Four potential criteria for deciding when to use antidepressants or psychotherapy for unipolar depression: a literature review

Combining psychopharmacotherapy and psychotherapy is not associated with better treatment outcome in major depressive disorder - evidence from the European Group for the Study of Resistant Depression

Despite plenty of effective antidepressant (AD) treatments, the outcome of major depressive disorder (MDD) is often unsatisfactory, probably due to improvable exploitation of available therapies. This European, cross-sectional, naturalistic multicenter study investigated the frequency of additional psychotherapy in terms of a manual-driven psychotherapy (MDP) in 1410 adult in- and outpatients with MDD, who were primarily treated with AD psychopharmacotherapy. Socio-demographic and clinical patterns were compared between patients receiving both treatments and those lacking concomitant MDP. In a total of 1279 MDD patients (90.7%) with known status of additional MDP, those undergoing a psychopharmacotherapy-MDP combination (31.2%) were younger, higher educated, more often employed and less severely ill with lower odds for suicidality as compared to patients receiving exclusively psychopharmacotherapy (68.8%). They experienced an earlier mean age of MDD onset, melancholic features, comorbid asthma and migraine and received lower daily doses of their first-line ADs. While agomelatine was more often established in these patients, MDD patients without MDP received selective serotonin reuptake inhibitors more frequently. These two patient groups did not differ in terms of response, non-response and treatment resistant depression (TRD). Accordingly, the employment of additional MDP could not be related to better treatment outcomes in MDD. The fact that MDP was applied in a minority of patients with rather beneficial socio-demographic and clinical characteristics might reflect inferior accessibility of these psychotherapeutic techniques for socially and economically disadvantaged populations.

Predictors and moderators of outcome in child and adolescent anxiety and depression: a systematic review of psychological treatment studies

The aim of this literature review was to examine pre-treatment child and adolescent characteristics as predictors and moderators of outcome in psychotherapy treatment trials of anxiety and depressive disorders. A literature search was conducted using several databases and resulted in 45 published studies (32 anxiety studies and 13 depression studies) meeting predefined methodological criteria. Ten client demographic (age, gender, ethnicity, IQ) and clinical factors (duration, type of diagnosis, pre-treatment severity, comorbidity) were examined across studies. The majority of findings showed non-significant associations between demographic factors (gender and age) with treatment outcome for both the anxiety and the depression treatment trials. Some important differences between the results of the anxiety and depression treatment trials were found. The majority of findings for the anxiety studies suggest that there are no demographic or clinical factors that predict or moderate treatment outcome. For the depression studies, however, the findings suggest that baseline symptom severity and comorbid anxiety may impact on treatment response. Overall, existing studies of pre-treatment patient variables as predictors and moderators of anxiety and depression treatment outcome provide little consistent knowledge concerning for what type of patients and under what conditions treatments work. Suggestions for future research are discussed.

An ultra-short screening version of the Recalled Parental Rearing Behavior questionnaire (FEE-US) and its factor structure in a representative German sample

BACKGROUND

The Recalled Parental Rearing Behavior questionnaire (FEE, [1,2]) assesses perceived parental rearing behavior separately for each parent. An ultra-short screening version (FEE-US) with the same three scales each for the mother and the father is reported and factor-analytically validated.

METHODS

N = 4,640 subjects aged 14 to 92 (M = 48.4 years) were selected by the random-route sampling method. The ultra-short questionnaire version was derived from the long version through item and factor analyses. In a confirmatory factor analysis framework, the hypothesized three-factorial structure was fitted to the empirical data and tested for measurement invariance, differential item functioning, item discriminability, and convergent and discriminant factorial validity. Effects of gender or age were assessed using MANOVAs.

RESULTS

The a-priori hypothesized model resulted in mostly adequate overall fit. Neither gender nor age group yielded considerable effects on the factor structure, but had small effects on means of raw score sums. Factorial validities could be confirmed. Scale sums are well-suited to rank respondents along the respective latent dimension.

CONCLUSION

The structure of the long version with the factors Rejection & Punishment, Emotional Warmth, and Control & Overprotection could be replicated for both father and mother items in the ultra-short screening version using confirmatory factor analyses. These results indicate that the ultra-short screening version is a time-saving and promising screening instrument for research settings and in individual counseling. However, the shortened scales do not necessarily represent the full spectrum covered by the full-scale dimensions.

Do prostate cancer patients suffer more from depressed mood or anhedonia?

OBJECTIVE

This study aimed to compare the prevalence of depressed mood and anhedonia in a sample of men with prostate cancer (PCa) and to determine which of these key symptoms contributed most to the overall depressive status of that sample.

METHOD

From Zung Self-rating Depression Scale (SDS) responses collected on 526 PCa patients, direct comparisons were made between the prevalence of the first two DSM-IV-TR symptoms of Major Depressive Episode. These symptoms were then tested for their predictive power on depression total score and Zung's criteria for 'clinically significant' depression.

RESULTS

Mean scores for anhedonia were significantly higher than for depressed mood, and nearly 25 times as many patients had a high score for anhedonia as for depressed mood. The same pattern of results was apparent for those patients who had clinically significant levels of depression. Anhedonia was a more powerful predictor of total SDS depression score for the entire sample as well as for those patients with more severe depression.

CONCLUSION

Because the biological basis for anhedonia is different to that for depressed mood, treatment options also differ for patients who show a preponderance of anhedonia in their depressive symptomatology. Suggestions are made for treatment choices for these PCa patients.