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Kuzminskaite E, Gathier AW, Cuijpers P, Penninx BW, Ammerman RT, Brakemeier EL, Bruijniks S, Carletto S, Chakrabarty T, Douglas K, Dunlop BW, Elsaesser M, Euteneuer F, Guhn A, Handley ED, Heinonen E, Huibers MJ, Jobst A, Johnson GR, Klein DN, Kopf-Beck J, Lemmens L, Lu XW, Mohamed S, Nakagawa A, Okada S, Rief W, Tozzi L, Trivedi MH, van Bronswijk S, van Oppen P, Zisook S, Zobel I, Vinkers CH. Treatment efficacy and effectiveness in adults with major depressive disorder and childhood trauma history: a systematic review and meta-analysis. Lancet Psychiatry 2022; 9:860-873. [PMID: 36156242 DOI: 10.1016/s2215-0366(22)00227-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 04/28/2022] [Accepted: 06/02/2022] [Indexed: 11/23/2022]
Abstract
BACKGROUND Childhood trauma is a common and potent risk factor for developing major depressive disorder in adulthood, associated with earlier onset, more chronic or recurrent symptoms, and greater probability of having comorbidities. Some studies indicate that evidence-based pharmacotherapies and psychotherapies for adult depression might be less efficacious in patients with a history of childhood trauma than patients without childhood trauma, but findings are inconsistent. Therefore, we examined whether individuals with major depressive disorder, including chronic forms of depression, and a reported history of childhood trauma, had more severe depressive symptoms before treatment, had more unfavourable treatment outcomes following active treatments, and were less likely to benefit from active treatments relative to a control condition, compared with individuals with depression without childhood trauma. METHODS We did a comprehensive meta-analysis (PROSPERO CRD42020220139). Study selection combined the search of bibliographical databases (PubMed, PsycINFO, and Embase) from Nov 21, 2013, to March 16, 2020, and full-text randomised clinical trials (RCTs) identified from several sources (1966 up to 2016-19) to identify articles in English. RCTs and open trials comparing the efficacy or effectiveness of evidence-based pharmacotherapy, psychotherapy, or combination intervention for adult patients with depressive disorders and the presence or absence of childhood trauma were included. Two independent researchers extracted study characteristics. Group data for effect-size calculations were requested from study authors. The primary outcome was depression severity change from baseline to the end of the acute treatment phase, expressed as standardised effect size (Hedges' g). Meta-analyses were done using random-effects models. FINDINGS From 10 505 publications, 54 trials met the inclusion criteria, of which 29 (20 RCTs and nine open trials) contributed data of a maximum of 6830 participants (age range 18-85 years, male and female individuals and specific ethnicity data unavailable). More than half (4268 [62%] of 6830) of patients with major depressive disorder reported a history of childhood trauma. Despite having more severe depression at baseline (g=0·202, 95% CI 0·145 to 0·258, I2=0%), patients with childhood trauma benefitted from active treatment similarly to patients without childhood trauma history (treatment effect difference between groups g=0·016, -0·094 to 0·125, I2=44·3%), with no significant difference in active treatment effects (vs control condition) between individuals with and without childhood trauma (childhood trauma g=0·605, 0·294 to 0·916, I2=58·0%; no childhood trauma g=0·178, -0·195 to 0·552, I2=67·5%; between-group difference p=0·051), and similar dropout rates (risk ratio 1·063, 0·945 to 1·195, I2=0%). Findings did not significantly differ by childhood trauma type, study design, depression diagnosis, assessment method of childhood trauma, study quality, year, or treatment type or length, but differed by country (North American studies showed larger treatment effects for patients with childhood trauma; false discovery rate corrected p=0·0080). Most studies had a moderate to high risk of bias (21 [72%] of 29), but the sensitivity analysis in low-bias studies yielded similar findings to when all studies were included. INTERPRETATION Contrary to previous studies, we found evidence that the symptoms of patients with major depressive disorder and childhood trauma significantly improve after pharmacological and psychotherapeutic treatments, notwithstanding their higher severity of depressive symptoms. Evidence-based psychotherapy and pharmacotherapy should be offered to patients with major depressive disorder regardless of childhood trauma status. FUNDING None.
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van Bentum JS, Sijbrandij M, Saueressig F, Huibers MJ. The association between childhood maltreatment and suicidal intrusions: A cross-sectional study. J Trauma Stress 2022; 35:1273-1281. [PMID: 35285097 PMCID: PMC9542979 DOI: 10.1002/jts.22821] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 01/27/2022] [Accepted: 02/09/2022] [Indexed: 11/18/2022]
Abstract
Childhood maltreatment may play an important role in the transition from suicidal ideation to suicidal behavior. Recently, research has begun evaluating the association between childhood maltreatment and involuntary and distressing intrusions about one's own suicide, also called suicidal intrusions. This cross-sectional, multicenter study aimed to investigate the association between childhood maltreatment and the severity of suicidal intrusions using online questionnaires. Participants were suicidal outpatients currently receiving treatment at a Dutch mental health institution (N = 149). The Childhood Trauma Questionnaire-Short Form and Suicidal Intrusions Attributes Scale were administered online. A simple linear regression was performed followed by a multiple linear regression with backward selection to separate the predictors of childhood maltreatment subscales. Next, significant predictor variables were used to perform an additional regression analysis with gender, age, posttraumatic stress disorder (PTSD) diagnosis, and depressive symptoms as potential covariates. The results showed that childhood maltreatment was significantly associated with suicidal intrusion scores, B = .22, t(147) = 2.010, p = .046. A multiple linear regression analysis showed that the only specific form of childhood maltreatment associated with suicidal intrusions was sexual abuse; the association remained after controlling for age, gender, PTSD diagnosis and depressive symptoms, F(5, 143) = 11.15, p < .001. In summary, the present study confirms the link between childhood maltreatment, particularly childhood sexual abuse, and suicidal intrusions. This finding implies that in the treatment of suicidal intrusions and suicidality, childhood sexual abuse should be identified and targeted with evidence-based treatments for PTSD.
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Affiliation(s)
- Jaël S. van Bentum
- Department of Clinical Neuro and Developmental PsychologyAmsterdam Public Health Research InstituteVrije Universiteit AmsterdamAmsterdamThe Netherlands
| | - Marit Sijbrandij
- Department of Clinical Neuro and Developmental PsychologyAmsterdam Public Health Research InstituteVrije Universiteit AmsterdamAmsterdamThe Netherlands,World Health Organization Collaborating Centre for Research and Dissemination of Psychological InterventionsVrije Universiteit AmsterdamThe Netherlands
| | - Fenna Saueressig
- Department of Clinical Neuro and Developmental PsychologyAmsterdam Public Health Research InstituteVrije Universiteit AmsterdamAmsterdamThe Netherlands
| | - Marcus J.H. Huibers
- Department of Clinical Neuro and Developmental PsychologyAmsterdam Public Health Research InstituteVrije Universiteit AmsterdamAmsterdamThe Netherlands,Department of PsychologyUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
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Geschwind N, van Teffelen M, Hammarberg E, Arntz A, Huibers MJ, Renner F. Impact of measurement frequency on self-reported depressive symptoms: An experimental study in a clinical setting. Journal of Affective Disorders Reports 2021. [DOI: 10.1016/j.jadr.2021.100168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Abstract
Psychotherapies may work through techniques that are specific to each therapy or through factors that all therapies have in common. Proponents of the common factors model often point to meta-analyses of comparative outcome studies that show all therapies have comparable effects. However, not all meta-analyses support the common factors model; the included studies often have several methodological problems; and there are alternative explanations for finding comparable outcomes. To date, research on the working mechanisms and mediators of therapies has always been correlational, and in order to establish that a mediator is indeed a causal factor in the recovery process of a patient, studies must show a temporal relationship between the mediator and an outcome, a dose–response association, evidence that no third variable causes changes in the mediator and the outcome, supportive experimental research, and have a strong theoretical framework. Currently, no common or specific factor meets these criteria and can be considered an empirically validated working mechanism. Therefore, it is still unknown whether therapies work through common or specific factors, or both.
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Affiliation(s)
- Pim Cuijpers
- Department of Clinical, Neuro-, and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, 1081 BT Amsterdam, The Netherlands
| | - Mirjam Reijnders
- Department of Clinical, Neuro-, and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, 1081 BT Amsterdam, The Netherlands
| | - Marcus J.H. Huibers
- Department of Clinical, Neuro-, and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, 1081 BT Amsterdam, The Netherlands
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van Bronswijk SC, Lemmens LH, Keefe JR, Huibers MJ, DeRubeis RJ, Peeters FP. A prognostic index for long-term outcome after successful acute phase cognitive therapy and interpersonal psychotherapy for major depressive disorder. Depress Anxiety 2019; 36:252-261. [PMID: 30516871 PMCID: PMC6587800 DOI: 10.1002/da.22868] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2018] [Revised: 10/21/2018] [Accepted: 11/08/2018] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Major depressive disorder (MDD) has a highly recurrent nature. After successful treatment, it is important to identify individuals who are at risk of an unfavorable long-term course. Despite extensive research, there is no consensus yet on the clinically relevant predictors of long-term outcome in MDD, and no prediction models are implemented in clinical practice. The aim of this study was to create a prognostic index (PI) to estimate long-term depression severity after successful and high quality acute treatment for MDD. METHODS Data come from responders to cognitive therapy (CT) and interpersonal psychotherapy (IPT) in a randomized clinical trial (n = 85; CT = 45, IPT = 40). Primary outcome was depression severity, assessed with the Beck Depression Inventory II, measured throughout a 17-month follow-up phase. We examined 29 variables as potential predictors, using a model-based recursive partitioning method and bootstrap resampling in conjunction with backwards elimination. The selected predictors were combined into a PI. Individual PI scores were estimated using a cross-validation approach. RESULTS A total of three post-treatment predictors were identified: depression severity, hopelessness, and self-esteem. Cross-validated PI scores evidenced a strong correlation (r = 0.60) with follow-up depression severity. CONCLUSION Long-term predictions of MDD are multifactorial, involving a combination of variables that each has a small prognostic effect. If replicated and validated, the PI can be implemented to predict follow-up depression severity for each individual after acute treatment response, and to personalize long-term treatment strategies.
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Affiliation(s)
- Suzanne C. van Bronswijk
- Department of Psychiatry and PsychologyMaastricht University Medical CenterMaastrichtthe Netherlands,School for Mental Health and Neuroscience, Faculty of Health, Medicine and Life Sciences, Maastricht UniversityMaastrichtthe Netherlands
| | - Lotte H.J.M. Lemmens
- Department of Clinical Psychological ScienceMaastricht UniversityMaastrichtthe Netherlands
| | - John R. Keefe
- Department of PsychologyUniversity of PennsylvaniaPhiladelphiaPAUnited States,Department of PsychiatryWeill Cornell Medical CollegeNew YorkUnited States
| | - Marcus J.H. Huibers
- Department of PsychologyUniversity of PennsylvaniaPhiladelphiaPAUnited States,Department of Clinical PsychologyVU University AmsterdamAmsterdamthe Netherlands
| | - Robert J. DeRubeis
- Department of PsychologyUniversity of PennsylvaniaPhiladelphiaPAUnited States
| | - Frenk P.M.L. Peeters
- Department of Psychiatry and PsychologyMaastricht University Medical CenterMaastrichtthe Netherlands,School for Mental Health and Neuroscience, Faculty of Health, Medicine and Life Sciences, Maastricht UniversityMaastrichtthe Netherlands
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Lemmens LH, Galindo-Garre F, Arntz A, Peeters F, Hollon SD, DeRubeis RJ, Huibers MJ. Exploring mechanisms of change in cognitive therapy and interpersonal psychotherapy for adult depression. Behav Res Ther 2017; 94:81-92. [DOI: 10.1016/j.brat.2017.05.005] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2016] [Revised: 05/03/2017] [Accepted: 05/06/2017] [Indexed: 11/27/2022]
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Janssen N, Huibers MJ, Lucassen P, Voshaar RO, van Marwijk H, Bosmans J, Pijnappels M, Spijker J, Hendriks GJ. Behavioural activation by mental health nurses for late-life depression in primary care: a randomized controlled trial. BMC Psychiatry 2017; 17:230. [PMID: 28651589 PMCID: PMC5485578 DOI: 10.1186/s12888-017-1388-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Depressive symptoms are common in older adults. The effectiveness of pharmacological treatments and the availability of psychological treatments in primary care are limited. A behavioural approach to depression treatment might be beneficial to many older adults but such care is still largely unavailable. Behavioural Activation (BA) protocols are less complicated and more easy to train than other psychological therapies, making them very suitable for delivery by less specialised therapists. The recent introduction of the mental health nurse in primary care centres in the Netherlands has created major opportunities for improving the accessibility of psychological treatments for late-life depression in primary care. BA may thus address the needs of older patients while improving treatment outcome and lowering costs.The primary objective of this study is to compare the effectiveness and cost-effectiveness of BA in comparison with treatment as usual (TAU) for late-life depression in Dutch primary care. A secondary goal is to explore several potential mechanisms of change, as well as predictors and moderators of treatment outcome of BA for late-life depression. METHODS/DESIGN Cluster-randomised controlled multicentre trial with two parallel groups: a) behavioural activation, and b) treatment as usual, conducted in primary care centres with a follow-up of 52 weeks. The main inclusion criterion is a PHQ-9 score > 9. Patients are excluded from the trial in case of severe mental illness that requires specialized treatment, high suicide risk, drug and/or alcohol abuse, prior psychotherapy, change in dosage or type of prescribed antidepressants in the previous 12 weeks, or moderate to severe cognitive impairment. The intervention consists of 8 weekly 30-min BA sessions delivered by a trained mental health nurse. DISCUSSION We expect BA to be an effective and cost-effective treatment for late-life depression compared to TAU. BA delivered by mental health nurses could increase the availability and accessibility of non-pharmacological treatments for late-life depression in primary care. TRIAL REGISTRATION This study is retrospectively registered in the Dutch Clinical Trial Register NTR6013 on August 25th 2016.
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Affiliation(s)
- Noortje Janssen
- 0000000122931605grid.5590.9Behavioural Science Institute, Radboud University, Nijmegen, The Netherlands ,0000 0004 0444 9382grid.10417.33Department of Primary and Community Care, Radboud University Medical Centre Nijmegen, Nijmegen, The Netherlands ,Institute for Integrated Mental Health Care “Pro Persona, Nijmegen, The Netherlands
| | - Marcus J.H. Huibers
- 0000 0004 1754 9227grid.12380.38Department of Clinical Psychology, VU University Amsterdam, Amsterdam, The Netherlands
| | - Peter Lucassen
- 0000 0004 0444 9382grid.10417.33Department of Primary and Community Care, Radboud University Medical Centre Nijmegen, Nijmegen, The Netherlands
| | - Richard Oude Voshaar
- 0000 0004 0407 1981grid.4830.fUniversity Medical Center Groningen, Interdisciplinary Center for Psychopathology of Emotion regulation (ICPE), University of Groningen, Groningen, The Netherlands
| | - Harm van Marwijk
- 0000000121662407grid.5379.8Centre for Primary Care, Institute for Population Health, University of Manchester, Manchester, UK ,0000 0004 1754 9227grid.12380.38Department of Health Sciences and EMGO Institute for Health and Care Research, Faculty of Earth and Life Sciences, VU university Amsterdam, Amsterdam, The Netherlands
| | - Judith Bosmans
- 0000 0004 1754 9227grid.12380.38Department of Health Sciences and EMGO Institute for Health and Care Research, Faculty of Earth and Life Sciences, VU university Amsterdam, Amsterdam, The Netherlands
| | - Mirjam Pijnappels
- 0000 0004 1754 9227grid.12380.38MOVE Research Institute Amsterdam, Faculty of Human Movement Sciences, VU University Amsterdam, Amsterdam, The Netherlands
| | - Jan Spijker
- 0000000122931605grid.5590.9Behavioural Science Institute, Radboud University, Nijmegen, The Netherlands ,Institute for Integrated Mental Health Care “Pro Persona, Nijmegen, The Netherlands ,0000 0004 0444 9382grid.10417.33Department of Psychiatry, Radboud University Medical Centre Nijmegen, Nijmegen, The Netherlands
| | - Gert-Jan Hendriks
- Behavioural Science Institute, Radboud University, Nijmegen, The Netherlands. .,Institute for Integrated Mental Health Care "Pro Persona, Nijmegen, The Netherlands. .,Department of Psychiatry, Radboud University Medical Centre Nijmegen, Nijmegen, The Netherlands.
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Lemmens LH, DeRubeis RJ, Arntz A, Peeters FP, Huibers MJ. Sudden gains in Cognitive Therapy and Interpersonal Psychotherapy for adult depression. Behav Res Ther 2016; 77:170-6. [DOI: 10.1016/j.brat.2015.12.014] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Revised: 12/15/2015] [Accepted: 12/20/2015] [Indexed: 10/22/2022]
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Moradveisi L, Huibers MJ, Renner F, Arasteh M, Arntz A. The influence of comorbid personality disorder on the effects of behavioural activation vs. antidepressant medication for major depressive disorder: Results from a randomized trial in Iran. Behav Res Ther 2013; 51:499-506. [DOI: 10.1016/j.brat.2013.05.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2013] [Revised: 05/07/2013] [Accepted: 05/10/2013] [Indexed: 11/26/2022]
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Leone SS, Wessely S, Huibers MJ, Knottnerus JA, Kant IJ. Two sides of the same coin? On the history and phenomenology of chronic fatigue and burnout. Psychol Health 2011; 26:449-64. [DOI: 10.1080/08870440903494191] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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Wagena EJ, Huibers MJ, van Schayck CP. [Therapies for smoking cessation (antidepressants, nicotine-replacement and counseling) and implications for the treatment of patients with chronic obstructive pulmonary disease]. Ned Tijdschr Geneeskd 2001; 145:1492-6. [PMID: 11512420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
Abstract
Only a small percentage of smokers who state they want to stop smoking in the next half year, succeed in doing so. This is not only due to the addictive nature of smoking cigarettes, but also because of psychological and social factors. Approximately 80% of the people who have used nicotine-replacement therapy return to smoking after some time. Therefore, the interest in non-nicotine pharmacotherapy has increased considerably in recent years. The antidepressants bupropion and nortriptyline are, compared to a placebo, particularly effective smoking cessation aids (relative risk (RR)nortriptyline: 2.7; 95% CI: 1.3-5.3; RRbupropion: 1.5; 95% CI: 1.1-2.6). A combined strategy of nicotine-replacement therapy with counselling or antidepressants (bupropion or nortriptyline) with counselling, in which the physiological as well as the psychological aspects of smoking cessation are treated, seems to be the most effective. Although smoking cessation is seen as the single most important way of preventing a further deterioration of the lung function at all stages of chronic obstructive pulmonary disease (COPD), little research has been conducted amongst COPD patients. Especially the use of the antidepressants bupropion or nortriptyline seems particularly interesting for the treatment of patients with COPD. This is not only because smoking cigarettes is the major risk factor for the development of the disease, but also because COPD patients have a higher than normal prevalence of depression. Furthermore, an association has been found between smoking cigarettes and depression, and the presence of depression or depressive symptoms appears to be an important cause of relapse.
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Affiliation(s)
- E J Wagena
- Universiteit Maastricht, capaciteitsgroep Huisartsgeneeskunde, Postbus 616, 6200 MD Maastricht.
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Wagena EJ, Huibers MJ, van Schayck CP. Antidepressants in the treatment of patients with COPD: possible associations between smoking cigarettes, COPD and depression. Thorax 2001; 56:587-8. [PMID: 11462058 PMCID: PMC1746119 DOI: 10.1136/thorax.56.8.587a] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Wagena EJ, Zeegers MP, Huibers MJ, Chavannes NH, van Schayck CP. [Bupropion: an effective new aid for smoking cessation]. Ned Tijdschr Geneeskd 2001; 145:103-4. [PMID: 11225253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
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