolinska Institute for Disability Research, Stockholm, Sweden
| | - Helen Christensen
- Black Dog Institute and University of New South Wales, Prince of Wales Hospital, Sydney, Australia
| | - Jan P. Klein
- Department of Psychiatry and Psychotherapy, Lübeck University, Lübeck, Germany
| | - Johanna Schröder
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Juana Bretón-López
- Department of Psychology and Technology, Jaume University, Castellon, Spain
- CIBER Fisiopatología Obesidad y Nutrición (CIBERobn), Instituto Salud Carlos III, Spain
| | - Justine Scheider
- Institute of Mental Health, University of Nottingham, Nottingham, UK
| | - Kathy Griffiths
- Research School of Psychology, College of Biology, Medicine & Environment, Australian National University, Canberra, Australia
| | - Louise Farrer
- Centre for Mental Health Research, The Australian National University, Canberra, Australia
| | - Marcus J. H. Huibers
- Department of Clinical Psychology, VU Amsterdam and Institute for Public Health Research, Amsterdam, the Netherlands
| | - Rachel Phillips
- Department of Primary Care and Public Health Sciences, King's College London, London, UK
| | - Simon Gilbody
- Department of Health Sciences, University of York, York, UK
| | - Steffen Moritz
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Thomas Berger
- Department of Clinical Psychology and Psychotherapy, University of Bern, Bern, Switzerland
| | - Victor Pop
- CoRPS – Center of Research on Psychology in Somatic diseases, Tilburg University, Tilburg, the Netherlands
| | - Viola Spek
- CoRPS – Center of Research on Psychology in Somatic diseases, Tilburg University, Tilburg, the Netherlands
| | - Pim Cuijpers
- Department of Clinical Psychology, VU Amsterdam and Institute for Public Health Research, Amsterdam, the Netherlands
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Study Protocol for a Randomized Double Blind, Placebo Controlled Trial Exploring the Effectiveness of a Micronutrient Formula in Improving Symptoms of Anxiety and Depression. MEDICINES 2018; 5:medicines5020056. [PMID: 30720786 PMCID: PMC6023275 DOI: 10.3390/medicines5020056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Revised: 06/10/2018] [Accepted: 06/11/2018] [Indexed: 11/29/2022]
Abstract
Background: Anxiety and depression are conferring an increasing burden on society. Although treatments exist for both conditions, side effects, and difficulties accessing treatment prevent many people from receiving adequate assistance. Nutritional approaches have demonstrated some success in treating anxiety and depression. We plan to investigate whether a micronutrient formula, Daily Essential Nutrients, improves symptoms of anxiety and depression compared to a placebo in a community recruited sample. Methods: This will be a randomized, double blind placebo controlled study (RCT). Two hundred adults will be assigned to either a placebo or micronutrient group (placebo or Daily Essential Nutrients (DEN)) in a 1:1 ratio. Baseline data will be collected for 2 weeks, followed by 10 weeks of placebo or micronutrient intervention. Psychometrics will be used to measure progress and participant safety will be monitored weekly. Results: The primary outcome measures will be total scores on three measures of symptom severity at 10 weeks. Linear mixed modelling will be used to measure between group differences and effect sizes will be calculated using pooled mean scores and standard deviations over the course of the trial. Conclusions: If effective, micronutrients could provide an alternative treatment, with fewer barriers and adverse events than currently available treatments.
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Hartmann WE, St Arnault DM, Gone JP. A Return to "The Clinic" for Community Psychology: Lessons from a Clinical Ethnography in Urban American Indian Behavioral Health. AMERICAN JOURNAL OF COMMUNITY PSYCHOLOGY 2018; 61:62-75. [PMID: 29266300 DOI: 10.1002/ajcp.12212] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Community psychology (CP) abandoned the clinic and disengaged from movements for community mental health (CMH) to escape clinical convention and pursue growing aspirations as an independent field of context-oriented, community-engaged, and values-driven research and action. In doing so, however, CP positioned itself on the sidelines of influential contemporary movements that promote potentially harmful, reductionist biomedical narratives in mental health. We advocate for a return to the clinic-the seat of institutional power in mental health-using critical clinic-based inquiry to open sites for clinical-community dialogue that can instigate transformative change locally and nationally. To inform such works within the collaborative and emancipatory traditions of CP, we detail a recently completed clinical ethnography and offer "lessons learned" regarding challenges likely to re-emerge in similar efforts. Conducted with an urban American Indian community behavioral health clinic, this ethnography examined how culture and culture concepts (e.g., cultural competence) shaped clinical practice with socio-political implications for American Indian peoples and the pursuit of transformative change in CMH. Lessons learned identify exceptional clinicians versed in ecological thinking and contextualist discourses of human suffering as ideal partners for this work; encourage intense contextualization and constraining critique to areas of mutual interest; and support relational approaches to clinic collaborations.
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Affiliation(s)
- William E Hartmann
- School of Interdisciplinary Arts and Sciences, University of Washington Bothell, Bothell, WA, USA
| | | | - Joseph P Gone
- Department of Psychology, University of Michigan, Ann Arbor, MI, USA
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Kolovos S, van Dongen JM, Riper H, Buntrock C, Cuijpers P, Ebert DD, Geraedts AS, Kenter RM, Nobis S, Smith A, Warmerdam L, Hayden JA, van Tulder MW, Bosmans JE. Cost effectiveness of guided Internet-based interventions for depression in comparison with control conditions: An individual-participant data meta-analysis. Depress Anxiety 2018; 35:209-219. [PMID: 29329486 PMCID: PMC5888145 DOI: 10.1002/da.22714] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Revised: 11/24/2017] [Accepted: 12/11/2017] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND There is limited evidence on the cost effectiveness of Internet-based treatments for depression. The aim was to evaluate the cost effectiveness of guided Internet-based interventions for depression compared to controls. METHODS Individual-participant data from five randomized controlled trials (RCT), including 1,426 participants, were combined. Cost-effectiveness analyses were conducted at 8 weeks, 6 months, and 12 months follow-up. RESULTS The guided Internet-based interventions were more costly than the controls, but not statistically significant (12 months mean difference = €406, 95% CI: - 611 to 1,444). The mean differences in clinical effects were not statistically significant (12 months mean difference = 1.75, 95% CI: - .09 to 3.60 in Center for Epidemiologic Studies Depression Scale [CES-D] score, .06, 95% CI: - .02 to .13 in response rate, and .00, 95% CI: - .03 to .03 in quality-adjusted life-years [QALYs]). Cost-effectiveness acceptability curves indicated that high investments are needed to reach an acceptable probability that the intervention is cost effective compared to control for CES-D and response to treatment (e.g., at 12-month follow-up the probability of being cost effective was .95 at a ceiling ratio of 2,000 €/point of improvement in CES-D score). For QALYs, the intervention's probability of being cost effective compared to control was low at the commonly accepted willingness-to-pay threshold (e.g., at 12-month follow-up the probability was .29 and. 31 at a ceiling ratio of 24,000 and 35,000 €/QALY, respectively). CONCLUSIONS Based on the present findings, guided Internet-based interventions for depression are not considered cost effective compared to controls. However, only a minority of RCTs investigating the clinical effectiveness of guided Internet-based interventions also assessed cost effectiveness and were included in this individual-participant data meta-analysis.
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Affiliation(s)
- Spyros Kolovos
- Department of Health SciencesFaculty of Earth and Life Sciences, Amsterdam Public Health Research InstituteVU University AmsterdamAmsterdamThe Netherlands,Department of ClinicalNeuro and Developmental Psychology, Amsterdam Public Health Research InstituteVrije Universiteit AmsterdamAmsterdamThe Netherlands
| | - Johanna M. van Dongen
- Department of Health SciencesFaculty of Earth and Life Sciences, Amsterdam Public Health Research InstituteVU University AmsterdamAmsterdamThe Netherlands
| | - Heleen Riper
- Department of ClinicalNeuro and Developmental Psychology, Amsterdam Public Health Research InstituteVrije Universiteit AmsterdamAmsterdamThe Netherlands
| | - Claudia Buntrock
- Department of ClinicalNeuro and Developmental Psychology, Amsterdam Public Health Research InstituteVrije Universiteit AmsterdamAmsterdamThe Netherlands,Department of Clinical Psychology and Psychotherapy, Institute of PsychologyUniversity of Erlangen‐NürnbergNägelsbachstrErlangenGermany
| | - Pim Cuijpers
- Department of ClinicalNeuro and Developmental Psychology, Amsterdam Public Health Research InstituteVrije Universiteit AmsterdamAmsterdamThe Netherlands
| | - David D. Ebert
- Department of Clinical Psychology and Psychotherapy, Institute of PsychologyUniversity of Erlangen‐NürnbergNägelsbachstrErlangenGermany
| | | | - Robin M. Kenter
- Department of ClinicalNeuro and Developmental Psychology, Amsterdam Public Health Research InstituteVrije Universiteit AmsterdamAmsterdamThe Netherlands
| | - Stephanie Nobis
- Division of Online Health TrainingInnovation IncubatorLeuphana University LueneburgLueneburgGermany
| | - Andrea Smith
- Department of Community Health and EpidemiologyFaculty of MedicineDalhousie UniversityHalifaxNova ScotiaCanada
| | - Lisanne Warmerdam
- Stichting Benchmark GGZ (the Dutch Benchmark Foundation in Mental Health Care)BilthovenThe Netherlands
| | - Jill A. Hayden
- Department of Community Health and EpidemiologyFaculty of MedicineDalhousie UniversityHalifaxNova ScotiaCanada
| | - Maurits W. van Tulder
- Department of Health SciencesFaculty of Earth and Life Sciences, Amsterdam Public Health Research InstituteVU University AmsterdamAmsterdamThe Netherlands
| | - Judith E. Bosmans
- Department of Health SciencesFaculty of Earth and Life Sciences, Amsterdam Public Health Research InstituteVU University AmsterdamAmsterdamThe Netherlands
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Belvederi Murri M, Ekkekakis P, Magagnoli M, Zampogna D, Cattedra S, Capobianco L, Serafini G, Calcagno P, Zanetidou S, Amore M. Physical Exercise in Major Depression: Reducing the Mortality Gap While Improving Clinical Outcomes. Front Psychiatry 2018; 9:762. [PMID: 30687141 PMCID: PMC6335323 DOI: 10.3389/fpsyt.2018.00762] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Accepted: 12/20/2018] [Indexed: 12/11/2022] Open
Abstract
Major depression shortens life while the effectiveness of frontline treatments remains modest. Exercise has been shown to be effective both in reducing mortality and in treating symptoms of major depression, but it is still underutilized in clinical practice, possibly due to prevalent misperceptions. For instance, a common misperception is that exercise is beneficial for depression mostly because of its positive effects on the body ("from the neck down"), whereas its effectiveness in treating core features of depression ("from the neck up") is underappreciated. Other long-held misperceptions are that patients suffering from depression will not engage in exercise even if physicians prescribe it, and that only vigorous exercise is effective. Lastly, a false assumption is that exercise may be more harmful than beneficial in old age, and therefore should only be recommended to younger patients. This narrative review summarizes relevant literature to address the aforementioned misperceptions and to provide practical recommendations for prescribing exercise to individuals with major depression.
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Affiliation(s)
- Martino Belvederi Murri
- Section of Psychiatry, Department of Neuroscience, Ophthalmology, Genetics and Infant-Maternal Science, University of Genoa, Genoa, Italy.,IRCCS Ospedale Policlinico San Martino, Genova, Italy.,Department of Psychological Medicine, King's College London, London, United Kingdom
| | | | - Marco Magagnoli
- Section of Psychiatry, Department of Neuroscience, Ophthalmology, Genetics and Infant-Maternal Science, University of Genoa, Genoa, Italy
| | - Domenico Zampogna
- Section of Psychiatry, Department of Neuroscience, Ophthalmology, Genetics and Infant-Maternal Science, University of Genoa, Genoa, Italy
| | - Simone Cattedra
- Section of Psychiatry, Department of Neuroscience, Ophthalmology, Genetics and Infant-Maternal Science, University of Genoa, Genoa, Italy
| | - Laura Capobianco
- Section of Psychiatry, Department of Neuroscience, Ophthalmology, Genetics and Infant-Maternal Science, University of Genoa, Genoa, Italy
| | - Gianluca Serafini
- Section of Psychiatry, Department of Neuroscience, Ophthalmology, Genetics and Infant-Maternal Science, University of Genoa, Genoa, Italy.,IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Pietro Calcagno
- Section of Psychiatry, Department of Neuroscience, Ophthalmology, Genetics and Infant-Maternal Science, University of Genoa, Genoa, Italy
| | - Stamatula Zanetidou
- Department of Mental Health, Consultation Liaison Psychiatry Service, Bologna, Italy
| | - Mario Amore
- Section of Psychiatry, Department of Neuroscience, Ophthalmology, Genetics and Infant-Maternal Science, University of Genoa, Genoa, Italy.,IRCCS Ospedale Policlinico San Martino, Genova, Italy
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Alsaraireh FA, Aloush SM. Mindfulness Meditation Versus Physical Exercise in the Management of Depression Among Nursing Students. J Nurs Educ 2017; 56:599-604. [DOI: 10.3928/01484834-20170918-04] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2016] [Accepted: 04/25/2017] [Indexed: 02/06/2023]
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Control conditions for randomised trials of behavioural interventions in psychiatry: a decision framework. Lancet Psychiatry 2017; 4:725-732. [PMID: 28396067 DOI: 10.1016/s2215-0366(17)30153-0] [Citation(s) in RCA: 107] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Revised: 03/16/2017] [Accepted: 03/20/2017] [Indexed: 11/21/2022]
Abstract
In psychiatry, comparative analyses of therapeutic options and the aggregation of data from clinical trials across different therapeutic approaches play an important role in clinical decision making, treatment guidelines, and health policy. This approach assumes that trials of pharmacological and behavioural therapies generally produce the same level of evidence when properly designed. However, trial design for behavioural interventions has some unique characteristics and control groups vary widely, which influence the effects observed in any given trial. In this Personal View, we review various control conditions typically used in psychiatry, outline their effect on the internal validity and expected effect size of a trial, and propose a decision framework for choosing a control condition depending on the risk to the patient population and the stage of development of the therapeutic intervention. We argue that the choice of control group and its justification need to be taken into consideration when comparing behavioural and pharmacological therapies.
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Mohamed S, Johnson GR, Chen P, Hicks PB, Davis LL, Yoon J, Gleason TC, Vertrees JE, Weingart K, Tal I, Scrymgeour A, Lawrence DD, Planeta B, Thase ME, Huang GD, Zisook S. Effect of Antidepressant Switching vs Augmentation on Remission Among Patients With Major Depressive Disorder Unresponsive to Antidepressant Treatment: The VAST-D Randomized Clinical Trial. JAMA 2017; 318:132-145. [PMID: 28697253 PMCID: PMC5817471 DOI: 10.1001/jama.2017.8036] [Citation(s) in RCA: 94] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
IMPORTANCE Less than one-third of patients with major depressive disorder (MDD) achieve remission with their first antidepressant. OBJECTIVE To determine the relative effectiveness and safety of 3 common alternate treatments for MDD. DESIGN, SETTING, AND PARTICIPANTS From December 2012 to May 2015, 1522 patients at 35 US Veterans Health Administration medical centers who were diagnosed with nonpsychotic MDD, unresponsive to at least 1 antidepressant course meeting minimal standards for treatment dose and duration, participated in the study. Patients were randomly assigned (1:1:1) to 1 of 3 treatments and evaluated for up to 36 weeks. INTERVENTIONS Switch to a different antidepressant, bupropion (switch group, n = 511); augment current treatment with bupropion (augment-bupropion group, n = 506); or augment with an atypical antipsychotic, aripiprazole (augment-aripiprazole group, n = 505) for 12 weeks (acute treatment phase) and up to 36 weeks for longer-term follow-up (continuation phase). MAIN OUTCOMES AND MEASURES The primary outcome was remission during the acute treatment phase (16-item Quick Inventory of Depressive Symptomatology-Clinician Rated [QIDS-C16] score ≤5 at 2 consecutive visits). Secondary outcomes included response (≥50% reduction in QIDS-C16 score or improvement on the Clinical Global Impression Improvement scale), relapse, and adverse effects. RESULTS Among 1522 randomized patients (mean age, 54.4 years; men, 1296 [85.2%]), 1137 (74.7%) completed the acute treatment phase. Remission rates at 12 weeks were 22.3% (n = 114) for the switch group, 26.9% (n = 136)for the augment-bupropion group, and 28.9% (n = 146) for the augment-aripiprazole group. The augment-aripiprazole group exceeded the switch group in remission (relative risk [RR], 1.30 [95% CI, 1.05-1.60]; P = .02), but other remission comparisons were not significant. Response was greater for the augment-aripiprazole group (74.3%) than for either the switch group (62.4%; RR, 1.19 [95% CI, 1.09-1.29]) or the augment-bupropion group (65.6%; RR, 1.13 [95% CI, 1.04-1.23]). No significant treatment differences were observed for relapse. Anxiety was more frequent in the 2 bupropion groups (24.3% in the switch group [n = 124] vs 16.6% in the augment-aripiprazole group [n = 84]; and 22.5% in augment-bupropion group [n = 114]). Adverse effects more frequent in the augment-aripiprazole group included somnolence, akathisia, and weight gain. CONCLUSIONS AND RELEVANCE Among a predominantly male population with major depressive disorder unresponsive to antidepressant treatment, augmentation with aripiprazole resulted in a statistically significant but only modestly increased likelihood of remission during 12 weeks of treatment compared with switching to bupropion monotherapy. Given the small effect size and adverse effects associated with aripiprazole, further analysis including cost-effectiveness is needed to understand the net utility of this approach. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT01421342.
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Affiliation(s)
- Somaia Mohamed
- Veterans Affairs (VA) New England Mental Illness Research, Education, and Clinical Center, VA Connecticut Healthcare System, West Haven
- Yale University School of Medicine, West Haven, Connecticut
| | - Gary R. Johnson
- Cooperative Studies Program Coordinating Center, VA Connecticut Healthcare System, West Haven
| | - Peijun Chen
- Louis Stokes VA Medical Center and Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Paul B. Hicks
- Central Texas Veterans Healthcare System and Department of Psychiatry and Behavioral Science, Texas A&M Health Science Center College of Medicine, Temple
- Central Texas Veterans Healthcare System, Temple
| | - Lori L. Davis
- Tuscaloosa VA Medical Center, Tuscaloosa, Alabama
- University of Alabama School of Medicine, Birmingham
| | - Jean Yoon
- Health Economics Resource Center, VA Palo Alto, Menlo Park, California
| | - Theresa C. Gleason
- Department of Veterans Affairs, Office of Research and Development, Washington, DC
| | - Julia E. Vertrees
- Cooperative Studies Program Clinical Research Pharmacy Coordinating Center, Albuquerque, New Mexico
| | - Kimberly Weingart
- VA San Diego Healthcare System, San Diego, California
- University of California, San Diego
| | - Ilanit Tal
- VA San Diego Healthcare System, San Diego, California
| | - Alexandra Scrymgeour
- Cooperative Studies Program Clinical Research Pharmacy Coordinating Center, Albuquerque, New Mexico
| | - David D. Lawrence
- Cooperative Studies Program Coordinating Center, VA Connecticut Healthcare System, West Haven
| | - Beata Planeta
- Cooperative Studies Program Coordinating Center, VA Connecticut Healthcare System, West Haven
| | | | - Grant D. Huang
- Cooperative Studies Program Central Office, Department of Veterans Affairs Office of Research and Development, Washington, DC
| | - Sidney Zisook
- VA San Diego Healthcare System, San Diego, California
- University of California, San Diego
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