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Ito M, Tajika A, Toyomoto R, Imai H, Sakata M, Honda Y, Kishimoto S, Fukuda M, Horinouchi N, Sahker E, Furukawa TA. The short and long-term efficacy of nurse-led interventions for improving blood pressure control in people with hypertension in primary care settings: a systematic review and meta-analysis. BMC Prim Care 2024; 25:143. [PMID: 38678180 PMCID: PMC11056068 DOI: 10.1186/s12875-024-02380-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 04/09/2024] [Indexed: 04/29/2024]
Abstract
BACKGROUND Previous systematic reviews suggest that nurse-led interventions improve short-term blood pressure (BP) control for people with hypertension. However, the long-term effects, adverse events, and appropriate target BP level are unclear. This study aimed to evaluate the long-term efficacy and safety of nurse-led interventions. METHODS We conducted a systematic review and meta-analysis. We searched the Cochrane Central Register of Controlled Trials, PubMed, and CINAHL, as well as three Japanese article databases, as relevant randomized controlled trials from the oldest possible to March 2021. This search was conducted on 17 April 2021. We did an update search on 17 October 2023. We included studies on adults aged 18 years or older with hypertension. The treatments of interest were community-based nurse-led BP control interventions in addition to primary physician-provided care as usual. The comparator was usual care only. Primary outcomes were long-term achievement of BP control goals and serious adverse events (range: 27 weeks to 3 years). Secondary outcomes were short-term achievement of BP control goals and serious adverse events (range: 4 to 26 weeks), change of systolic and diastolic BP from baseline, medication adherence, incidence of hypertensive complications, and total mortality. RESULTS We included 35 studies. Nurse-led interventions improved long-term BP control (RR 1.10, 95%CI 1.03 to 1.18). However, no significant differences were found in the short-term effects of nurse-led intervention compared to usual care about BP targets. Little information on serious adverse events was available. There was no difference in mortality at both terms between the two groups. Establishing the appropriate target BP from the extant trials was impossible. CONCLUSIONS Nurse-led interventions may be more effective than usual care for achieving BP control at long-term follow-up. It is important to continue lifestyle modification for people with hypertension. We must pay attention to adverse events, and more studies examining appropriate BP targets are needed. Nurse-led care represents an important complement to primary physician-led usual care.
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Affiliation(s)
- Masami Ito
- Departments of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine / School of Public Health, Yoshida Konoe-Cho, Sakyo-Ku, Kyoto, 606-8501, Japan
| | - Aran Tajika
- Departments of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine / School of Public Health, Yoshida Konoe-Cho, Sakyo-Ku, Kyoto, 606-8501, Japan
| | - Rie Toyomoto
- Departments of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine / School of Public Health, Yoshida Konoe-Cho, Sakyo-Ku, Kyoto, 606-8501, Japan
| | - Hissei Imai
- Departments of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine / School of Public Health, Yoshida Konoe-Cho, Sakyo-Ku, Kyoto, 606-8501, Japan
| | - Masatsugu Sakata
- Departments of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine / School of Public Health, Yoshida Konoe-Cho, Sakyo-Ku, Kyoto, 606-8501, Japan
| | - Yukiko Honda
- Department of Community Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
- Department of Social Medicine, National Centre for Child Health and Development, Tokyo, Japan
| | - Sanae Kishimoto
- Departments of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine / School of Public Health, Yoshida Konoe-Cho, Sakyo-Ku, Kyoto, 606-8501, Japan
| | - Memori Fukuda
- Department of Health Informatics, Kyoto University Graduate School of Medicine / School of Public Health, Kyoto, Japan
| | - Noboru Horinouchi
- Departments of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine / School of Public Health, Yoshida Konoe-Cho, Sakyo-Ku, Kyoto, 606-8501, Japan
- Department of General Medicine, Oita University Faculty of Medicine, Oita, Japan
| | - Ethan Sahker
- Departments of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine / School of Public Health, Yoshida Konoe-Cho, Sakyo-Ku, Kyoto, 606-8501, Japan
- Population Health and Policy Research Unit, Medical Education Center, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Toshi A Furukawa
- Departments of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine / School of Public Health, Yoshida Konoe-Cho, Sakyo-Ku, Kyoto, 606-8501, Japan.
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Shiraishi N, Sakata M, Toyomoto R, Yoshida K, Luo Y, Nakagami Y, Tajika A, Suga H, Ito H, Sumi M, Muto T, Ichikawa H, Ikegawa M, Watanabe T, Sahker E, Uwatoko T, Noma H, Horikoshi M, Iwami T, Furukawa TA. Three types of university students with subthreshold depression characterized by distinctive cognitive behavioral skills. Cogn Behav Ther 2024; 53:207-219. [PMID: 38008940 DOI: 10.1080/16506073.2023.2288557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Accepted: 11/15/2023] [Indexed: 11/28/2023]
Abstract
Subthreshold depression impairs young people's quality of life and places them at greater risk of developing major depression. Cognitive behavioral therapy (CBT) is an evidence-based approach for addressing such depressive states. This study identified subtypes of university students with subthreshold depression and revealed discrete profiles of five CBT skills: self-monitoring, cognitive restructuring, behavioral activation, assertive communication, and problem solving. Using data from the Healthy Campus Trial (registration number: UMINCTR-000031307), a hierarchical clustering analysis categorized 1,080 students into three clusters: Reflective Low-skilled, Non-reflective High-skilled, and Non-reflective Low-skilled students. Non-reflective Low-skilled students were significantly more depressed than other students (p < .001). The severity of depression seemed to be related to the combination of self-monitoring skills and other CBT skills. Considering the high prevalence of poor self-monitoring skills in persons with autism, the most severe depression was observed in the significant association between Non-reflective Low-skilled students and autistic traits (p = .008). These findings suggest that subthreshold depression can be categorized into three subtypes based on CBT skill profiles. The assessment of autistic traits is also suggested when we provide CBT interventions for Non-reflective Low-skilled students.
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Affiliation(s)
- Nao Shiraishi
- Department of Psychiatry and Cognitive-Behavioral Medicine, Nagoya City University Graduate School of Medical Science, Nagoya, Japan
| | - Masatsugu Sakata
- Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine/School of Public Health, Kyoto, Japan
| | - Rie Toyomoto
- Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine/School of Public Health, Kyoto, Japan
| | - Kazufumi Yoshida
- Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine/School of Public Health, Kyoto, Japan
| | - Yan Luo
- Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine/School of Public Health, Kyoto, Japan
| | - Yukako Nakagami
- Department of Health Service, Kyoto University, Kyoto, Japan
| | - Aran Tajika
- Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine/School of Public Health, Kyoto, Japan
| | | | - Hiroshi Ito
- Department of Medical Service Center, Ritsumeikan University, Kyoto, Japan
| | - Michihisa Sumi
- Department of Medical Service Center, Ritsumeikan University, Kyoto, Japan
| | - Takashi Muto
- Department of Psychology, Doshisha University, Kyoto, Japan
| | - Hiroshi Ichikawa
- Department of Medical Life Systems, Doshisha University, Kyoto, Japan
| | - Masaya Ikegawa
- Department of Medical Life Systems, Doshisha University, Kyoto, Japan
| | - Takafumi Watanabe
- Department of Psychiatry and Cognitive-Behavioral Medicine, Nagoya City University Graduate School of Medical Science, Nagoya, Japan
| | - Ethan Sahker
- Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine/School of Public Health, Kyoto, Japan
- Medical Education Center, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Teruhisa Uwatoko
- Department of Psychiatry, Kyoto University Hospital, Kyoto, Japan
| | - Hisashi Noma
- Department of Data Science, The Institute of Statistical Mathematics, Tokyo, Japan
| | - Masaru Horikoshi
- Center for Cognitive Behavior Therapy and Research, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Taku Iwami
- Department of Health Service, Kyoto University, Kyoto, Japan
| | - Toshi A Furukawa
- Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine/School of Public Health, Kyoto, Japan
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Leucht S, Siafis S, Schneider-Thoma J, Tajika A, Priller J, Davis JM, Furukawa TA. Are the results of open randomised controlled trials comparing antipsychotic drugs in schizophrenia biased? Exploratory meta- and subgroup analysis. Schizophrenia (Heidelb) 2024; 10:17. [PMID: 38355616 PMCID: PMC10866997 DOI: 10.1038/s41537-024-00442-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Accepted: 01/30/2024] [Indexed: 02/16/2024]
Abstract
A recent meta-epidemiological study did not reveal major differences between the results of blinded and open randomised-controlled trials (RCTs). Fewer patients may consent to double-blind RCTs than to open RCTs, compromising generalisability, making this question very important. However, the issue has not been addressed in schizophrenia. We used a database of randomised, acute-phase antipsychotic drug trials. Whenever at least one open and one blinded RCT was available for a comparison of two drugs, we contrasted the results by random-effects meta-analysis with subgroup tests. The primary outcome was overall symptoms as measured by the Positive and Negative Syndrome Scale, supplemented by seven secondary efficacy and side-effect outcomes. We also examined whether open RCTs were biased in favour of more recently introduced antipsychotics, less efficacious or more prone to side-effects antipsychotics, and pharmaceutical sponsors. 183 RCTs (155 blinded and 28 open) with 34715 participants comparing two active drugs were available. The results did not suggest general differences between open and blinded RCTs, which examined two active drugs. Only 12 out of 122 subgroup tests had a p-value below 0.1, four below 0.05, and if a Bonferroni correction for multiple tests had been applied, only one would have been significant. There were some exceptions which, however, did not always confirm the originally hypothesized direction of bias. Due to the relatively small number of open RCTs, our analysis is exploratory, but this fundamental question should be given more scientific attention. Currently, open RCTs should be excluded from meta-analyses, at least in sensitivity analyses.
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Affiliation(s)
- Stefan Leucht
- Department of Psychiatry and Psychotherapy, Technical University of Munich, School of Medicine and Health Klinikum rechts der Isar, Ismaningerstr. 22, 81675, Munich, Germany.
- German Center for Mental Health (DZPG), Munich, Germany.
| | - Spyridon Siafis
- Department of Psychiatry and Psychotherapy, Technical University of Munich, School of Medicine and Health Klinikum rechts der Isar, Ismaningerstr. 22, 81675, Munich, Germany
- German Center for Mental Health (DZPG), Munich, Germany
| | - Johannes Schneider-Thoma
- Department of Psychiatry and Psychotherapy, Technical University of Munich, School of Medicine and Health Klinikum rechts der Isar, Ismaningerstr. 22, 81675, Munich, Germany
- German Center for Mental Health (DZPG), Munich, Germany
| | - Aran Tajika
- Department of Health Promotion and Human Behavior, Graduate School of Medicine / School of Public Health, Kyoto University, Kyoto, Japan
| | - Josef Priller
- Department of Psychiatry and Psychotherapy, Technical University of Munich, School of Medicine and Health Klinikum rechts der Isar, Ismaningerstr. 22, 81675, Munich, Germany
- German Center for Mental Health (DZPG), Munich, Germany
| | - John M Davis
- Psychiatric Institute, University of Illinois at Chicago (mc 912), 1601 W. Taylor St., Chicago, IL, 60612, USA
- Johns Hopkins University, Baltimore, MD, USA
| | - Toshi A Furukawa
- Department of Health Promotion and Human Behavior, Graduate School of Medicine / School of Public Health, Kyoto University, Kyoto, Japan
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Kato M, Hori H, Tajika A. Appropriate duration of antidepressant medications for prevention of depressive relapse and the impact of life stage. Mol Psychiatry 2023; 28:4937-4938. [PMID: 36882502 DOI: 10.1038/s41380-023-02023-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Revised: 02/25/2023] [Accepted: 02/28/2023] [Indexed: 03/09/2023]
Affiliation(s)
- Masaki Kato
- Department of Neuropsychiatry, Kansai Medical University, Osaka, Japan.
| | - Hikaru Hori
- Department of Psychiatry, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Aran Tajika
- Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine/School of Public Health, Kyoto, Japan
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Guaiana G, Meader N, Barbui C, Davies SJ, Furukawa TA, Imai H, Dias S, Caldwell DM, Koesters M, Tajika A, Bighelli I, Pompoli A, Cipriani A, Dawson S, Robertson L. Pharmacological treatments in panic disorder in adults: a network meta-analysis. Cochrane Database Syst Rev 2023; 11:CD012729. [PMID: 38014714 PMCID: PMC10683020 DOI: 10.1002/14651858.cd012729.pub3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2023]
Abstract
BACKGROUND A panic attack is a discrete period of fear or anxiety that has a rapid onset and reaches a peak within 10 minutes. The main symptoms involve bodily systems, such as racing heart, chest pain, sweating, shaking, dizziness, flushing, churning stomach, faintness and breathlessness. Other recognised panic attack symptoms involve fearful cognitions, such as the fear of collapse, going mad or dying, and derealisation (the sensation that the world is unreal). Panic disorder is common in the general population with a prevalence of 1% to 4%. The treatment of panic disorder includes psychological and pharmacological interventions, including antidepressants and benzodiazepines. OBJECTIVES To compare, via network meta-analysis, individual drugs (antidepressants and benzodiazepines) or placebo in terms of efficacy and acceptability in the acute treatment of panic disorder, with or without agoraphobia. To rank individual active drugs for panic disorder (antidepressants, benzodiazepines and placebo) according to their effectiveness and acceptability. To rank drug classes for panic disorder (selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), tricyclic antidepressants (TCAs), mono-amine oxidase inhibitors (MAOIs) and benzodiazepines (BDZs) and placebo) according to their effectiveness and acceptability. To explore heterogeneity and inconsistency between direct and indirect evidence in a network meta-analysis. SEARCH METHODS We searched the Cochrane Common Mental Disorders Specialised Register, CENTRAL, CDSR, MEDLINE, Ovid Embase and PsycINFO to 26 May 2022. SELECTION CRITERIA We included randomised controlled trials (RCTs) of people aged 18 years or older of either sex and any ethnicity with clinically diagnosed panic disorder, with or without agoraphobia. We included trials that compared the effectiveness of antidepressants and benzodiazepines with each other or with a placebo. DATA COLLECTION AND ANALYSIS Two authors independently screened titles/abstracts and full texts, extracted data and assessed risk of bias. We analysed dichotomous data and continuous data as risk ratios (RRs), mean differences (MD) or standardised mean differences (SMD): response to treatment (i.e. substantial improvement from baseline as defined by the original investigators: dichotomous outcome), total number of dropouts due to any reason (as a proxy measure of treatment acceptability: dichotomous outcome), remission (i.e. satisfactory end state as defined by global judgement of the original investigators: dichotomous outcome), panic symptom scales and global judgement (continuous outcome), frequency of panic attacks (as recorded, for example, by a panic diary; continuous outcome), agoraphobia (dichotomous outcome). We assessed the certainty of evidence using threshold analyses. MAIN RESULTS Overall, we included 70 trials in this review. Sample sizes ranged between 5 and 445 participants in each arm, and the total sample size per study ranged from 10 to 1168. Thirty-five studies included sample sizes of over 100 participants. There is evidence from 48 RCTs (N = 10,118) that most medications are more effective in the response outcome than placebo. In particular, diazepam, alprazolam, clonazepam, paroxetine, venlafaxine, clomipramine, fluoxetine and adinazolam showed the strongest effect, with diazepam, alprazolam and clonazepam ranking as the most effective. We found heterogeneity in most of the comparisons, but our threshold analyses suggest that this is unlikely to impact the findings of the network meta-analysis. Results from 64 RCTs (N = 12,310) suggest that most medications are associated with either a reduced or similar risk of dropouts to placebo. Alprazolam and diazepam were associated with a lower dropout rate compared to placebo and were ranked as the most tolerated of all the medications examined. Thirty-two RCTs (N = 8569) were included in the remission outcome. Most medications were more effective than placebo, namely desipramine, fluoxetine, clonazepam, diazepam, fluvoxamine, imipramine, venlafaxine and paroxetine, and their effects were clinically meaningful. Amongst these medications, desipramine and alprazolam were ranked highest. Thirty-five RCTs (N = 8826) are included in the continuous outcome reduction in panic scale scores. Brofaromine, clonazepam and reboxetine had the strongest reductions in panic symptoms compared to placebo, but results were based on either one trial or very small trials. Forty-one RCTs (N = 7853) are included in the frequency of panic attack outcome. Only clonazepam and alprazolam showed a strong reduction in the frequency of panic attacks compared to placebo, and were ranked highest. Twenty-six RCTs (N = 7044) provided data for agoraphobia. The strongest reductions in agoraphobia symptoms were found for citalopram, reboxetine, escitalopram, clomipramine and diazepam, compared to placebo. For the pooled intervention classes, we examined the two primary outcomes (response and dropout). The classes of medication were: SSRIs, SNRIs, TCAs, MAOIs and BDZs. For the response outcome, all classes of medications examined were more effective than placebo. TCAs as a class ranked as the most effective, followed by BDZs and MAOIs. SSRIs as a class ranked fifth on average, while SNRIs were ranked lowest. When we compared classes of medication with each other for the response outcome, we found no difference between classes. Comparisons between MAOIs and TCAs and between BDZs and TCAs also suggested no differences between these medications, but the results were imprecise. For the dropout outcome, BDZs were the only class associated with a lower dropout compared to placebo and were ranked first in terms of tolerability. The other classes did not show any difference in dropouts compared to placebo. In terms of ranking, TCAs are on average second to BDZs, followed by SNRIs, then by SSRIs and lastly by MAOIs. BDZs were associated with lower dropout rates compared to SSRIs, SNRIs and TCAs. The quality of the studies comparing antidepressants with placebo was moderate, while the quality of the studies comparing BDZs with placebo and antidepressants was low. AUTHORS' CONCLUSIONS In terms of efficacy, SSRIs, SNRIs (venlafaxine), TCAs, MAOIs and BDZs may be effective, with little difference between classes. However, it is important to note that the reliability of these findings may be limited due to the overall low quality of the studies, with all having unclear or high risk of bias across multiple domains. Within classes, some differences emerged. For example, amongst the SSRIs paroxetine and fluoxetine seem to have stronger evidence of efficacy than sertraline. Benzodiazepines appear to have a small but significant advantage in terms of tolerability (incidence of dropouts) over other classes.
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Affiliation(s)
| | - Nicholas Meader
- Centre for Reviews and Dissemination, University of York, York, UK
- Cochrane Common Mental Disorders, University of York, York, UK
| | - Corrado Barbui
- Department of Neurosciences, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
- Cochrane Global Mental Health, University of Verona, Verona, Italy
| | - Simon Jc Davies
- Geriatric Psychiatry Division, CAMH, University of Toronto, Toronto, Canada
| | - Toshi A Furukawa
- Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine/School of Public Health, Kyoto, Japan
| | - Hissei Imai
- Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine/School of Public Health, Kyoto, Japan
| | - Sofia Dias
- Centre for Reviews and Dissemination, University of York, York, UK
| | - Deborah M Caldwell
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Markus Koesters
- Center for Evidence-Based Healthcare, University Hospital Carl Gustav Carus and Carl Gustav Carus Faculty of Medicine, Technische Universität Dresden, Chemnitz, Germany
| | - Aran Tajika
- Department of Psychiatry, Kyoto University Hospital, Kyoto, Japan
| | - Irene Bighelli
- Klinik und Poliklinik für Psychiatrie und Psychotherapie, Technische Universität München Klinikum rechts der Isar, München, Germany
| | | | - Andrea Cipriani
- Department of Psychiatry, University of Oxford, Oxford, UK
- Warneford Hospital, Oxford Health NHS Foundation Trust, Oxford, UK
- Oxford Precision Psychiatry Lab, Oxford Health Biomedical Research Centre, Oxford, UK
| | - Sarah Dawson
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
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Shiraishi N, Sakata M, Toyomoto R, Yoshida K, Luo Y, Nakagami Y, Tajika A, Watanabe T, Sahker E, Uwatoko T, Shimamoto T, Iwami T, Furukawa TA. Dynamics of depressive states among university students in Japan during the COVID-19 pandemic: an interrupted time series analysis. Ann Gen Psychiatry 2023; 22:38. [PMID: 37814328 PMCID: PMC10563354 DOI: 10.1186/s12991-023-00468-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 09/22/2023] [Indexed: 10/11/2023] Open
Abstract
BACKGROUND The coronavirus disease 2019 (COVID-19) pandemic was reported to have increased depression among university students which was associated with impairments in their campus lives. This study examined changes in depressive states among Japanese university students during the COVID-19 pandemic. METHODS A secondary data analysis from a factorial randomized controlled trial involving smartphone-based cognitive-behavioral therapy was performed. Six cohorts (N = 1626) underwent an 8-week intervention during the spring or autumn of 2019-2021, with a 9-month follow-up. We evaluated participants' depressive states weekly using the Patient Health Questionnaire-9 (PHQ-9) during the intervention, with monthly evaluations thereafter. The follow-up periods included Japan's four states of emergency (SOEs) to control COVID-19. Hypothesizing that SOEs caused a sudden worsening of depressive states, Study 1 compared the cohorts' PHQ-9 scores, and Study 2 employed time series analysis with a mixed-effects model to estimate identified changes in PHQ-9 scores. RESULTS Although no changes in depressive states were observed in relation to the SOEs, Study 1 identified sudden increases in PHQ-9 scores at the 28-week evaluation point, which corresponded to the beginning of the new academic year for the three autumn cohorts. In contrast, the three spring cohorts did not exhibit similar changes. Study 2 showed that, for all three autumn cohorts (n = 522), the 0.60-point change was significant (95% CI 0.42-0.78; p < .001) at 28 weeks; that is, when their timeline was interrupted. CONCLUSIONS While the results do not indicate any notable impact of the SOEs, they highlight the influence of the new academic year on university students' mental health during COVID-19. Trial registration UMIN, CTR-000031307. Registered on February 14, 2018.
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Affiliation(s)
- N Shiraishi
- Department of Psychiatry and Cognitive-Behavioral Medicine, Nagoya City University Graduate School of Medical Science, 1 Kawasumi, Mizuho-Cho, Mizuho-Ku, Nagoya, 467-8601, Japan.
| | - M Sakata
- Department of Health Promotion and Human Behavior, Graduate School of Medicine/School of Public Health, Kyoto University, Kyoto, Japan
| | - R Toyomoto
- Department of Health Promotion and Human Behavior, Graduate School of Medicine/School of Public Health, Kyoto University, Kyoto, Japan
| | - K Yoshida
- Department of Health Promotion and Human Behavior, Graduate School of Medicine/School of Public Health, Kyoto University, Kyoto, Japan
| | - Y Luo
- Department of Health Promotion and Human Behavior, Graduate School of Medicine/School of Public Health, Kyoto University, Kyoto, Japan
| | - Y Nakagami
- Kyoto University Health Service, Kyoto, Japan
| | - A Tajika
- Department of Health Promotion and Human Behavior, Graduate School of Medicine/School of Public Health, Kyoto University, Kyoto, Japan
| | - T Watanabe
- Department of Psychiatry and Cognitive-Behavioral Medicine, Nagoya City University Graduate School of Medical Science, 1 Kawasumi, Mizuho-Cho, Mizuho-Ku, Nagoya, 467-8601, Japan
| | - E Sahker
- Department of Health Promotion and Human Behavior, Graduate School of Medicine/School of Public Health, Kyoto University, Kyoto, Japan
- Medical Education Center, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - T Uwatoko
- Department of Neuropsychiatry, Kyoto University Hospital, Kyoto, Japan
| | - T Shimamoto
- Kyoto University Health Service, Kyoto, Japan
| | - T Iwami
- Kyoto University Health Service, Kyoto, Japan
| | - T A Furukawa
- Department of Health Promotion and Human Behavior, Graduate School of Medicine/School of Public Health, Kyoto University, Kyoto, Japan
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Tajika A, Tsujimoto Y, Onishi A, Tsutsumi Y, Funada S, Ogawa Y, Takeshima N, Hayasaka Y, Iwakami N, Furukawa TA. Twenty-year follow-up of promising clinical studies reported in highly circulated newspapers: a meta-epidemiological study. BMJ Health Care Inform 2023; 30:e100768. [PMID: 37316250 DOI: 10.1136/bmjhci-2023-100768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 05/29/2023] [Indexed: 06/16/2023] Open
Abstract
OBJECTIVES Researchers have identified cases in which newspaper stories have exaggerated the results of medical studies reported in original articles. Moreover, the exaggeration sometimes begins with journal articles. We examined what proportion of the studies quoted in newspaper stories were confirmed. METHODS We identified newspaper stories from 2000 that mentioned the effectiveness of certain treatments or preventions based on original studies from 40 main medical journals. We searched for subsequent studies until June 2022 with the same topic and stronger research design than each original study. The results of the original studies were verified by comparison with those of subsequent studies. RESULTS We identified 164 original articles from 1298 newspaper stories and randomly selected 100 of them. Four studies were not found to be effective in terms of the primary outcome, and 18 had no subsequent studies. Of the remaining studies, the proportion of confirmed studies was 68.6% (95% CI 58.1% to 77.5%). Among the 59 confirmed studies, 13 of 16 studies were considered to have been replicated in terms of effect size. However, the results of the remaining 43 studies were not comparable. DISCUSSION In the dichotomous judgement of effectiveness, about two-thirds of the results were nominally confirmed by subsequent studies. However, for most confirmed results, it was impossible to determine whether the effect sizes were stable. CONCLUSIONS Newspaper readers should be aware that some claims made by high-quality newspapers based on high-profile journal articles may be overturned by subsequent studies within the next 20 years.
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Affiliation(s)
- Aran Tajika
- Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine / School of Public Health, Kyoto, Japan
| | - Yasushi Tsujimoto
- Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine / School of Public Health, Kyoto, Japan
- Oku Medical Clinic, Osaka, Japan
| | - Akira Onishi
- Department of Advanced Medicine for Rheumatic diseases, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Yusuke Tsutsumi
- Department of Emergency Medicine, National Hospital Organization Mito Medical Center, Ibaraki, Japan
- Department of Human Health Science, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Satoshi Funada
- Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine / School of Public Health, Kyoto, Japan
| | - Yusuke Ogawa
- Department of Healthcare Epidemiology, School of Public Health in the Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Nozomi Takeshima
- Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine / School of Public Health, Kyoto, Japan
| | - Yu Hayasaka
- Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine / School of Public Health, Kyoto, Japan
| | - Naotsugu Iwakami
- Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine / School of Public Health, Kyoto, Japan
| | - Toshi A Furukawa
- Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine / School of Public Health, Kyoto, Japan
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Toyomoto R, Sakata M, Yoshida K, Luo Y, Nakagami Y, Uwatoko T, Shimamoto T, Sahker E, Tajika A, Suga H, Ito H, Sumi M, Muto T, Ito M, Ichikawa H, Ikegawa M, Shiraishi N, Watanabe T, Watkins ER, Noma H, Horikoshi M, Iwami T, Furukawa TA. Corrigendum to "Prognostic factors and effect modifiers for personalisation of internet-based cognitive behavioural therapy among university students with subthreshold depression: A secondary analysis of a factorial trial" [J. Affect. Disord. 322 (2023) 156-162]. J Affect Disord 2023; 325:824-825. [PMID: 36682915 DOI: 10.1016/j.jad.2023.01.056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Affiliation(s)
- Rie Toyomoto
- Department of Health Promotion and Human Behaviour, Kyoto University Graduate School of Medicine, School of Public Health, Kyoto, Japan.
| | - Masatsugu Sakata
- Department of Health Promotion and Human Behaviour, Kyoto University Graduate School of Medicine, School of Public Health, Kyoto, Japan
| | - Kazufumi Yoshida
- Department of Health Promotion and Human Behaviour, Kyoto University Graduate School of Medicine, School of Public Health, Kyoto, Japan
| | - Yan Luo
- Department of Health Promotion and Human Behaviour, Kyoto University Graduate School of Medicine, School of Public Health, Kyoto, Japan
| | - Yukako Nakagami
- Agency for Student Support and Disability Resources, Kyoto University, Kyoto, Japan
| | - Teruhisa Uwatoko
- Department of Psychiatry, Kyoto University Hospital, Kyoto, Japan
| | - Tomonari Shimamoto
- Department of Preventive Services, Kyoto University Graduate School of Medicine, School of Public Health, Kyoto, Japan
| | - Ethan Sahker
- Department of Health Promotion and Human Behaviour, Kyoto University Graduate School of Medicine, School of Public Health, Kyoto, Japan; Population Health and Policy Research Unit, Medical Education Centre, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Aran Tajika
- Department of Health Promotion and Human Behaviour, Kyoto University Graduate School of Medicine, School of Public Health, Kyoto, Japan
| | | | - Hiroshi Ito
- Ritsumeikan Medical Service Centre, Kyoto, Japan
| | | | - Takashi Muto
- Faculty of Psychology, Doshisha University, Kyoto, Japan
| | - Masataka Ito
- Department of Life Design, Biwako-Gakuin College, Higashiomi, Japan
| | - Hiroshi Ichikawa
- Department of Medical Life Systems, Doshisha University, Kyoto, Japan
| | - Masaya Ikegawa
- Department of Medical Life Systems, Doshisha University, Kyoto, Japan
| | - Nao Shiraishi
- Department of Psychiatry and Cognitive-Behavioural Medicine, Nagoya City University Graduate School of Medical Science, Nagoya, Japan
| | - Takafumi Watanabe
- Department of Psychiatry and Cognitive-Behavioural Medicine, Nagoya City University Graduate School of Medical Science, Nagoya, Japan
| | | | - Hisashi Noma
- Institute of Statistical Mathematics, Tokyo, Japan
| | - Masaru Horikoshi
- National Centre of Neurology and Psychiatry/National Centre for Cognitive Behaviour Therapy and Research, Tokyo, Japan
| | - Taku Iwami
- Department of Preventive Services, Kyoto University Graduate School of Medicine, School of Public Health, Kyoto, Japan
| | - Toshi A Furukawa
- Department of Health Promotion and Human Behaviour, Kyoto University Graduate School of Medicine, School of Public Health, Kyoto, Japan
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Furukawa TA, Tajika A, Sakata M, Luo Y, Toyomoto R, Horikoshi M, Akechi T, Kawakami N, Nakayama T, Kondo N, Fukuma S, Noma H, Christensen H, Kessler RC, Cuijpers P, Wason JMS. Four 2×2 factorial trials of smartphone CBT to reduce subthreshold depression and to prevent new depressive episodes among adults in the community-RESiLIENT trial (Resilience Enhancement with Smartphone in LIving ENvironmenTs): a master protocol. BMJ Open 2023; 13:e067850. [PMID: 36828653 PMCID: PMC9972419 DOI: 10.1136/bmjopen-2022-067850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 02/08/2023] [Indexed: 02/26/2023] Open
Abstract
INTRODUCTION The health burden due to depression is ever increasing in the world. Prevention is a key to reducing this burden. Guided internet cognitive-behavioural therapies (iCBT) appear promising but there is room for improvement because we do not yet know which of various iCBT skills are more efficacious than others, and for whom. In addition, there has been no platform for iCBT that can accommodate ongoing evolution of internet technologies. METHODS AND ANALYSIS Based on our decade-long experiences in developing smartphone CBT apps and examining them in randomised controlled trials, we have developed the Resilience Training App Version 2. This app now covers five CBT skills: cognitive restructuring, behavioural activation, problem-solving, assertion training and behaviour therapy for insomnia. The current study is designed as a master protocol including four 2×2 factorial trials using this app (1) to elucidate specific efficacies of each CBT skill, (2) to identify participants' characteristics that enable matching between skills and individuals, and (3) to allow future inclusion of new skills. We will recruit 3520 participants with subthreshold depression and ca 1700 participants without subthreshold depression, to examine the short-term efficacies of CBT skills to reduce depressive symptoms in the former and to explore the long-term efficacies in preventing depression in the total sample. The primary outcome for the short-term efficacies is the change in depressive symptoms as measured with the Patient Health Questionnaire-9 at week 6, and that for the long-term efficacies is the incidence of major depressive episodes as assessed by the computerised Composite International Diagnostic Interview by week 50. ETHICS AND DISSEMINATION The trial has been approved by the Ethics Committee of Kyoto University Graduate School of Medicine (C1556). TRIAL REGISTRATION NUMBER UMIN000047124.
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Affiliation(s)
- Toshi A Furukawa
- Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine/School of Public Health, Kyoto, Japan
| | - Aran Tajika
- Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine/School of Public Health, Kyoto, Japan
| | - Masatsugu Sakata
- Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine/School of Public Health, Kyoto, Japan
| | - Yan Luo
- Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine/School of Public Health, Kyoto, Japan
| | - Rie Toyomoto
- Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine/School of Public Health, Kyoto, Japan
| | - Masaru Horikoshi
- National Center of Neurology and Psychiatry, Tokyo, Japan
- Center for Cognitive Behavior Therapy and Research, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Tatsuo Akechi
- Department of Psychiatry and Cognitive-Behavioral Medicine, Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi, Japan
| | - Norito Kawakami
- Department of Digital Mental Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Takeo Nakayama
- Health Informatics, Kyoto University School of Public Health, Kyoto, Japan
| | - Naoki Kondo
- Department of Social Epidemiology, Kyoto University Graduate School of Medicine/School of Public Health, Kyoto, Japan
- Institute for Future Initiative, The University of Tokyo, Tokyo, Japan
| | - Shingo Fukuma
- Human Health Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Hisashi Noma
- Department of Data Science, The Institute of Statistical Mathematics, Tachikawa, Tokyo, Japan
| | | | - Ronald C Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, USA
| | - Pim Cuijpers
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - James M S Wason
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
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Tajika A, Furukawa TA, Shinohara K, Kikuchi S, Toyomoto R, Furukawa Y, Ito M, Yoshida K, Honda Y, Takayama T, Schneider-Thoma J, Leucht S. Blinding successfulness in antipsychotic trials of acute treatment for schizophrenia: a systematic review. BMJ Ment Health 2023; 26:e300654. [PMID: 37085286 PMCID: PMC10124187 DOI: 10.1136/bmjment-2023-300654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 03/12/2023] [Indexed: 04/23/2023]
Affiliation(s)
- Aran Tajika
- Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine / School of Public Health, Kyoto, Kyoto, Japan
| | - Toshi A Furukawa
- Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine / School of Public Health, Kyoto, Kyoto, Japan
| | - Kiyomi Shinohara
- Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine / School of Public Health, Kyoto, Kyoto, Japan
| | - Shino Kikuchi
- Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine / School of Public Health, Kyoto, Kyoto, Japan
| | - Rie Toyomoto
- Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine / School of Public Health, Kyoto, Kyoto, Japan
| | - Yuki Furukawa
- Department of Neuropsychiatry, Tokyo University Hospital, Bunkyo-ku, Tokyo, Japan
| | - Masami Ito
- Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine / School of Public Health, Kyoto, Kyoto, Japan
| | - Kazufumi Yoshida
- Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine / School of Public Health, Kyoto, Kyoto, Japan
| | - Yukiko Honda
- Department of Community Medicine, Nagasaki University School of Medicine Graduate School of Biomedical Sciences, Nagasaki, Nagasaki, Japan
| | | | - Johannes Schneider-Thoma
- Department of Psychiatry and Psychotherapy, Technical University of Munich, Munchen, Bayern, Germany
| | - Stefan Leucht
- Department of Psychiatry and Psychotherapy, Technical University of Munich, Munchen, Bayern, Germany
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11
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Tsutsumi Y, Tsujimoto Y, Tajika A, Omae K, Fujii T, Onishi A, Kataoka Y, Katsura M, Noma H, Sahker E, Ostinelli EG, Furukawa TA. Proportion attributable to contextual effects in general medicine: a meta-epidemiological study based on Cochrane reviews. BMJ Evid Based Med 2023; 28:40-47. [PMID: 35853683 PMCID: PMC9887379 DOI: 10.1136/bmjebm-2021-111861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/24/2022] [Indexed: 02/03/2023]
Abstract
OBJECTIVES Our objectives were to examine the magnitude of the proportion attributable to contextual effects (PCE), which shows what proportion of the treatment arm response can be achieved by the placebo arm across various interventions, and to examine PCE variability by outcome type and condition. DESIGN We conducted a meta-epidemiological study. SETTING We searched the Cochrane Database of Systematic Reviews with the keyword 'placebo' in titles, abstracts and keywords on 1 January 2020. PARTICIPANTS We included reviews that showed statistically significant beneficial effects of the intervention over placebo for the first primary outcome. MAIN OUTCOME MEASURES We performed a random-effects meta-analysis to calculate PCEs based on the pooled result of each included review, grouped by outcome type and condition. The PCE quantifies how much of the observed treatment response can be achieved by the contextual effects. PUBLIC AND PATIENT INVOLVEMENT STATEMENT No patient or member of the public was involved in conducting this research. RESULTS We included 328 out of 3175 Cochrane systematic reviews. The results of meta-analyses showed that PCEs varied greatly depending on outcome type (I2=98%) or condition (I2=98%), but mostly lie between 0.40 and 0.95. Overall, the PCEs were 0.65 (95% CI 0.59 to 0.72) on average. Subjective outcomes were 0.50 (95% CI 0.41 to 0.59), which was significantly smaller than those of semiobjective (PCE 0.78; 95% CI 0.72 to 0.85) or objective outcomes (PCE 0.94; 95% CI 0.91 to 0.97). CONCLUSIONS The results suggest that much of the observed benefit is not just due to the specific effect of the interventions. The specific effects of interventions may be larger for subjective outcomes than for objective or semiobjective outcomes. However, PCEs were exceptionally variable. When we evaluate the magnitude of PCEs, we should consider each PCE individually, for each condition, intervention and outcome in its context, to assess the importance of an intervention for each specific clinical setting.
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Affiliation(s)
- Yusuke Tsutsumi
- Human Health Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
- Department of Emergency Medicine, National Hospital Organization Mito Medical Center, Ibaraki, Japan
| | - Yasushi Tsujimoto
- Department of Healthcare Epidemiology, Kyoto University Graduate School of Medicine/ School of Public Health, Kyoto, Japan
- Department of Nephrology and Dialysis, Kyoritsu Hospital, Kawanishi, Japan
| | - Aran Tajika
- Department of Psychiatry, Kyoto University Hospital, Kyoto, Japan
| | - Kenji Omae
- Department of Healthcare Epidemiology, Kyoto University Graduate School of Medicine/ School of Public Health, Kyoto, Japan
- Department of Innovative Research and Education for Clinicians and Trainees (DiRECT), Fukushima Medical University Hospital, Fukushima, Japan
| | - Tomoko Fujii
- Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine / School of Public Health, Kyoto, Japan
- Intensive Care Unit, Jikei University Hospital, Tokyo, Japan
| | - Akira Onishi
- Department of Rheumatology and Clinical Immunology, Kobe University Graduate School of Medicine, Hyogo, Japan
| | - Yuki Kataoka
- Department of Healthcare Epidemiology, Kyoto University Graduate School of Medicine/ School of Public Health, Kyoto, Japan
- Hospital Care Research Unit/ Department of Respiratory Medicine, Hyogo Prefectural Amagasaki General Medical Center, Hyogo, Japan
| | | | - Hisashi Noma
- Department of Data Science, The Institute of Statistical Mathematics, Tokyo, Japan
| | - Ethan Sahker
- Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine / School of Public Health, Kyoto, Japan
- Population Health and Policy Research Unit, Medical Education Center, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Edoardo Giuseppe Ostinelli
- Oxford Health NHS Foundation Trust, Warneford Hospital /Department of Psychiatry, University of Oxford, Oxford, UK
| | - Toshi A Furukawa
- Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine / School of Public Health, Kyoto, Japan
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12
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Toyomoto R, Sakata M, Yoshida K, Luo Y, Nakagami Y, Uwatoko T, Shimamoto T, Sahker E, Tajika A, Suga H, Ito H, Sumi M, Muto T, Ito M, Ichikawa H, Ikegawa M, Shiraishi N, Watanabe T, Watkins ER, Noma H, Horikoshi M, Iwami T, Furukawa TA. Prognostic factors and effect modifiers for personalisation of internet-based cognitive behavioural therapy among university students with subthreshold depression: A secondary analysis of a factorial trial. J Affect Disord 2023; 322:156-162. [PMID: 36379323 DOI: 10.1016/j.jad.2022.11.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 10/12/2022] [Accepted: 11/07/2022] [Indexed: 11/15/2022]
Abstract
BACKGROUND Internet-cognitive behavioural therapy (iCBT) for depression can include multiple components. This study explored depressive symptom improvement prognostic factors (PFs) and effect modifiers (EMs) for five common iCBT components including behavioural activation, cognitive restructuring, problem solving, self-monitoring, and assertion training. METHODS We used data from a factorial trial of iCBT for subthreshold depression among Japanese university students (N = 1093). The primary outcome was the change in PHQ-9 scores at 8 weeks from baseline. Interactions between each component and various baseline characteristics were estimated using a mixed-effects model for repeated measures. We calculated multiplicity-adjusted p-values at 5 % false discovery rate using the Benjamini-Hochberg procedure. RESULTS After multiplicity adjustment, the baseline PHQ-9 total score emerged as a PF and exercise habits as an EM for self-monitoring (adjusted p-values <0.05). The higher the PHQ-9 total score at baseline (range: 5-14), the greater the decrease after 8 weeks. For each 5-point increase at baseline, the change from baseline to 8 weeks was bigger by 2.8 points. The more frequent the exercise habits (range: 0-2 points), the less effective the self-monitoring component. The difference in PHQ-9 change scores between presence or absence of self-monitoring was smaller by 0.94 points when the participant exercised one level more frequently. Additionally, the study suggested seven out of 36 PFs and 14 out of 160 EMs examined were candidates for future research. LIMITATIONS Generalizability is limited to university students with subthreshold depression. CONCLUSIONS These results provide some helpful information for the future development of individualized iCBT algorithms for depression.
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Affiliation(s)
- Rie Toyomoto
- Department of Health Promotion and Human Behaviour, Kyoto University Graduate School of Medicine, School of Public Health, Kyoto, Japan.
| | - Masatsugu Sakata
- Department of Health Promotion and Human Behaviour, Kyoto University Graduate School of Medicine, School of Public Health, Kyoto, Japan
| | - Kazufumi Yoshida
- Department of Health Promotion and Human Behaviour, Kyoto University Graduate School of Medicine, School of Public Health, Kyoto, Japan
| | - Yan Luo
- Department of Health Promotion and Human Behaviour, Kyoto University Graduate School of Medicine, School of Public Health, Kyoto, Japan
| | - Yukako Nakagami
- Agency for Student Support and Disability Resources, Kyoto University, Kyoto, Japan
| | - Teruhisa Uwatoko
- Department of Psychiatry, Kyoto University Hospital, Kyoto, Japan
| | - Tomonari Shimamoto
- Department of Preventive Services, Kyoto University Graduate School of Medicine, School of Public Health, Kyoto, Japan
| | - Ethan Sahker
- Department of Health Promotion and Human Behaviour, Kyoto University Graduate School of Medicine, School of Public Health, Kyoto, Japan; Population Health and Policy Research Unit, Medical Education Centre, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Aran Tajika
- Department of Health Promotion and Human Behaviour, Kyoto University Graduate School of Medicine, School of Public Health, Kyoto, Japan
| | | | - Hiroshi Ito
- Ritsumeikan Medical Service Centre, Kyoto, Japan
| | | | - Takashi Muto
- Faculty of Psychology, Doshisha University, Kyoto, Japan
| | - Masataka Ito
- Department of Life Design, Biwako-Gakuin College, Higashiomi, Japan
| | - Hiroshi Ichikawa
- Department of Medical Life Systems, Doshisha University, Kyoto, Japan
| | - Masaya Ikegawa
- Department of Medical Life Systems, Doshisha University, Kyoto, Japan
| | - Nao Shiraishi
- Department of Psychiatry and Cognitive-Behavioural Medicine, Nagoya City University Graduate School of Medical Science, Nagoya, Japan
| | - Takafumi Watanabe
- Department of Psychiatry and Cognitive-Behavioural Medicine, Nagoya City University Graduate School of Medical Science, Nagoya, Japan
| | | | - Hisashi Noma
- Institute of Statistical Mathematics, Tokyo, Japan
| | - Masaru Horikoshi
- National Centre of Neurology and Psychiatry/National Centre for Cognitive Behaviour Therapy and Research, Tokyo, Japan
| | - Taku Iwami
- Department of Preventive Services, Kyoto University Graduate School of Medicine, School of Public Health, Kyoto, Japan
| | - Toshi A Furukawa
- Department of Health Promotion and Human Behaviour, Kyoto University Graduate School of Medicine, School of Public Health, Kyoto, Japan
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13
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Sakata M, Toyomoto R, Yoshida K, Luo Y, Nakagami Y, Uwatoko T, Shimamoto T, Tajika A, Suga H, Ito H, Sumi M, Muto T, Ito M, Ichikawa H, Ikegawa M, Shiraishi N, Watanabe T, Sahker E, Ogawa Y, Hollon SD, Collins LM, Watkins ER, Wason J, Noma H, Horikoshi M, Iwami T, Furukawa TA. Components of smartphone cognitive-behavioural therapy for subthreshold depression among 1093 university students: a factorial trial. Evid Based Ment Health 2022; 25:e18-e25. [PMID: 35577537 PMCID: PMC9811098 DOI: 10.1136/ebmental-2022-300455] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 03/23/2022] [Indexed: 01/17/2023]
Abstract
BACKGROUND Internet-based cognitive-behavioural therapy (iCBT) is effective for subthreshold depression. However, which skills provided in iCBT packages are more effective than others is unclear. Such knowledge can inform construction of more effective and efficient iCBT programmes. OBJECTIVE To examine the efficacy of five components of iCBT for subthreshold depression. METHODS We conducted an factorial trial using a smartphone app, randomly allocating presence or absence of five iCBT skills including self-monitoring, behavioural activation (BA), cognitive restructuring (CR), assertiveness training (AT) and problem-solving. Participants were university students with subthreshold depression. The primary outcome was the change on the Patient Health Questionnaire-9 (PHQ-9) from baseline to week 8. Secondary outcomes included changes in CBT skills. FINDINGS We randomised a total of 1093 participants. In all groups, participants had a significant PHQ-9 reduction from baseline to week 8. Depression reduction was not significantly different between presence or absence of any component, with corresponding standardised mean differences (negative values indicate specific efficacy in favour of the component) ranging between -0.04 (95% CI -0.16 to 0.08) for BA and 0.06 (95% CI -0.06 to 0.18) for AT. Specific CBT skill improvements were noted for CR and AT but not for the others. CONCLUSIONS There was significant reduction in depression for all participants regardless of the presence and absence of the examined iCBT components. CLINICAL IMPLICATION We cannot yet make evidence-based recommendations for specific iCBT components. We suggest that future iCBT optimisation research should scrutinise the amount and structure of components to examine. TRIAL REGISTRATION NUMBER UMINCTR-000031307.
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Affiliation(s)
- Masatsugu Sakata
- Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine/School of Public Health, Kyoto, Japan
| | - Rie Toyomoto
- Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine/School of Public Health, Kyoto, Japan
| | - Kazufumi Yoshida
- Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine/School of Public Health, Kyoto, Japan
| | - Yan Luo
- Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine/School of Public Health, Kyoto, Japan
| | | | - Teruhisa Uwatoko
- Department of Psychiatry, Kyoto University Hospital, Kyoto, Japan
| | | | - Aran Tajika
- Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine/School of Public Health, Kyoto, Japan
| | | | - Hiroshi Ito
- Ritsumeikan Medical Service Center, Kyoto, Japan
| | | | - Takashi Muto
- Faculty of Psychology, Doshisha University, Kyoto, Japan
| | - Masataka Ito
- Department of Life Design, Biwako Gakuin University, Higashiomi, Japan
| | - Hiroshi Ichikawa
- Department of Medical Life Systems, Doshisha University, Kyoto, Japan
| | - Masaya Ikegawa
- Department of Medical Life Systems, Doshisha University, Kyoto, Japan
| | - Nao Shiraishi
- Department of Psychitary and Cognitive-Behavioral Medicine, Nagoya City University, Nagoya, Japan
| | - Takafumi Watanabe
- Department of Psychitary and Cognitive-Behavioral Medicine, Nagoya City University, Nagoya, Japan
| | - Ethan Sahker
- Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine/School of Public Health, Kyoto, Japan
- Population Health and Policy Research Unit, Medical Education Center, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Yusuke Ogawa
- Department of Healthcare Epidemiology, Kyoto University Graduate School of Medicine / School of Public Health, Kyoto, Japan
| | - Steven D Hollon
- Department of Psychology, Vanderbilt University, Nashville, TN, USA
| | - Linda M Collins
- Department of Scoial and Behavioral Sciences, School of Global Public Health, New York University, New York, NY, USA
| | | | - James Wason
- Population Health Scineces Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Hisashi Noma
- Institute of Statistical Mathematics, Tachikawa, Tokyo, Japan
| | - Masaru Horikoshi
- National Center of Neurology and psychiatry/National Center for Cognitive Behavior Therapy and Research, Kodaira, Tokyo, Japan
| | - Taku Iwami
- Kyoto University Health Service, Kyoto, Japan
| | - Toshi A Furukawa
- Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine/School of Public Health, Kyoto, Japan
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14
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Aoki Y, Takaesu Y, Baba H, Iga J, Hori H, Inoue T, Mishima K, Tajika A, Kato M. Development and acceptability of a decision aid for major depressive disorder considering discontinuation of antidepressant treatment after remission. Neuropsychopharmacol Rep 2022; 42:306-314. [PMID: 35775506 PMCID: PMC9515698 DOI: 10.1002/npr2.12269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Revised: 05/16/2022] [Accepted: 05/21/2022] [Indexed: 12/02/2022] Open
Abstract
Aim While evidence‐based antidepressant treatment is available for major depressive disorder, standard approaches for discontinuation of antidepressants after remission have not yet been established. Decision aids are structured clinical tools that facilitate shared decision‐making between patients and healthcare providers. This study aimed to describe the development process and acceptability of decision aids for major depressive disorder following discontinuation of antidepressant treatment after remission. Methods We systematically developed a decision aids according to the International Patient Decision Aid Standards. First, a decision aids prototype was created using the results of a systematic review and meta‐analysis previously conducted to identify the consequences of continuing and discontinuing antidepressant treatment. Second, a mixed‐methods questionnaire (alpha acceptability testing) was administered to patients and healthcare providers to improve the decision aids prototype and develop it into a final version acceptable for clinical settings. Results Our decision aids consisted of a description of major depressive disorder, the option to continue or discontinue antidepressant treatment, the advantages and disadvantages of each option, the consequences of each option, and value clarification exercises for each option. The patients (n = 22) reported that the decision aids had acceptable language (91%), adequate information (91%), and a well‐balanced presentation (95%). Healthcare providers (n = 20) provided favorable feedback. The final decision aids fulfilled all six International Patient Decision Aid Standards qualifying criteria. Conclusion We successfully developed a decision aids for discontinuation of antidepressant treatment after remission, which could be used during the shared decision‐making process. Further studies are needed to verify the effects of using the decision aids during the shared decision‐making process.
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Affiliation(s)
- Yumi Aoki
- Department Psychiatric and Mental Health Nursing, Graduate School of Nursing St. Luke's International University Tokyo Japan
| | - Yoshikazu Takaesu
- Department of Neuropsychiatry, Graduate School of Medicine University of the Ryukyus Okinawa Japan
- Department of Neuropsychiatry Kyorin University School of Medicine Tokyo Japan
| | - Hajime Baba
- Department of Psychiatry, Juntendo Koshigaya Hospital Juntendo University Faculty of Medicine Saitama Japan
| | - Jun‐ichi Iga
- Department of Neuropsychiatry, Molecules and Function Ehime University Graduate School of Medicine Ehime Japan
| | - Hikaru Hori
- Department of Psychiatry, Faculty of Medicine Fukuoka University Fukuoka Japan
| | - Takeshi Inoue
- Department of Psychiatry Tokyo Medical University Tokyo Japan
| | - Kazuo Mishima
- Department of Neuropsychiatry Akita University Graduate School of Medicine Akita Japan
| | - Aran Tajika
- Department of Health Promotion and Human Behavior, School of Public Health Kyoto University Graduate School of Medicine Kyoto Japan
| | - Masaki Kato
- Department of Neuropsychiatry Kansai Medical University Osaka Japan
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Tajika A, Hori H, Iga JI, Koshikawa Y, Ogata H, Ogawa Y, Watanabe K, Kato T, Matsuo K, Kato M. Mood Stabilizers and Antipsychotics for Acute Mania: Systematic Review and Meta-Analysis of Augmentation Therapy vs Monotherapy From the Perspective of Time to the Onset of Treatment Effects. Int J Neuropsychopharmacol 2022; 25:839-852. [PMID: 35932466 PMCID: PMC9593220 DOI: 10.1093/ijnp/pyac050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 05/16/2022] [Revised: 07/25/2022] [Accepted: 08/04/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Existing meta-analytic evidence on bipolar mania treatment has revealed that augmentation therapy (AUG) with antipsychotics and mood stabilizers is more effective than monotherapy. However, the speed of the onset of treatment effects and subsequent changes in risk/benefit are unclear. METHODS We searched the Cochrane CENTRAL, MEDLINE, and EMBASE databases until January 2021. Our primary outcomes were response and tolerability. We set 3 time points: 1, 3, and 6 weeks after randomization. RESULTS Seventeen studies compared AUG therapy and MS monotherapy (comparison 1), and 8 studies compared AUG therapy and antipsychotics monotherapy (comparison 2). In comparison 1, AUG therapy resulted in significantly more responses than monotherapy, with an odds ratio of 1.45 (95% confidence interval [CI]: 1.17 to 1.80) at 3 weeks and 1.59 (95% CI: 1.28 to 1.99) at 6 weeks. Significant improvement was observed in the first week with a standardized mean difference of -0.25 (95% CI: -0.38 to -0.12). In comparison 2, AUG therapy was significantly more effective than monotherapy, with an odds ratio of 1.73 (95% CI: 1.25 to 2.40) at 3 weeks and 1.74 (95% CI: 1.11 to 2.73) at 6 weeks. Significant improvement was observed in the first week with an standardized mean difference of -0.23 (95% CI: -0.39 to -0.07). Regarding tolerability, there was no significant difference between AUG therapy and monotherapy at 3 and 6 weeks in both comparisons. CONCLUSIONS Early AUG therapy should be considered, as it has shown efficacy from weeks 1 to 6, although attention to side effects is necessary for acute mania treatment.
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Affiliation(s)
- Aran Tajika
- Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine and School of Public Health, Kyoto, Japan
| | - Hikaru Hori
- Department of Psychiatry, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Jun-ichi Iga
- Department of Neuropsychiatry, Molecules and Function, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime, Japan
| | | | - Haruhiko Ogata
- Department of Neuropsychiatry, Kansai Medical University
| | - Yusuke Ogawa
- Department of Healthcare Epidemiology, Kyoto University Graduate School of Medicine and School of Public Health, Kyoto, Japan
| | - Koichiro Watanabe
- Department of Neuropsychiatry, Kyorin University School of Medicine, Tokyo, Japan
| | - Tadafumi Kato
- Department of Neuropsychiatry, Kansai Medical University
| | - Koji Matsuo
- Department of Psychiatry, Faculty of Medicine, Saitama Medical University, Saitama, Japan
| | - Masaki Kato
- Correspondence: Masaki Kato, PhD, Department of Neuropsychiatry, Kansai Medical University, 2-5-1 Shin-Machi, Hirakata-Shi, Osaka, Japan 573-1010 ()
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Toyomoto R, Sakata M, Yoshida K, Luo Y, Nakagami Y, Iwami T, Aoki S, Irie T, Sakano Y, Suga H, Sumi M, Ichikawa H, Watanabe T, Tajika A, Uwatoko T, Sahker E, Furukawa TA. Validation of the Japanese Big Five Scale Short Form in a University Student Sample. Front Psychol 2022; 13:862646. [PMID: 35814124 PMCID: PMC9262100 DOI: 10.3389/fpsyg.2022.862646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 05/06/2022] [Indexed: 11/13/2022] Open
Abstract
The Japanese Big Five Scale Short Form (JBFS-SF), a 29-item self-report scale, has recently been used to measure the Big Five personality traits. However, the scale lacks psychometric validation. This study examined the validity and reliability of the JBFS-SF with data collected from 1,626 Japanese university students participating in a randomized controlled clinical trial. Structural validity was tested with exploratory and confirmatory factor analysis and measurement invariance tests were conducted across sex. Internal consistency was evaluated with McDonald’s omega. Additionally, construct validity was estimated across factors using the PHQ-9, GAD-7, AQ-J-10, and SSQ. EFA results showed that the JBFS-SF can be classified according to the expected five-factor structure, while three items had small loadings. Therefore, we dropped these three items and tested the reliability and validity of the 26-item version. CFA results found that a 26-item JBFS-FS has adequate structural validity (GFI = 0.907, AGFI = 0.886, CFI = 0.907, and RMSEA = 0.057). The omega of each factor was 0.74–0.85. Each JBFS-SF factor was specifically correlated with the PHQ-9, GAD-7, and SSQ. This research has shown that the JBFS-SF can be a clinically useful measure for assessing personality characteristics.
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Affiliation(s)
- Rie Toyomoto
- Department of Health Promotion and Human Behavior, School of Public Health, Kyoto University Graduate School of Medicine, Kyoto, Japan
- *Correspondence: Rie Toyomoto,
| | - Masatsugu Sakata
- Department of Health Promotion and Human Behavior, School of Public Health, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Kazufumi Yoshida
- Department of Health Promotion and Human Behavior, School of Public Health, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Yan Luo
- Department of Health Promotion and Human Behavior, School of Public Health, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Yukako Nakagami
- Agency for Health, Safety and Environment, Kyoto University Health Service, Kyoto, Japan
| | - Taku Iwami
- Agency for Health, Safety and Environment, Kyoto University Health Service, Kyoto, Japan
| | - Shuntaro Aoki
- Center for Medical Education and Career Development, Fukushima Medical University, Fukushima, Japan
| | - Tomonari Irie
- Department of Psychology and Counseling, School of Education and Culture, Hokusho University, Ebetsu, Japan
| | - Yuji Sakano
- Department of Clinical Psychology, Goryokai Medical Corporation, Sapporo, Japan
| | - Hidemichi Suga
- Department of Social Welfare, Ryukoku University Junior College, Kyoto, Japan
| | | | - Hiroshi Ichikawa
- Department of Medical Life Systems, Faculty of Life and Medical Sciences, Doshisha University, Kyoto, Japan
| | - Takafumi Watanabe
- Department of Psychiatry and Cognitive-Behavioral Medicine, Nagoya City University Graduate School of Medical Science, Nagoya, Japan
| | - Aran Tajika
- Department of Health Promotion and Human Behavior, School of Public Health, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Teruhisa Uwatoko
- Department of Psychiatry, Kyoto University Hospital, Kyoto, Japan
| | - Ethan Sahker
- Department of Health Promotion and Human Behavior, School of Public Health, Kyoto University Graduate School of Medicine, Kyoto, Japan
- Medical Education Center, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Toshi A. Furukawa
- Department of Health Promotion and Human Behavior, School of Public Health, Kyoto University Graduate School of Medicine, Kyoto, Japan
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17
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Shikuri Y, Tanoue H, Imai H, Nakamura H, Yamaguchi F, Goto T, Kido Y, Tajika A, Sawada H, Ishida Y, Yoshinaga N. Psychosocial interventions for community-dwelling individuals with schizophrenia: study protocol for a systematic review and meta-analysis. BMJ Open 2022; 12:e057286. [PMID: 35487709 PMCID: PMC9058762 DOI: 10.1136/bmjopen-2021-057286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Despite the recent global mental health movement of the transition from hospital-centred to integrated community-based services, comprehensive evidence of psychosocial interventions focusing on community-dwelling individuals with schizophrenia is still lacking. To overcome this gap in the current knowledge, we will conduct a systematic review and meta-analysis to assess the efficacy of all types of psychosocial interventions for community-dwelling (non-hospitalised) individuals with schizophrenia when compared with non-active control conditions (eg, treatment as usual). METHODS AND ANALYSIS This study protocol has been developed according to the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols guidelines. By March 2022, the following sources will have been searched, without restrictions for language or publication period: Embase, PubMed, PsycINFO, CINAHL, the Cochrane Central Register of Controlled Trials, ClinicalTrials.gov and the WHO International Clinical Trials Registry Platform. We will also try to identify other potentially eligible studies by searching the reference lists of included studies, other relevant systematic reviews and grey literature. All relevant randomised controlled trials from both high-income and low-income to middle-income countries will be allowed. Two independent reviewers will conduct the selection/screening of studies, data extraction and methodological quality assessment of included studies. The primary outcomes are quality of life and psychiatric hospital admission. Standard pairwise meta-analyses with a random-effects model will be conducted. Subgroup and sensitivity analyses will be performed to assess the robustness of the findings. Risk of bias will be assessed with the Revised Cochrane Risk-of-Bias Tool for Randomised Trials. The Grades of Recommendation Assessment, Development and Evaluation approach will be used to assess the quality of evidence. ETHICS AND DISSEMINATION Ethics approval is not required for this study. The study findings will be disseminated through conference presentations as well as peer-reviewed publications. PROSPERO REGISTRATION NUMBER CRD42021266187.
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Affiliation(s)
- Yuki Shikuri
- Graduate School of Nursing Science, University of Miyazaki, Miyazaki, Japan
| | - Hiroki Tanoue
- School of Nursing, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
| | - Hissei Imai
- Department of Health Promotion and Human Behavior, Graduate School of Medicine/School of Public Health, Kyoto University, Kyoto, Japan
| | - Hideki Nakamura
- Graduate School of Medical and Pharmaceutical Sciences, Chiba University, Chiba, Japan
| | - Fumitake Yamaguchi
- School of Nursing, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
| | - Taichi Goto
- Department of Pain and Translational Symptom Science, University of Maryland School of Nursing, Baltimore, Maryland, USA
| | - Yoshifumi Kido
- Faculty of Nursing, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Aran Tajika
- Department of Health Promotion and Human Behavior, Graduate School of Medicine/School of Public Health, Kyoto University, Kyoto, Japan
| | - Hirotake Sawada
- School of Nursing, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
| | - Yasushi Ishida
- Division of Psychiatry, Department of Clinical Neuroscience, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
| | - Naoki Yoshinaga
- School of Nursing, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
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Tsujimoto Y, Fujii T, Tsutsumi Y, Kataoka Y, Tajika A, Okada Y, Carrasco-Labra A, Devji T, Wang Y, Guyatt GH, Furukawa TA. Minimal important changes in standard deviation units are highly variable and no universally applicable value can be determined. J Clin Epidemiol 2022; 145:92-100. [DOI: 10.1016/j.jclinepi.2022.01.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Revised: 12/24/2021] [Accepted: 01/20/2022] [Indexed: 10/19/2022]
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19
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Imai H, Tajika A, Narita H, Yoshinaga N, Kimura K, Nakamura H, Takeshima N, Hayasaka Y, Ogawa Y, Furukawa T. Unguided computer-assisted self-help interventions without human contact in patients with obsessive-compulsive disorder: a systematic review and meta-analysis (Preprint). J Med Internet Res 2021; 24:e35940. [PMID: 35451993 PMCID: PMC9073609 DOI: 10.2196/35940] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 03/07/2022] [Accepted: 03/11/2022] [Indexed: 12/02/2022] Open
Abstract
Background Computer-assisted treatment may reduce therapist contact and costs and promote client participation. This meta-analysis examined the efficacy and acceptability of an unguided computer-assisted therapy in patients with obsessive-compulsive disorder (OCD) compared with a waiting list or attention placebo. Objective This study aimed to evaluate the effectiveness and adherence of computer-assisted self-help treatment without human contact in patients with OCD using a systematic review and meta-analysis approach. Methods Randomized controlled trials with participants primarily diagnosed with OCD by health professionals with clinically significant OCD symptoms as measured with validated scales were included. The interventions included self-help treatment through the internet, computers, and smartphones. We excluded interventions that used human contact. We conducted a search on PubMed, Cochrane Central Register of Controlled Trials, EMBASE, World Health Organization International Clinical Trials Registry Platform, and ClinicalTrials.gov, as well as the reference lists of the included studies. The risk of bias was evaluated using version 2 of the Cochrane risk-of-bias tool for randomized trials. We calculated the standardized mean differences for continuous outcomes and risk ratios for dichotomous outcomes. The primary outcomes were short-term improvement of OCD symptoms measured by validated scales and dropout for any reason. Results We included 11 randomized controlled trials with a total of 983 participants. The results indicated that unguided computer-assisted self-help therapy was significantly more effective than a waiting list or psychological placebo (standard mean difference −0.47, 95% CI −0.73 to −0.22). Unguided computer-assisted self-help therapy had more dropouts for any reason than waiting list or psychological placebo (risk ratio 1.98, 95% CI 1.21 to 3.23). However, the quality of evidence was very low because of the risk of bias and inconsistent results among the included studies. The subgroup analysis showed that exposure response and prevention and an intervention duration of more than 4 weeks strengthen the efficacy without worsening acceptability. Only a few studies have examined the interaction between participants and systems, and no study has used gamification. Most researchers only used text-based interventions, and no study has used a mobile device. The overall risk of bias of the included studies was high and the heterogeneity of results was moderate to considerable. Conclusions Unguided computer-assisted self-help therapy for OCD is effective compared with waiting lists or psychological placebo. An exposure response and prevention component and intervention duration of more than 4 weeks may strengthen the efficacy without worsening the acceptability of the therapy. Trial Registration PROSPERO (International Prospective Register of Systematic Reviews) CRD42021264644; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=264644
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Affiliation(s)
- Hissei Imai
- Department of Health Promotion and Human Behavior, Graduate School of Medicine, School of Public Health, Kyoto University, Kyoto, Japan
| | - Aran Tajika
- Department of Health Promotion and Human Behavior, Graduate School of Medicine, School of Public Health, Kyoto University, Kyoto, Japan
| | - Hisashi Narita
- Department of Psychiatry, Graduate School of Medicine, Hokkaido University, Sapporo, Japan
- Department of Neurology, Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Naoki Yoshinaga
- School of Nursing, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
| | - Kenichi Kimura
- Department of Psychiatry, Hakodate Watanabe Hospital, Hakodate, Japan
| | - Hideki Nakamura
- Department of Cognitive Behavioral Physiology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Nozomi Takeshima
- Department of Health Promotion and Human Behavior, Graduate School of Medicine, School of Public Health, Kyoto University, Kyoto, Japan
| | - Yu Hayasaka
- Department of Health Promotion and Human Behavior, Graduate School of Medicine, School of Public Health, Kyoto University, Kyoto, Japan
| | - Yusuke Ogawa
- Department of Healthcare Epidemiology, Graduate School of Medicine, School of Public Health, Kyoto University, Kyoto, Japan
| | - Toshi Furukawa
- Department of Health Promotion and Human Behavior, Graduate School of Medicine, School of Public Health, Kyoto University, Kyoto, Japan
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20
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Garcia FCC, Hirao A, Tajika A, Furukawa TA, Ikeda K, Yoshimoto J. Leveraging Longitudinal Lifelog Data Using Survival Models for Predicting Risk of Relapse among Patients with Depression in Remission. Annu Int Conf IEEE Eng Med Biol Soc 2021; 2021:2455-2458. [PMID: 34891776 DOI: 10.1109/embc46164.2021.9629798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Managing depression relapse is a challenge given factors such as inconsistent follow-up and cumbersome psychological distress evaluation methods which leaves patients with a high risk of relapse to leave their symptoms untreated. In an attempt to bridge this gap, we proposed an approach on the use of personal longitudinal lifelog activity data gathered from individual smartphones of patients in remission and maintenance therapy (N=87) to predict their risk of depression relapse. Through the use of survival models, we modeled the activity data as covariates to predict survival curves to determine if patients are at risk of relapse. We compared three models: CoxPH, Random Survival Forests, and DeepSurv, and found that DeepSurv performed the best in terms of Concordance Index and Brier Score. Our results show the possibility of utilizing lifelog data as a means of predicting the onset of relapse and towards building eventual tools for a more coherent patient evaluation and intervention system.
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21
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Furukawa TA, Shinohara K, Sahker E, Karyotaki E, Miguel C, Ciharova M, Bockting CLH, Breedvelt JJF, Tajika A, Imai H, Ostinelli EG, Sakata M, Toyomoto R, Kishimoto S, Ito M, Furukawa Y, Cipriani A, Hollon SD, Cuijpers P. Initial treatment choices to achieve sustained response in major depression: a systematic review and network meta-analysis. World Psychiatry 2021; 20:387-396. [PMID: 34505365 PMCID: PMC8429344 DOI: 10.1002/wps.20906] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Major depression is often a relapsing disorder. It is therefore important to start its treatment with therapies that maximize the chance of not only getting the patients well but also keeping them well. We examined the associations between initial treatments and sustained response by conducting a network meta-analysis of randomized controlled trials (RCTs) in which adult patients with major depression were randomized to acute treatment with a psychotherapy (PSY), a protocolized antidepressant pharmacotherapy (PHA), their combination (COM), standard treatment in primary or secondary care (STD), or pill placebo, and were then followed up through a maintenance phase. By design, acute phase treatment could be continued into the maintenance phase, switched to another treatment or followed by discretionary treatment. We included 81 RCTs, with 13,722 participants. Sustained response was defined as responding to the acute treatment and subsequently having no depressive relapse through the maintenance phase (mean duration: 42.2±16.2 weeks, range 24-104 weeks). We extracted the data reported at the time point closest to 12 months. COM resulted in more sustained response than PHA, both when these treatments were continued into the maintenance phase (OR=2.52, 95% CI: 1.66-3.85) and when they were followed by discretionary treatment (OR=1.80, 95% CI: 1.21-2.67). The same applied to COM in comparison with STD (OR=2.90, 95% CI: 1.68-5.01 when COM was continued into the maintenance phase; OR=1.97, 95% CI: 1.51-2.58 when COM was followed by discretionary treatment). PSY also kept the patients well more often than PHA, both when these treatments were continued into the maintenance phase (OR=1.53, 95% CI: 1.00-2.35) and when they were followed by discretionary treatment (OR=1.66, 95% CI: 1.13-2.44). The same applied to PSY compared with STD (OR=1.76, 95% CI: 0.97-3.21 when PSY was continued into the maintenance phase; OR=1.83, 95% CI: 1.20-2.78 when PSY was followed by discretionary treatment). Given the average sustained response rate of 29% on STD, the advantages of PSY or COM over PHA or STD translated into risk differences ranging from 12 to 16 percentage points. We conclude that PSY and COM have more enduring effects than PHA. Clinical guidelines on the initial treatment choice for depression may need to be updated accordingly.
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Affiliation(s)
- Toshi A Furukawa
- Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine / School of Public Health, Kyoto, Japan
| | - Kiyomi Shinohara
- Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine / School of Public Health, Kyoto, Japan
| | - Ethan Sahker
- Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine / School of Public Health, Kyoto, Japan
| | - Eirini Karyotaki
- Department of Clinical, Neuro- and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit, Amsterdam, The Netherlands
| | - Clara Miguel
- Department of Clinical, Neuro- and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit, Amsterdam, The Netherlands
| | - Marketa Ciharova
- Department of Clinical, Neuro- and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit, Amsterdam, The Netherlands
| | - Claudi L H Bockting
- Department of Psychiatry & Centre for Urban Mental Health, University of Amsterdam, Amsterdam, The Netherlands
| | - Josefien J F Breedvelt
- Department of Psychiatry & Centre for Urban Mental Health, University of Amsterdam, Amsterdam, The Netherlands
| | - Aran Tajika
- Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine / School of Public Health, Kyoto, Japan
| | - Hissei Imai
- Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine / School of Public Health, Kyoto, Japan
| | - Edoardo G Ostinelli
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK
- Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, UK
| | - Masatsugu Sakata
- Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine / School of Public Health, Kyoto, Japan
| | - Rie Toyomoto
- Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine / School of Public Health, Kyoto, Japan
| | - Sanae Kishimoto
- Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine / School of Public Health, Kyoto, Japan
| | - Masami Ito
- Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine / School of Public Health, Kyoto, Japan
| | - Yuki Furukawa
- Department of Neuropsychiatry, University of Tokyo Hospital, Tokyo, Japan
| | - Andrea Cipriani
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK
- Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, UK
| | - Steven D Hollon
- Department of Psychology, Vanderbilt University, Nashville, TN, USA
| | - Pim Cuijpers
- Department of Clinical, Neuro- and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit, Amsterdam, The Netherlands
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Kumagai N, Tajika A, Hasegawa A, Kawanishi N, Fujita H, Tsujino N, Jinnin R, Uchida M, Okamoto Y, Akechi T, Furukawa TA. Assessing recurrence of depression using a zero-inflated negative binomial model: A secondary analysis of lifelog data. Psychiatry Res 2021; 300:113919. [PMID: 33864960 DOI: 10.1016/j.psychres.2021.113919] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2020] [Accepted: 03/28/2021] [Indexed: 11/27/2022]
Abstract
When studying recurrence of depression, researchers should pay attention to cases where physicians' assessment corresponds to the patients' perception. However, they should also focus on potential signs of recurrence when the recurrence is suspected by the physicians but not the patients (false-negative zeros). Because false negatives can delay diagnosis and treatment, we aimed to investigate "sitting idly" as a predictor influencing no alert sign of recurrence and estimated the counts of recurrence of depression. A smartphone application and a wearable device were used to collect lifelog data from 89 remitted depressive patients over one year. Recurrent depression was defined using the Japanese version of the Kessler Psychological Distress Scale and Patient Health Questionnaire-9 scores. Estimates of the population-averaged parameters indicated that daily hours of sitting idly increased the chances of recurrent depression occurring two to four weeks later. Exposure to daily ultraviolet light reduced depression relapse. Although long sleep was a determinant of zero outcome of the recurrence of depression after two to four weeks, daily hours of sitting idly can negate it. Thus, daily hours of sitting idly could reduce overdispersion of the recurrence of depression, and we could measure recurrent depression accurately by considering changes in sitting idly.
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Affiliation(s)
| | - Aran Tajika
- Department of Psychiatry, Kyoto University Hospital, Kyoto, Japan.
| | - Akio Hasegawa
- Advanced Telecommunications Research Institute International, Kyoto, Japan
| | | | - Hirokazu Fujita
- Center to Promote Creativity in Medical Education, Kochi Medical School, Kochi University, Kochi, Japan
| | - Naohisa Tsujino
- Department of Neuropsychiatry, School of Medicine, Toho University, Tokyo, Japan; Department of Psychiatry, Saiseikai Yokohama-shi Tobu Hospital, Kanagawa, Japan
| | - Ran Jinnin
- Department of Psychiatry & Neurosciences, Graduate School of Biomedical & Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Megumi Uchida
- Department of Psychiatry and Cognitive-Behavioral Medicine, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Yasumasa Okamoto
- Department of Psychiatry & Neurosciences, Graduate School of Biomedical & Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Tatsuo Akechi
- Department of Psychiatry and Cognitive-Behavioral Medicine, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Toshi A Furukawa
- Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine / School of Public Health, Kyoto, Japan
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Kimachi M, Onishi A, Tajika A, Kimachi K, Furukawa TA. Systematic differences in effect estimates between observational studies and randomized control trials in meta-analyses in nephrology. Sci Rep 2021; 11:6088. [PMID: 33731727 PMCID: PMC7971062 DOI: 10.1038/s41598-021-85519-5] [Citation(s) in RCA: 3] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Accepted: 02/23/2021] [Indexed: 01/02/2023] Open
Abstract
The limited availability of randomized controlled trials (RCTs) in nephrology undermines causal inferences in meta-analyses. Systematic reviews of observational studies have grown more common under such circumstances. We conducted systematic reviews of all comparative observational studies in nephrology from 2006 to 2016 to assess the trends in the past decade. We then focused on the meta-analyses combining observational studies and RCTs to evaluate the systematic differences in effect estimates between study designs using two statistical methods: by estimating the ratio of odds ratios (ROR) of the pooled OR obtained from observational studies versus those from RCTs and by examining the discrepancies in their statistical significance. The number of systematic reviews of observational studies in nephrology had grown by 11.7-fold in the past decade. Among 56 records combining observational studies and RCTs, ROR suggested that the estimates between study designs agreed well (ROR 1.05, 95% confidence interval 0.90–1.23). However, almost half of the reviews led to discrepant interpretations in terms of statistical significance. In conclusion, the findings based on ROR might encourage researchers to justify the inclusion of observational studies in meta-analyses. However, caution is needed, as the interpretations based on statistical significance were less concordant than those based on ROR.
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Affiliation(s)
- Miho Kimachi
- Department of Healthcare Epidemiology, School of Public Health in the Graduate School of Medicine, Kyoto University, Yoshida-Konoe-cho, Sakyo-ku, Kyoto, 606-8501, Japan.
| | - Akira Onishi
- Department of Rheumatology and Clinical Immunology, Kobe University Graduate School of Medicine, Hyōgo, Japan
| | - Aran Tajika
- Department of Psychiatry, Kyoto University Hospital, Kyoto, Japan
| | - Kimihiko Kimachi
- Department of Healthcare Epidemiology, School of Public Health in the Graduate School of Medicine, Kyoto University, Yoshida-Konoe-cho, Sakyo-ku, Kyoto, 606-8501, Japan
| | - Toshi A Furukawa
- Department of Health Promotion and Human Behavior, School of Public Health in the Graduate School of Medicine, Kyoto University, Kyoto, Japan
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Kato M, Hori H, Inoue T, Iga J, Iwata M, Inagaki T, Shinohara K, Imai H, Murata A, Mishima K, Tajika A. Discontinuation of antidepressants after remission with antidepressant medication in major depressive disorder: a systematic review and meta-analysis. Mol Psychiatry 2021; 26:118-133. [PMID: 32704061 PMCID: PMC7815511 DOI: 10.1038/s41380-020-0843-0] [Citation(s) in RCA: 52] [Impact Index Per Article: 17.3] [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: 03/30/2020] [Revised: 07/03/2020] [Accepted: 07/08/2020] [Indexed: 12/25/2022]
Abstract
A significant clinical issue encountered after a successful acute major depressive disorder (MDD) treatment is the relapse of depressive symptoms. Although continuing maintenance therapy with antidepressants is generally recommended, there is no established protocol on whether or not it is necessary to prescribe the antidepressant used to achieve remission. In this meta-analysis, the risk of relapse and treatment failure when either continuing with the same drug used to achieved remission or switching to a placebo was assessed in several clinically significant subgroups. The pooled odds ratio (OR) (±95% confidence intervals (CI)) was calculated using a random effects model. Across 40 studies (n = 8890), the relapse rate was significantly lower in the antidepressant group than the placebo group by about 20% (OR = 0.38, CI: 0.33-0.43, p < 0.00001; 20.9% vs 39.7%). The difference in the relapse rate between the antidepressant and placebo groups was greater for tricyclics (25.3%; OR = 0.30, CI: 0.17-0.50, p < 0.00001), SSRIs (21.8%; OR = 0.33, CI: 0.28-0.38, p < 0.00001), and other newer agents (16.0%; OR = 0.44, CI: 0.36-0.54, p < 0.00001) in that order, while the effect size of acceptability was greater for SSRIs than for other antidepressants. A flexible dose schedule (OR = 0.30, CI: 0.23-0.48, p < 0.00001) had a greater effect size than a fixed dose (OR = 0.41, CI: 0.36-0.48, p < 0.00001) in comparison to placebo. Even in studies assigned after continuous treatment for more than 6 months after remission, the continued use of antidepressants had a lower relapse rate than the use of a placebo (OR = 0.40, CI: 0.29-0.55, p < 0.00001; 20.2% vs 37.2%). The difference in relapse rate was similar from a maintenance period of 6 months (OR = 0.41, CI: 0.35-0.48, p < 0.00001; 19.6% vs 37.6%) to over 1 year (OR = 0.35, CI: 0.29-0.41, p < 0.00001; 19.9% vs 39.8%). The all-cause dropout of antidepressant and placebo groups was 43% and 58%, respectively, (OR = 0.47, CI: 0.40-0.55, p < 0.00001). The tolerability rate was ~4% for both groups. The rate of relapse (OR = 0.32, CI: 0.18-0.64, p = 0.0010, 41.0% vs 66.7%) and all-cause dropout among adolescents was higher than in adults. To prevent relapse and treatment failure, maintenance therapy, and careful attention for at least 6 months after remission is recommended. SSRIs are well-balanced agents, and flexible dose adjustments are more effective for relapse prevention.
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Affiliation(s)
- Masaki Kato
- Department of Neuropsychiatry, Kansai Medical University, Osaka, Japan.
| | - Hikaru Hori
- Department of Psychiatry, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Takeshi Inoue
- Department of Psychiatry, Tokyo Medical University, Tokyo, Japan
| | - Junichi Iga
- Department of Neuropsychiatry, Molecules and Function, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime, Japan
| | - Masaaki Iwata
- Department of Neuropsychiatry, Faculty of Medicine, Tottori University, Yonago, Japan
| | - Takahiko Inagaki
- Adolescent Mental Health Service, Biwako Hospital, Otsu, Japan.,Department of Psychiatry, Shiga University of Medical Science, Otsu, Japan
| | - Kiyomi Shinohara
- Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine and School of Public Health, Kyoto, Japan
| | - Hissei Imai
- Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine and School of Public Health, Kyoto, Japan
| | - Atsunobu Murata
- Department of Pathology of Mental Diseases, National Institute of Mental Health, National Center of Neurology and Psychiatry, Kodaira, Japan
| | - Kazuo Mishima
- Department of Neuropsychiatry, Akita University Graduate School of Medicine, Akita, Japan
| | - Aran Tajika
- Department of Psychiatry, Kyoto University Hospital, Kyoto, Japan
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Ogawa Y, Takeshima N, Hayasaka Y, Tajika A, Watanabe N, Streiner D, Furukawa TA. Antidepressants plus benzodiazepines for adults with major depression: a Cochrane Review. BJPsych advances 2020. [DOI: 10.1192/bja.2020.18] [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: 11/23/2022]
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Guaiana G, Barbui C, Meader N, Davies SJC, Furukawa TA, Imai H, Dias S, Caldwell DM, Koesters M, Tajika A, Bighelli I, Pompoli A, Cipriani A. Pharmacological treatments in panic disorder in adults: a network meta-analysis. Hippokratia 2020. [DOI: 10.1002/14651858.cd012729.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
| | - Corrado Barbui
- Department of Neurosciences, Biomedicine and Movement Sciences, Section of Psychiatry; University of Verona; Verona Italy
- Cochrane Global Mental Health; University of Verona; Verona Italy
| | - Nicholas Meader
- Centre for Reviews and Dissemination; University of York; York UK
- Cochrane Common Mental Disorders; University of York; York UK
| | - Simon JC Davies
- Geriatric Psychiatry Division, CAMH; University of Toronto; Toronto Canada
| | - Toshi A Furukawa
- Department of Health Promotion and Human Behavior; Kyoto University Graduate School of Medicine/School of Public Health; Kyoto Japan
| | - Hissei Imai
- Department of Health Promotion and Human Behavior; Kyoto University Graduate School of Medicine/School of Public Health; Kyoto Japan
| | - Sofia Dias
- Centre for Reviews and Dissemination; University of York; York UK
| | - Deborah M Caldwell
- Population Health Sciences, Bristol Medical School; University of Bristol; Bristol UK
| | - Markus Koesters
- Department of Psychiatry II; Ulm University; Guenzburg Germany
| | - Aran Tajika
- Department of Psychiatry; Kyoto University Hospital; Kyoto Japan
| | - Irene Bighelli
- Klinik und Poliklinik für Psychiatrie und Psychotherapie; Technische Universität München Klinikum rechts der Isar; München Germany
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Kumagai N, Tajika A, Hasegawa A, Kawanishi N, Horikoshi M, Shimodera S, Kurata K, Chino B, Furukawa TA. Predicting recurrence of depression using lifelog data: an explanatory feasibility study with a panel VAR approach. BMC Psychiatry 2019; 19:391. [PMID: 31829206 PMCID: PMC6907185 DOI: 10.1186/s12888-019-2382-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [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: 04/22/2019] [Accepted: 11/29/2019] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Although depression has a high rate of recurrence, no prior studies have established a method that could identify the warning signs of its recurrence. METHODS We collected digital data consisting of individual activity records such as location or mobility information (lifelog data) from 89 patients who were on maintenance therapy for depression for a year, using a smartphone application and a wearable device. We assessed depression and its recurrence using both the Kessler Psychological Distress Scale (K6) and the Patient Health Questionnaire-9. RESULTS A panel vector autoregressive analysis indicated that long sleep time was a important risk factor for the recurrence of depression. Long sleep predicted the recurrence of depression after 3 weeks. CONCLUSIONS The panel vector autoregressive approach can identify the warning signs of depression recurrence; however, the convenient sampling of the present cohort may limit the scope towards drawing a generalised conclusion.
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Affiliation(s)
- Narimasa Kumagai
- grid.443473.3Department of Economics, Seinan Gakuin University, 6-2-92, Nishijin, Sawara-ku, Fukuoka, 814-8511 Japan
| | - Aran Tajika
- Department of Psychiatry, Kyoto University Hospital, 54 Shogoin-Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan.
| | - Akio Hasegawa
- 0000 0001 2291 1583grid.418163.9Advanced Telecommunications Research Institute International, 2-2-2 Hikaridai, Seika-cho, Soraku-gun, Kyoto, 619-0288 Japan
| | - Nao Kawanishi
- Sonas Inc., 6F, Grace Imas Building, 5-24-2, Hongo, Bunkyo-ku, Tokyo, 113-0033 Japan
| | - Masaru Horikoshi
- 0000 0004 1763 8916grid.419280.6National Center for Cognitive Behavior Therapy and Research, National Center of Neurology and Psychiatry, 4-1-1 Ogawahigashi-cho, Kodaira, Tokyo, 187-8553 Japan
| | - Shinji Shimodera
- Ginza Shimodera Clinic, 8B-6-9-6 Ginza Chuo Ward, Tokyo, 104-0061 Japan ,0000 0004 0372 2033grid.258799.8Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine / School of Public Health, Yoshida Konoe-cho, Sakyo-ku, Kyoto, 606-8501 Japan
| | - Ken’ichi Kurata
- Kabe Mental Health Clinic, 4-6-2 Kabe, Asakita-ku, Hiroshima, 731-0221 Japan
| | - Bun Chino
- Ginza Taimei Clinic, 5-1-15 Ginza, Chuou-ku, Tokyo, 104-0061 Japan
| | - Toshi A. Furukawa
- 0000 0004 0372 2033grid.258799.8Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine / School of Public Health, Yoshida Konoe-cho, Sakyo-ku, Kyoto, 606-8501 Japan
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Tajika A, Furukawa TA, Inagaki M, Kato T, Mantani A, Kurata K, Ogawa Y, Takeshima N, Hayasaka Y, Noma H, Maruo K. Trajectory of criterion symptoms of major depression under newly started antidepressant treatment: sleep disturbances and anergia linger on while suicidal ideas and psychomotor symptoms disappear early. Acta Psychiatr Scand 2019; 140:532-540. [PMID: 31618446 DOI: 10.1111/acps.13115] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/13/2019] [Indexed: 11/30/2022]
Abstract
OBJECTIVE In modern psychiatry, depression is diagnosed with the diagnostic criteria; however, the trajectory of each of the criterion symptoms is unknown. This study aims to examine this. METHODS We made repeated assessments of the nine diagnostic criterion symptoms with the Patient Health Questionnaire-9 (PHQ-9) among 2011 participants of a 25-week pragmatic randomised controlled trial of sertraline and/or mirtazapine for hitherto untreated major depressive episodes. The changes from baseline were estimated with the mixed-effects model with repeated measures. The time to disappearance of each symptom was modeled using the Kaplan-Meier survival analysis. RESULTS The total score on PHQ-9 was 18.5 (SD = 3.9, n = 2011) at baseline, which decreased to 15.3 (5.2, n = 2011) at week 1, to 11.5 (5.9, n = 1953) at week 3, to 7.8 (6.0, n = 1927) at week 9, and to 6.0 (5.9, n = 1910) at week 25. Suicidal ideas, psychomotor symptoms decreased rapidly, while anergia and sleep disturbance also decreased but only slowly. The survival analyses confirmed the primary analyses. CONCLUSIONS Upon initiation of antidepressant treatment, patients with newly treated major depressive episodes can expect their suicidal ideas and psychomotor symptoms to disappear first but sleep disturbances and anergia to linger on.
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Affiliation(s)
- A Tajika
- Department of Neurosychiatry, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - T A Furukawa
- Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine/School of Public Health, Kyoto, Japan
| | - M Inagaki
- Department of Psychiatry, Shimane University Faculty of Medicine, Izumo, Japan
| | - T Kato
- Aratama Kokorono Clinic, Nagoya, Japan
| | - A Mantani
- Mantani Mental Clinic, Hiroshima, Japan
| | - K Kurata
- Kabe Mental Health Clinic, Hiroshima, Japan
| | - Y Ogawa
- Department of Healthcare Epidemiology, Kyoto University Graduate School of Medicine/School of Public Health, Kyoto, Japan
| | - N Takeshima
- Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine/School of Public Health, Kyoto, Japan
| | - Y Hayasaka
- Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine/School of Public Health, Kyoto, Japan
| | - H Noma
- Department of Data Science, The Institute of Statistical Mathematics, Tokyo, Japan
| | - K Maruo
- Department of Biostatistics, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
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Akechi T, Kato T, Fujise N, Yonemoto N, Tajika A, Furukawa TA. Why some depressive patients perform suicidal acts and others do not. Psychiatry Clin Neurosci 2019; 73:660-661. [PMID: 31355505 DOI: 10.1111/pcn.12918] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Revised: 07/03/2019] [Accepted: 07/23/2019] [Indexed: 11/26/2022]
Affiliation(s)
- Tatsuo Akechi
- Department of Psychiatry and Cognitive-Behavioral Medicine, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | | | - Noboru Fujise
- Health Care Center, Kumamoto University, Kumamoto, Japan
| | - Naohiro Yonemoto
- Department of Biostatistics, Kyoto University School of Public Health, Kyoto, Japan
| | - Aran Tajika
- Department of Psychiatry, Kyoto University Hospital, Kyoto, Japan
| | - Toshi A Furukawa
- Department of Health Promotion of Human Behavior and Clinical Epidemiology, Kyoto University Graduate School of Medicine / School of Public Health, Kyoto, Japan
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Abstract
BACKGROUND Anxiety frequently coexists with depression and adding benzodiazepines to antidepressant treatment is common practice to treat people with major depression. However, more evidence is needed to determine whether this combined treatment is more effective and not any more harmful than antidepressants alone. It has been suggested that benzodiazepines may lose their efficacy with long-term administration and their chronic use carries risks of dependence.This is the 2019 updated version of a Cochrane Review first published in 2001, and previously updated in 2005. This update follows a new protocol to conform with the most recent Cochrane methodology guidelines, with the inclusion of 'Summary of findings' tables and GRADE evaluations for quality of evidence. OBJECTIVES To assess the effects of combining antidepressants with benzodiazepines compared with antidepressants alone for major depression in adults. SEARCH METHODS We searched the Cochrane Common Mental Disorders Group's Controlled Trials Register (CCMDCTR), the Cochrane Central Register of Controlled Trials, MEDLINE, Embase and PsycINFO to May 2019. We searched the World Health Organization (WHO) trials portal and ClinicalTrials.gov to identify any additional unpublished or ongoing studies. SELECTION CRITERIA All randomised controlled trials that compared combined antidepressant plus benzodiazepine treatment with antidepressants alone for adults with major depression. We excluded studies administering psychosocial therapies targeted at depression and anxiety disorders concurrently. Antidepressants had to be prescribed, on average, at or above the minimum effective dose as presented by Hansen 2009 or according to the North American or European regulations. The combination therapy had to last at least four weeks. DATA COLLECTION AND ANALYSIS Two review authors independently extracted data and assessed risk of bias in the included studies, according to the criteria of the Cochrane Handbook for Systematic Reviews of Interventions. We entered data into Review Manager 5. We used intention-to-treat data. We combined continuous outcome variables of depressive and anxiety severity using standardised mean differences (SMD) with 95% confidence intervals (CIs). For dichotomous efficacy outcomes, we calculated the risk ratio (RR) with 95% CI. Regarding the primary outcome of acceptability, only overall dropout rates were available for all studies. MAIN RESULTS We identified 10 studies published between 1978 to 2002 involving 731 participants. Six studies used tricyclic antidepressants (TCAs), two studies used selective serotonin reuptake inhibitors (SSRIs), one study used another heterocyclic antidepressant and one study used TCA or heterocyclic antidepressant.Combined therapy of benzodiazepines plus antidepressants was more effective than antidepressants alone for depressive severity in the early phase (four weeks) (SMD -0.25, 95% CI -0.46 to -0.03; 10 studies, 598 participants; moderate-quality evidence), but there was no difference between treatments in the acute phase (five to 12 weeks) (SMD -0.18, 95% CI -0.40 to 0.03; 7 studies, 347 participants; low-quality evidence) or in the continuous phase (more than 12 weeks) (SMD -0.21, 95% CI -0.76 to 0.35; 1 study, 50 participants; low-quality evidence). For acceptability of treatment, there was no difference in the dropouts due to any reason between combined therapy and antidepressants alone (RR 0.76, 95% CI 0.54 to 1.07; 10 studies, 731 participants; moderate-quality evidence).For response in depression, combined therapy was more effective than antidepressants alone in the early phase (RR 1.34, 95% CI 1.13 to 1.58; 10 studies, 731 participants), but there was no evidence of a difference in the acute phase (RR 1.12, 95% CI 0.93 to 1.35; 7 studies, 383 participants) or in the continuous phase (RR 0.97, 95% CI 0.73 to 1.29; 1 study, 52 participants). For remission in depression, combined therapy was more effective than antidepressants alone in the early phase (RR 1.39, 95% CI 1.03 to 1.90, 10 studies, 731 participants), but there was no evidence of a difference in the acute phase (RR 1.27, 95% CI 0.99 to 1.63; 7 studies, 383 participants) or in the continuous phase (RR 1.31, 95% CI 0.80 to 2.16; 1 study, 52 participants). There was no evidence of a difference between combined therapy and antidepressants alone for anxiety severity in the early phase (SMD -0.76, 95% CI -1.67 to 0.14; 3 studies, 129 participants) or in the acute phase (SMD -0.48, 95% CI -1.06 to 0.10; 3 studies, 129 participants). No studies measured severity of insomnia. In terms of adverse effects, the dropout rates due to adverse events were lower for combined therapy than for antidepressants alone (RR 0.54, 95% CI 0.32 to 0.90; 10 studies, 731 participants; moderate-quality evidence). However, participants in the combined therapy group reported at least one adverse effect more often than participants who received antidepressants alone (RR 1.12, 95% CI 1.01 to 1.23; 7 studies, 510 participants; moderate-quality evidence).Most domains of risk of bias in the majority of the included studies were unclear. Random sequence generation, allocation concealment, blinding and selective outcome reporting were problematic due to insufficient details reported in most of the included studies and lack of availability of the study protocols. The greatest limitation in the quality of evidence was issues with attrition. AUTHORS' CONCLUSIONS Combined antidepressant plus benzodiazepine therapy was more effective than antidepressants alone in improving depression severity, response in depression and remission in depression in the early phase. However, these effects were not maintained in the acute or the continuous phase. Combined therapy resulted in fewer dropouts due to adverse events than antidepressants alone, but combined therapy was associated with a greater proportion of participants reporting at least one adverse effect.The moderate quality evidence of benefits of adding a benzodiazepine to an antidepressant in the early phase must be balanced judiciously against possible harms and consideration given to other alternative treatment strategies when antidepressant monotherapy may be considered inadequate. We need long-term, pragmatic randomised controlled trials to compare combination therapy against the monotherapy of antidepressant in major depression.
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Affiliation(s)
- Yusuke Ogawa
- School of Public Health in the Graduate School of Medicine, Kyoto UniversityDepartment of Healthcare EpidemiologyYoshida Konoe‐cho, Sakyo‐kuKyotoJapan606‐8501
| | - Nozomi Takeshima
- Kyoto University Graduate School of Medicine/School of Public HealthDepartment of Health Promotion and Human BehaviorYoshida Konoe‐cho, Sakyo‐kuKyotoJapan606‐8501
| | - Yu Hayasaka
- Kyoto University Graduate School of Medicine/School of Public HealthDepartment of Health Promotion and Human BehaviorYoshida Konoe‐cho, Sakyo‐kuKyotoJapan606‐8501
| | - Aran Tajika
- Kyoto University HospitalDepartment of PsychiatryKyotoJapan
| | - Norio Watanabe
- Kyoto University Graduate School of Medicine/School of Public HealthDepartment of Health Promotion and Human BehaviorYoshida Konoe‐cho, Sakyo‐kuKyotoJapan606‐8501
| | - David Streiner
- McMaster UniversityDepartment of Psychiatry and Behavioural Neurosciences100 West 5th StreetRoom B‐366HamiltonONCanadaL8N 3K7
| | - Toshi A Furukawa
- Kyoto University Graduate School of Medicine/School of Public HealthDepartment of Health Promotion and Human BehaviorYoshida Konoe‐cho, Sakyo‐kuKyotoJapan606‐8501
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Imai H, Takeshima N, Hayasaka Y, Yonemoto N, Ogawa Y, Tajika A, Fujita H, Kato T, Furukawa TA. Association between patients' feedback comments and depressive mood, satisfaction, homework conducted, and dropouts during self-guided smartphone cognitive behavioral therapy. Psychiatry Clin Neurosci 2019; 73:349-350. [PMID: 30968499 DOI: 10.1111/pcn.12849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Revised: 03/18/2019] [Accepted: 04/03/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Hissei Imai
- Department of Health Promotion of Human Behavior, Kyoto University Graduate School of Medicine, School of Public Health, Kyoto, Japan
| | - Nozomi Takeshima
- Department of Health Promotion of Human Behavior, Kyoto University Graduate School of Medicine, School of Public Health, Kyoto, Japan
| | - Yu Hayasaka
- Department of Health Promotion of Human Behavior, Kyoto University Graduate School of Medicine, School of Public Health, Kyoto, Japan
| | - Naohiro Yonemoto
- Department of Biostatistics, Kyoto University Graduate School of Public Health, Kyoto, Japan
| | - Yusuke Ogawa
- Department of Healthcare Epidemiology, Graduate School of Medicine, School of Public Health, Kyoto University, Kyoto, Japan.,Integrated Clinical Education Center, Kyoto University Hospital, Kyoto, Japan
| | - Aran Tajika
- Department of Psychiatry, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Hirokazu Fujita
- Center to Promote Creativity in Medical Education, Kochi Medical School, Kochi University, Nankoku, Japan
| | | | - Toshi A Furukawa
- Department of Health Promotion of Human Behavior, Kyoto University Graduate School of Medicine, School of Public Health, Kyoto, Japan
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Tomlinson A, Efthimiou O, Boaden K, New E, Mather S, Salanti G, Imai H, Ogawa Y, Tajika A, Kishimoto S, Kikuchi S, Chevance A, Furukawa TA, Cipriani A. Side effect profile and comparative tolerability of 21 antidepressants in the acute treatment of major depression in adults: protocol for a network meta-analysis. Evid Based Ment Health 2019; 22:61-66. [PMID: 30996028 PMCID: PMC10270374 DOI: 10.1136/ebmental-2019-300087] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Revised: 04/01/2019] [Accepted: 04/02/2019] [Indexed: 12/12/2022]
Abstract
INTRODUCTION We have recently compared all second-generation as well as selected first-generation antidepressants in terms of efficacy and acceptability in the acute treatment of major depression. Here we present a protocol for a network meta-analysis aimed at extending these results, updating the evidence base and comparing all second-generation as well as selected first-generation antidepressants in terms of specific adverse events and tolerability in the acute treatment of major depression in adults. METHODS AND ANALYSIS We will include all double-blind randomised controlled trials comparing one active drug with another or with placebo in the acute treatment major depression in adults. We will compare the following active agents: agomelatine, amitriptyline, bupropion, citalopram, clomipramine, desvenlafaxine, duloxetine, escitalopram, fluoxetine, fluvoxamine, levomilnacipran, milnacipran, mirtazapine, nefazodone, paroxetine, reboxetine, sertraline, trazodone, venlafaxine, vilazodone and vortioxetine. The main outcomes will include the total number of patients experiencing specific adverse events; experiencing serious adverse events; and experiencing at least one adverse event. Published and unpublished studies will be retrieved through relevant database searches, trial registries and websites; reference selection and data extraction will be completed by at least two independent reviewers. For each outcome we will undertake a network meta-analysis to synthesise all evidence. We will use local and global methods to evaluate consistency. We will perform all analyses in R. We will assess the quality of evidence contributing to network estimates with the Confidence in Network Meta-Analysis web application. DISCUSSION This work will provide an in- depth analysis and an insight into the specific adverse events of individual antidepressants. ETHICS AND DISSEMINATION This review does not require ethical approval. PROSPERO REGISTRATION NUMBER CRD42019128141.
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Affiliation(s)
| | | | | | - Emma New
- Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford
| | - Sarah Mather
- Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford
| | - Georgia Salanti
- Institute of Social and Preventive Medicine, Bern, Switzerland
| | - Hissei Imai
- Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine/School of Public Health, Kyoto, Japan
| | - Yusuke Ogawa
- Department of Healthcare Epidemiology, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Aran Tajika
- Department of Psychiatry, Kyoto University Hospital, Kyoto, Japan
| | - Sanae Kishimoto
- Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine/School of Public Health, Kyoto, Japan
| | - Sino Kikuchi
- Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine/School of Public Health, Kyoto, Japan
| | - Astrid Chevance
- Paris Descartes University, Paris, France
- METHODS Team, Center for Research in Epidemiology and Statistics, Sorbonne Paris Cité, Paris, France
| | - Toshi A Furukawa
- Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine/School of Public Health, Kyoto, Japan
| | - Andrea Cipriani
- Department of Psychiatry, University of Oxford, Oxford, UK
- Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford
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Dumas-Mallet E, Tajika A, Smith A, Boraud T, Furukawa TA, Gonon F. Do newspapers preferentially cover biomedical studies involving national scientists? Public Underst Sci 2019; 28:191-200. [PMID: 30370822 DOI: 10.1177/0963662518809804] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
News value theory rates geographical proximity as an important factor in the process of issue selection by journalists. But does this apply to science journalism? Previous observational studies investigating whether newspapers preferentially cover scientific studies involving national scientists have generated conflicting answers. Here we used a database of 123 biomedical studies, 113 of them involving at least one research team working in eight countries (Australia, Canada, France, Ireland, Japan, New Zealand, the United Kingdom, and the United States). We compiled all the newspaper articles covering these 123 studies and published in English, French, and Japanese languages. In all eight countries, we found that newspapers preferentially covered studies involving a national team. Moreover, these "national" studies on average gave rise to a larger number of newspaper articles than "foreign" studies. Finally, our study resolves the conflict with previous conclusions by providing an alternative interpretation of published observations.
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Cipriani A, Furukawa TA, Salanti G, Chaimani A, Atkinson LZ, Ogawa Y, Leucht S, Ruhe HG, Turner EH, Higgins JPT, Egger M, Takeshima N, Hayasaka Y, Imai H, Shinohara K, Tajika A, Ioannidis JPA, Geddes JR. Comparative Efficacy and Acceptability of 21 Antidepressant Drugs for the Acute Treatment of Adults With Major Depressive Disorder: A Systematic Review and Network Meta-Analysis. Focus (Am Psychiatr Publ) 2018; 16:420-429. [PMID: 32021580 DOI: 10.1176/appi.focus.16407] [Citation(s) in RCA: 143] [Impact Index Per Article: 23.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
(Reprinted with permission from Lancet 2018; 391:1357-66).
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Pompoli A, Furukawa TA, Efthimiou O, Imai H, Tajika A, Salanti G. Dismantling cognitive-behaviour therapy for panic disorder: a systematic review and component network meta-analysis. Psychol Med 2018; 48:1945-1953. [PMID: 29368665 PMCID: PMC6137372 DOI: 10.1017/s0033291717003919] [Citation(s) in RCA: 76] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Revised: 12/13/2017] [Accepted: 12/14/2017] [Indexed: 12/23/2022]
Abstract
Cognitive-behaviour therapy (CBT) for panic disorder may consist of different combinations of several therapeutic components such as relaxation, breathing retraining, cognitive restructuring, interoceptive exposure and/or in vivo exposure. It is therefore important both theoretically and clinically to examine whether specific components of CBT or their combinations are superior to others in the treatment of panic disorder. Component network meta-analysis (NMA) is an extension of standard NMA that can be used to disentangle the treatment effects of different components included in composite interventions. We searched MEDLINE, EMBASE, PsycINFO and Cochrane Central, with supplementary searches of reference lists and clinical trial registries, for all randomized controlled trials comparing different CBT-based psychological therapies for panic disorder with each other or with control interventions. We applied component NMA to disentangle the treatment effects of different components included in these interventions. After reviewing 2526 references, we included 72 studies with 4064 participants. Interoceptive exposure and face-to-face setting were associated with better treatment efficacy and acceptability. Muscle relaxation and virtual-reality exposure were associated with significantly lower efficacy. Components such as breathing retraining and in vivo exposure appeared to improve treatment acceptability while having small effects on efficacy. The comparison of the most v. the least efficacious combination, both of which may be provided as 'evidence-based CBT,' yielded an odds ratio for the remission of 7.69 (95% credible interval: 1.75 to 33.33). Effective CBT packages for panic disorder would include face-to-face and interoceptive exposure components, while excluding muscle relaxation and virtual-reality exposure.
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Affiliation(s)
| | - Toshi A. Furukawa
- Departments of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine/School of Public Health, Kyoto, Japan
| | - Orestis Efthimiou
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland
- Department of Hygiene and Epidemiology, University of Ioannina School of Medicine, Ioannina, Greece
| | - Hissei Imai
- Departments of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine/School of Public Health, Kyoto, Japan
| | - Aran Tajika
- Departments of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine/School of Public Health, Kyoto, Japan
| | - Georgia Salanti
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland
- Department of Hygiene and Epidemiology, University of Ioannina School of Medicine, Ioannina, Greece
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Kato T, Furukawa TA, Mantani A, Kurata K, Kubouchi H, Hirota S, Sato H, Sugishita K, Chino B, Itoh K, Ikeda Y, Shinagawa Y, Kondo M, Okamoto Y, Fujita H, Suga M, Yasumoto S, Tsujino N, Inoue T, Fujise N, Akechi T, Yamada M, Shimodera S, Watanabe N, Inagaki M, Miki K, Ogawa Y, Takeshima N, Hayasaka Y, Tajika A, Shinohara K, Yonemoto N, Tanaka S, Zhou Q, Guyatt GH. Optimising first- and second-line treatment strategies for untreated major depressive disorder - the SUN☺D study: a pragmatic, multi-centre, assessor-blinded randomised controlled trial. BMC Med 2018; 16:103. [PMID: 29991347 PMCID: PMC6040068 DOI: 10.1186/s12916-018-1096-5] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Accepted: 06/05/2018] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND For patients starting treatment for depression, current guidelines recommend titrating the antidepressant dosage to the maximum of the licenced range if tolerated. When patients do not achieve remission within several weeks, recommendations include adding or switching to another antidepressant. However, the relative merits of these guideline strategies remain unestablished. METHODS This multi-centre, open-label, assessor-blinded, pragmatic trial involved two steps. Step 1 used open-cluster randomisation, allocating clinics into those titrating sertraline up to 50 mg/day or 100 mg/day by week 3. Step 2 used central randomisation to allocate patients who did not remit after 3 weeks of treatment to continue sertraline, to add mirtazapine or to switch to mirtazapine. The primary outcome was depression severity measured with the Patient Health Questionnaire-9 (PHQ-9) (scores between 0 and 27; higher scores, greater depression) at week 9. We applied mixed-model repeated-measures analysis adjusted for key baseline covariates. RESULTS Between December 2010 and March 2015, we recruited 2011 participants with hitherto untreated major depression at 48 clinics in Japan. In step 1, 970 participants were allocated to the 50 mg/day and 1041 to the 100 mg/day arms; 1927 (95.8%) provided primary outcomes. There was no statistically significant difference in the adjusted PHQ-9 score at week 9 between the 50 mg/day arm and the 100 mg/day arm (0.25 point, 95% confidence interval (CI), - 0.58 to 1.07, P = 0.55). Other outcomes proved similar in the two groups. In step 2, 1646 participants not remitted by week 3 were randomised to continue sertraline (n = 551), to add mirtazapine (n = 537) or to switch to mirtazapine (n = 558): 1613 (98.0%) provided primary outcomes. At week 9, adding mirtazapine achieved a reduction in PHQ-9 scores of 0.99 point (0.43 to 1.55, P = 0.0012); switching achieved a reduction of 1.01 points (0.46 to 1.56, P = 0.0012), both relative to continuing sertraline. Combination increased the percentage of remission by 12.4% (6.1 to 19.0%) and switching by 8.4% (2.5 to 14.8%). There were no differences in adverse effects. CONCLUSIONS In patients with new onset depression, we found no advantage of titrating sertraline to 100 mg vs 50 mg. Patients unremitted by week 3 gained a small benefit in reduction of depressive symptoms at week 9 by switching sertraline to mirtazapine or by adding mirtazapine. TRIAL REGISTRATION ClinicalTrials.gov, NCT01109693 . Registered on 23 April 2010.
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Affiliation(s)
| | - Toshi A Furukawa
- Department of Health Promotion of Human Behavior, Kyoto University Graduate School of Medicine / School of Public Health, Yoshida Konoe-cho, Sakyo-ku, Kyoto, 606-8501, Japan.
| | | | | | | | | | | | | | | | | | | | | | - Masaki Kondo
- Department of Psychiatry and Cognitive-Behavioral Medicine, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Yasumasa Okamoto
- Department of Neuropsychiatry, Hiroshima University Graduate School of Biomedical & Health Sciences, Hiroshima, Japan
| | - Hirokazu Fujita
- Center to Promote Creativity in Medical Education, Kochi Medical School, Kochi University, Nankoku, Japan
| | - Motomu Suga
- Department of Neuropsychiatry, University of Tokyo Hospital, Tokyo, Japan
| | - Shingo Yasumoto
- Department of Neuropsychiatry, Kurume University Medical School, Kurume, Japan
| | - Naohisa Tsujino
- Department of Psychiatry, Toho University School of Medicine, Tokyo, Japan
| | - Takeshi Inoue
- Department of Neuropsychiatry, Tokyo Medical University, Tokyo, Japan
| | - Noboru Fujise
- Department of Neuropsychiatry, Kumamoto University Graduate School of Medicine, Kumamoto, Japan
| | - Tatsuo Akechi
- Department of Psychiatry and Cognitive-Behavioral Medicine, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Mitsuhiko Yamada
- Department of Neuropsychopharmacology, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Shinji Shimodera
- Center to Promote Creativity in Medical Education, Kochi Medical School, Kochi University, Nankoku, Japan
| | - Norio Watanabe
- Department of Health Promotion of Human Behavior, Kyoto University Graduate School of Medicine / School of Public Health, Yoshida Konoe-cho, Sakyo-ku, Kyoto, 606-8501, Japan
| | - Masatoshi Inagaki
- Department of Neuropsychiatry, Okayama University Hospital, Okayama, Japan
| | | | - Yusuke Ogawa
- Department of Health Promotion of Human Behavior, Kyoto University Graduate School of Medicine / School of Public Health, Yoshida Konoe-cho, Sakyo-ku, Kyoto, 606-8501, Japan
| | - Nozomi Takeshima
- Department of Health Promotion of Human Behavior, Kyoto University Graduate School of Medicine / School of Public Health, Yoshida Konoe-cho, Sakyo-ku, Kyoto, 606-8501, Japan
| | - Yu Hayasaka
- Department of Health Promotion of Human Behavior, Kyoto University Graduate School of Medicine / School of Public Health, Yoshida Konoe-cho, Sakyo-ku, Kyoto, 606-8501, Japan
| | - Aran Tajika
- Department of Health Promotion of Human Behavior, Kyoto University Graduate School of Medicine / School of Public Health, Yoshida Konoe-cho, Sakyo-ku, Kyoto, 606-8501, Japan
| | - Kiyomi Shinohara
- Department of Health Promotion of Human Behavior, Kyoto University Graduate School of Medicine / School of Public Health, Yoshida Konoe-cho, Sakyo-ku, Kyoto, 606-8501, Japan
| | - Naohiro Yonemoto
- Department of Biostatistics, Kyoto University Graduate School of Medicine / School of Public Health, Kyoto, Japan
| | - Shiro Tanaka
- Department of Clinical Biostatistics, Kyoto University Graduate School of Medicine / School of Public Health, Kyoto, Japan
| | - Qi Zhou
- Departments of Clinical Epidemiology and Biostatistics and of Medicine, McMaster University, Hamilton, Canada
| | - Gordon H Guyatt
- Departments of Clinical Epidemiology and Biostatistics and of Medicine, McMaster University, Hamilton, Canada
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Cipriani A, Salanti G, Furukawa TA, Egger M, Leucht S, Ruhe HG, Turner EH, Atkinson LZ, Chaimani A, Higgins JPT, Ogawa Y, Takeshima N, Hayasaka Y, Imai H, Shinohara K, Tajika A, Ioannidis JPA, Geddes JR. Antidepressants might work for people with major depression: where do we go from here? Lancet Psychiatry 2018; 5:461-463. [PMID: 29628364 DOI: 10.1016/s2215-0366(18)30133-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Accepted: 03/28/2018] [Indexed: 01/19/2023]
Affiliation(s)
- Andrea Cipriani
- Department of Psychiatry, University of Oxford, Oxford, UK; Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford OX3 7JX, UK.
| | - Georgia Salanti
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Toshi A Furukawa
- Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine and School of Public Health, Kyoto, Japan
| | - Matthias Egger
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Stefan Leucht
- Department of Psychiatry and Psychotherapy, TU-Munich, Munich, Germany
| | - Henricus G Ruhe
- Department of Psychiatry, University of Oxford, Oxford, UK; Department of Psychiatry, Radboud University Nijmegen, Nijmegen, Netherlands
| | - Erick H Turner
- Behavioral Health and Neurosciences Division, VA Portland Health Care System, Portland, OR, USA; Department of Psychiatry and Department of Pharmacology, Oregon Health & Science University, Portland, OR, USA
| | | | - Anna Chaimani
- INSERM, UMR1153 Epidemiology and Statistics, Sorbonne Paris Cité Research Center (CRESS), METHODS Team, Paris & French Cochrane Center, Paris, France
| | - Julian P T Higgins
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Yusuke Ogawa
- Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine and School of Public Health, Kyoto, Japan
| | - Nozomi Takeshima
- Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine and School of Public Health, Kyoto, Japan
| | - Yu Hayasaka
- Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine and School of Public Health, Kyoto, Japan
| | - Hissei Imai
- Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine and School of Public Health, Kyoto, Japan
| | - Kiyomi Shinohara
- Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine and School of Public Health, Kyoto, Japan
| | - Aran Tajika
- Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine and School of Public Health, Kyoto, Japan
| | - John P A Ioannidis
- Department of Medicine, Department of Health Research and Policy, Stanford University, Stanford, CA, USA; Department of Biomedical Data Science, Stanford University School of Medicine and Department of Statistics, Stanford University School of Humanities and Sciences, Stanford University, Stanford, CA, USA; Meta-Research Innovation Center at Stanford, Stanford University, Stanford, CA, USA
| | - John R Geddes
- Department of Psychiatry, University of Oxford, Oxford, UK; Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford OX3 7JX, UK
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Cipriani A, Furukawa TA, Salanti G, Chaimani A, Atkinson LZ, Ogawa Y, Leucht S, Ruhe HG, Turner EH, Higgins JPT, Egger M, Takeshima N, Hayasaka Y, Imai H, Shinohara K, Tajika A, Ioannidis JPA, Geddes JR. Comparative efficacy and acceptability of 21 antidepressant drugs for the acute treatment of adults with major depressive disorder: a systematic review and network meta-analysis. Lancet 2018; 391:1357-1366. [PMID: 29477251 PMCID: PMC5889788 DOI: 10.1016/s0140-6736(17)32802-7] [Citation(s) in RCA: 1570] [Impact Index Per Article: 261.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Revised: 10/02/2017] [Accepted: 10/16/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND Major depressive disorder is one of the most common, burdensome, and costly psychiatric disorders worldwide in adults. Pharmacological and non-pharmacological treatments are available; however, because of inadequate resources, antidepressants are used more frequently than psychological interventions. Prescription of these agents should be informed by the best available evidence. Therefore, we aimed to update and expand our previous work to compare and rank antidepressants for the acute treatment of adults with unipolar major depressive disorder. METHODS We did a systematic review and network meta-analysis. We searched Cochrane Central Register of Controlled Trials, CINAHL, Embase, LILACS database, MEDLINE, MEDLINE In-Process, PsycINFO, the websites of regulatory agencies, and international registers for published and unpublished, double-blind, randomised controlled trials from their inception to Jan 8, 2016. We included placebo-controlled and head-to-head trials of 21 antidepressants used for the acute treatment of adults (≥18 years old and of both sexes) with major depressive disorder diagnosed according to standard operationalised criteria. We excluded quasi-randomised trials and trials that were incomplete or included 20% or more of participants with bipolar disorder, psychotic depression, or treatment-resistant depression; or patients with a serious concomitant medical illness. We extracted data following a predefined hierarchy. In network meta-analysis, we used group-level data. We assessed the studies' risk of bias in accordance to the Cochrane Handbook for Systematic Reviews of Interventions, and certainty of evidence using the Grading of Recommendations Assessment, Development and Evaluation framework. Primary outcomes were efficacy (response rate) and acceptability (treatment discontinuations due to any cause). We estimated summary odds ratios (ORs) using pairwise and network meta-analysis with random effects. This study is registered with PROSPERO, number CRD42012002291. FINDINGS We identified 28 552 citations and of these included 522 trials comprising 116 477 participants. In terms of efficacy, all antidepressants were more effective than placebo, with ORs ranging between 2·13 (95% credible interval [CrI] 1·89-2·41) for amitriptyline and 1·37 (1·16-1·63) for reboxetine. For acceptability, only agomelatine (OR 0·84, 95% CrI 0·72-0·97) and fluoxetine (0·88, 0·80-0·96) were associated with fewer dropouts than placebo, whereas clomipramine was worse than placebo (1·30, 1·01-1·68). When all trials were considered, differences in ORs between antidepressants ranged from 1·15 to 1·55 for efficacy and from 0·64 to 0·83 for acceptability, with wide CrIs on most of the comparative analyses. In head-to-head studies, agomelatine, amitriptyline, escitalopram, mirtazapine, paroxetine, venlafaxine, and vortioxetine were more effective than other antidepressants (range of ORs 1·19-1·96), whereas fluoxetine, fluvoxamine, reboxetine, and trazodone were the least efficacious drugs (0·51-0·84). For acceptability, agomelatine, citalopram, escitalopram, fluoxetine, sertraline, and vortioxetine were more tolerable than other antidepressants (range of ORs 0·43-0·77), whereas amitriptyline, clomipramine, duloxetine, fluvoxamine, reboxetine, trazodone, and venlafaxine had the highest dropout rates (1·30-2·32). 46 (9%) of 522 trials were rated as high risk of bias, 380 (73%) trials as moderate, and 96 (18%) as low; and the certainty of evidence was moderate to very low. INTERPRETATION All antidepressants were more efficacious than placebo in adults with major depressive disorder. Smaller differences between active drugs were found when placebo-controlled trials were included in the analysis, whereas there was more variability in efficacy and acceptability in head-to-head trials. These results should serve evidence-based practice and inform patients, physicians, guideline developers, and policy makers on the relative merits of the different antidepressants. FUNDING National Institute for Health Research Oxford Health Biomedical Research Centre and the Japan Society for the Promotion of Science.
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Affiliation(s)
- Andrea Cipriani
- Department of Psychiatry, University of Oxford, Oxford, UK; Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, UK.
| | - Toshi A Furukawa
- Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine and School of Public Health, Kyoto, Japan
| | - Georgia Salanti
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Anna Chaimani
- School of Medicine, Paris Descartes University, Paris, France; INSERM, UMR1153 Epidemiology and Statistics, Sorbonne Paris Cité Research Center, METHODS Team, Paris, France; Cochrane France, Paris, France
| | - Lauren Z Atkinson
- Department of Psychiatry, University of Oxford, Oxford, UK; Oxford Centre for Human Brain Activity, Department of Psychiatry, Warneford Hospital, Oxford, UK
| | - Yusuke Ogawa
- Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine and School of Public Health, Kyoto, Japan
| | - Stefan Leucht
- Department of Psychiatry and Psychotherapy, Technische Universität München, Munich, Germany
| | - Henricus G Ruhe
- Department of Psychiatry, University of Oxford, Oxford, UK; Department of Psychiatry, Radboud University Nijmegen Medical Centre, Nijmegen, Netherlands
| | - Erick H Turner
- Behavioral Health and Neurosciences Division, VA Portland Health Care System, Portland, OR, USA; Department of Psychiatry and Department Pharmacology, Oregon Health & Science University, Portland, OR, USA
| | - Julian P T Higgins
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Matthias Egger
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Nozomi Takeshima
- Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine and School of Public Health, Kyoto, Japan
| | - Yu Hayasaka
- Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine and School of Public Health, Kyoto, Japan
| | - Hissei Imai
- Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine and School of Public Health, Kyoto, Japan
| | - Kiyomi Shinohara
- Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine and School of Public Health, Kyoto, Japan
| | - Aran Tajika
- Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine and School of Public Health, Kyoto, Japan
| | - John P A Ioannidis
- Department of Medicine, Department of Health Research and Policy, Department of Biomedical Data Science, and Department of Statistics, Stanford University, Stanford, CA, USA; Meta-Research Innovation Center at Stanford, Stanford University, Stanford, CA, USA
| | - John R Geddes
- Department of Psychiatry, University of Oxford, Oxford, UK; Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, UK
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Furukawa TA, Horikoshi M, Fujita H, Tsujino N, Jinnin R, Kako Y, Ogawa S, Sato H, Kitagawa N, Shinagawa Y, Ikeda Y, Imai H, Tajika A, Ogawa Y, Akechi T, Yamada M, Shimodera S, Watanabe N, Inagaki M, Hasegawa A. Cognitive and Behavioral Skills Exercises Completed by Patients with Major Depression During Smartphone Cognitive Behavioral Therapy: Secondary Analysis of a Randomized Controlled Trial. JMIR Ment Health 2018; 5:e4. [PMID: 29326098 PMCID: PMC5785683 DOI: 10.2196/mental.9092] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Revised: 11/16/2017] [Accepted: 11/17/2017] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND A strong and growing body of evidence has demonstrated the effectiveness of cognitive behavioral therapy (CBT), either face-to-face, in person, or as self-help via the Internet, for depression. However, CBT is a complex intervention consisting of several putatively effective components, and how each component may or may not contribute to the overall effectiveness of CBT is poorly understood. OBJECTIVE The aim of this study was to investigate how the users of smartphone CBT use and benefit from various components of the program. METHODS This is a secondary analysis from a 9-week, single-blind, randomized controlled trial that has demonstrated the effectiveness of adjunctive use of smartphone CBT (Kokoro-App) over antidepressant pharmacotherapy alone among patients with drug-resistant major depressive disorder (total n=164, standardized mean difference in depression severity at week 9=0.40, J Med Internet Res). Kokoro-App consists of three cognitive behavioral skills of self-monitoring, behavioral activation, and cognitive restructuring, with corresponding worksheets to fill in. All activities of the participants learning each session of the program and completing each worksheet were uploaded onto Kokoro-Web, which each patient could use for self-check. We examined what use characteristics differentiated the more successful users of the CBT app from the less successful ones, split at the median of change in depression severity. RESULTS A total of 81 patients with major depression were allocated to the smartphone CBT. On average, they completed 7.0 (standard deviation [SD] 1.4) out of 8 sessions of the program; it took them 10.8 (SD 4.2) days to complete one session, during which they spent 62 min (SD 96) on the app. There were no statistically significant differences in the number of sessions completed, time spent for the program, or the number of completed self-monitoring worksheets between the beneficiaries and the nonbeneficiaries. However, the former completed more behavioral activation tasks, engaged in different types of activities, and also filled in more cognitive restructuring worksheets than the latter. Activities such as "test-drive a new car," "go to a coffee shop after lunch," or "call up an old friend" were found to be particularly rewarding. All cognitive restructuring strategies were found to significantly decrease the distress level, with "What would be your advice to a friend who has a similar problem?" found more helpful than some other strategies. CONCLUSIONS The CBT program offered via smartphone and connected to the remote server is not only effective in alleviating depression but also opens a new avenue in gathering information of what and how each participant may utilize the program. The activities and strategies found useful in this analysis will provide valuable information in brush-ups of the program itself and of mobile health (mHealth) in general. TRIAL REGISTRATION Japanese Clinical Trials Registry UMIN CTR 000013693; https://upload.umin.ac.jp/cgi-open-bin/ctr_e/ ctr_view.cgi?recptno=R000015984 (Archived by WebCite at http://www.webcitation.org/6u6pxVwik).
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Affiliation(s)
- Toshi A Furukawa
- Department of Psychiatry and Cognitive-Behavioral Medicine, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Masaru Horikoshi
- Center of Cognitive-Behavior Therapy, National Center of Neurology and Psychiatry, Kodaira, Japan
| | - Hirokazu Fujita
- Center to Promote Creativity in Medical Education, Kochi Medical School, Kochi University, Nankoku, Japan
| | - Naohisa Tsujino
- Department of Neuropsychiatry, Toho University School of Medicine, Tokyo, Japan
| | - Ran Jinnin
- Department of Psychiatry and Neurosciences, Hiroshima University Graduate School of Biomedical & Health Sciences, Hiroshima, Japan
| | - Yuki Kako
- Department of Psychiatry, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Sei Ogawa
- Department of Psychiatry and Cognitive-Behavioral Medicine, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | | | | | | | | | - Hissei Imai
- Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine/School of Public Health, Kyoto, Japan
| | - Aran Tajika
- Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine/School of Public Health, Kyoto, Japan
| | - Yusuke Ogawa
- Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine/School of Public Health, Kyoto, Japan
| | - Tatsuo Akechi
- Department of Psychiatry and Cognitive-Behavioral Medicine, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Mitsuhiko Yamada
- National Institute of Mental Health, National Center of Neurology and Psychiatry, Kodaira, Japan
| | - Shinji Shimodera
- Department of Psychiatry, Kochi Medical School, Kochi University, Nankoku, Japan
| | - Norio Watanabe
- Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine/School of Public Health, Kyoto, Japan
| | | | - Akio Hasegawa
- Advanced Telecommunications Research Institute International, Kyoto, Japan
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Pompoli A, Furukawa TA, Imai H, Tajika A, Efthimiou O, Salanti G. Psychological therapies for panic disorder with or without agoraphobia in adults: a network meta-analysis. BJPsych advances 2018. [DOI: 10.1192/bja.2017.15] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Guaiana G, Barbui C, Caldwell DM, Davies SJC, Furukawa TA, Imai H, Koesters M, Tajika A, Bighelli I, Pompoli A, Cipriani A. Antidepressants, benzodiazepines and azapirones for panic disorder in adults: a network meta-analysis. Cochrane Database of Systematic Reviews 2017. [DOI: 10.1002/14651858.cd012729] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Affiliation(s)
- Giuseppe Guaiana
- Western University; Department of Psychiatry; Saint Thomas Elgin General Hospital 189 Elm Street St Thomas ON Canada N5R 5C4
| | - Corrado Barbui
- University of Verona; Department of Neuroscience, Biomedicine and Movement Sciences, Section of Psychiatry; Verona Italy
| | - Deborah M Caldwell
- University of Bristol; School of Social and Community Medicine; Canynge Hall, 39 Whatley Road Bristol Avon UK BS8 2PS
| | - Simon JC Davies
- University of Toronto; Geriatric Psychiatry Division, CAMH; 6th Floor, 80 Workman Way Toronto Canada M6J 1H4
| | - Toshi A Furukawa
- Kyoto University Graduate School of Medicine/School of Public Health; Department of Health Promotion and Human Behavior; Yoshida Konoe-cho, Sakyo-ku, Kyoto Japan 606-8501
| | - Hissei Imai
- Kyoto University Graduate School of Medicine/School of Public Health; Department of Health Promotion and Human Behavior; Yoshida Konoe-cho, Sakyo-ku, Kyoto Japan 606-8501
| | - Markus Koesters
- Ulm University; Department of Psychiatry II; Ludwig-Heilmeyer-Str. 2 Guenzburg Germany D-89312
| | - Aran Tajika
- Kyoto University Graduate School of Medicine/School of Public Health; Department of Health Promotion and Human Behavior; Yoshida Konoe-cho, Sakyo-ku, Kyoto Japan 606-8501
| | - Irene Bighelli
- Klinikum rechts der Isar, Technische Universität München; Department of Psychiatry and Psychotherapy; Ismaningerstr. 22 Munich Germany
| | - Alessandro Pompoli
- Private practice, no academic affiliations; Le grotte 12 Malcesine Verona Italy 37018
| | - Andrea Cipriani
- University of Oxford; Department of Psychiatry; Warneford Hospital Oxford UK OX3 7JX
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Takekita Y, Suwa T, Sunada N, Kawashima H, Fabbri C, Kato M, Tajika A, Kinoshita T, Furukawa TA, Serretti A. Remifentanil in electroconvulsive therapy: a systematic review and meta-analysis of randomized controlled trials. Eur Arch Psychiatry Clin Neurosci 2016; 266:703-717. [PMID: 26822480 DOI: 10.1007/s00406-016-0670-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Accepted: 01/11/2016] [Indexed: 01/29/2023]
Abstract
In electroconvulsive therapy (ECT), remifentanil is often used concurrently with anesthetics. The objective of this study was to provide an up-to-date and comprehensive review on how the addition of remifentanil to anesthetics affects seizure duration and circulatory dynamics in mECT. We performed a meta-analysis of RCTs that investigated seizure duration and circulatory dynamics in patients treated with ECT using anesthetics alone (non-remifentanil group) and with anesthetics plus remifentanil (remifentanil group). A total of 13 RCTs (380 patients and 1024 ECT sessions) were included. The remifentanil group showed a significantly prolonged seizure duration during ECT compared to the non-remifentanil group [motor: 9 studies, SMD = 1.25, 95 % CI (0.21, 2.29), p = 0.02; electroencephalogram: 8 studies, SMD = 0.98, 95 % CI (0.14, 1.82), p = 0.02]. The maximum systolic blood pressure (SBP) was significantly reduced in the remifentanil group compared to the non-remifentanil group [7 studies, SMD = -0.36, 95 % CI (-0.65, 0.07), p = 0.02]. Substantial heterogeneity was observed for meta-analyses for seizure durations, but a pre-planned subgroup analysis revealed that seizure duration was prolonged only when the use of the anesthetic dose was reduced in the remifentanil group. The results of our study suggest that addition of remifentanil to anesthesia in ECT may lead to prolonged seizure duration when it allows the use of reduced anesthetic doses. Further, the addition of remifentanil was associated with reduced maximum SBP.
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Affiliation(s)
- Yoshiteru Takekita
- Department of Biomedical and NeuroMotor Sciences, University of Bologna, Viale Carlo Pepoli 5, 40123, Bologna, Italy. .,Department of Neuropsychiatry, Kansai Medical University, 10-15 Fumizono-cho, Moriguchi-shi, Osaka, 570-8506, Japan.
| | - Taro Suwa
- Department of Neuropsychiatry, Graduate School of Medicine, Kyoto University, 54 Syogoin-kawaharacho, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Naotaka Sunada
- Department of Neuropsychiatry, Kansai Medical University, 10-15 Fumizono-cho, Moriguchi-shi, Osaka, 570-8506, Japan
| | - Hirotsugu Kawashima
- Department of Psychiatry, Toyooka Hospital, 1094, Tobera, Toyooka-shi, Hyogo, 668-8501, Japan
| | - Chiara Fabbri
- Department of Biomedical and NeuroMotor Sciences, University of Bologna, Viale Carlo Pepoli 5, 40123, Bologna, Italy
| | - Masaki Kato
- Department of Neuropsychiatry, Kansai Medical University, 10-15 Fumizono-cho, Moriguchi-shi, Osaka, 570-8506, Japan
| | - Aran Tajika
- Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine/School of Public Health, Yoshida Konoe-cho, Sakyo-ku, Kyoto, 606-8501, Japan
| | - Toshihiko Kinoshita
- Department of Neuropsychiatry, Kansai Medical University, 10-15 Fumizono-cho, Moriguchi-shi, Osaka, 570-8506, Japan
| | - Toshi A Furukawa
- Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine/School of Public Health, Yoshida Konoe-cho, Sakyo-ku, Kyoto, 606-8501, Japan
| | - Alessandro Serretti
- Department of Biomedical and NeuroMotor Sciences, University of Bologna, Viale Carlo Pepoli 5, 40123, Bologna, Italy
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Imai H, Tajika A, Chen P, Pompoli A, Furukawa TA. Psychological therapies versus pharmacological interventions for panic disorder with or without agoraphobia in adults. Cochrane Database Syst Rev 2016; 10:CD011170. [PMID: 27730622 PMCID: PMC6457876 DOI: 10.1002/14651858.cd011170.pub2] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Panic disorder is common and deleterious to mental well-being. Psychological therapies and pharmacological interventions are both used as treatments for panic disorder with and without agoraphobia. However, there are no up-to-date reviews on the comparative efficacy and acceptability of the two treatment modalities, and such a review is necessary for improved treatment planning for this disorder. OBJECTIVES To assess the efficacy and acceptability of psychological therapies versus pharmacological interventions for panic disorder, with or without agoraphobia, in adults. SEARCH METHODS We searched the Cochrane Common Mental Disorders Group Specialised Register on 11 September 2015. This register contains reports of relevant randomised controlled trials from the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (1950 to present), Embase (1974 to present), and PsycINFO (1967 to present). We cross-checked reference lists of relevant papers and systematic reviews. We did not apply any restrictions on date, language, or publication status. SELECTION CRITERIA We included all randomised controlled trials comparing psychological therapies with pharmacological interventions for panic disorder with or without agoraphobia as diagnosed by operationalised criteria in adults. DATA COLLECTION AND ANALYSIS Two review authors independently extracted data and resolved any disagreements in consultation with a third review author. For dichotomous data, we calculated risk ratios (RR) with 95% confidence intervals (CI). We analysed continuous data using standardised mean differences (with 95% CI). We used the random-effects model throughout. MAIN RESULTS We included 16 studies with a total of 966 participants in the present review. Eight of the studies were conducted in Europe, four in the USA, two in the Middle East, and one in Southeast Asia.None of the studies reported long-term remission/response (long term being six months or longer from treatment commencement).There was no evidence of a difference between psychological therapies and selective serotonin reuptake inhibitors (SSRIs) in terms of short-term remission (RR 0.85, 95% CI 0.62 to 1.17; 6 studies; 334 participants) or short-term response (RR 0.97, 95% CI 0.51 to 1.86; 5 studies; 277 participants) (very low-quality evidence), and no evidence of a difference between psychological therapies and SSRIs in treatment acceptability as measured using dropouts for any reason (RR 1.33, 95% CI 0.80 to 2.22; 6 studies; 334 participants; low-quality evidence).There was no evidence of a difference between psychological therapies and tricyclic antidepressants in terms of short-term remission (RR 0.82, 95% CI 0.62 to 1.09; 3 studies; 229 participants), short-term response (RR 0.75, 95% CI 0.51 to 1.10; 4 studies; 270 participants), or dropouts for any reason (RR 0.83, 95% CI 0.53 to 1.30; 5 studies; 430 participants) (low-quality evidence).There was no evidence of a difference between psychological therapies and other antidepressants in terms of short-term remission (RR 0.90, 95% CI 0.48 to 1.67; 3 studies; 135 participants; very low-quality evidence) and evidence that psychological therapies did not significantly increase or decrease the short-term response over other antidepressants (RR 0.96, 95% CI 0.67 to 1.37; 3 studies; 128 participants) or dropouts for any reason (RR 1.55, 95% CI 0.91 to 2.65; 3 studies; 180 participants) (low-quality evidence).There was no evidence of a difference between psychological therapies and benzodiazepines in terms of short-term remission (RR 1.08, 95% CI 0.70 to 1.65; 3 studies; 95 participants), short-term response (RR 1.58, 95% CI 0.70 to 3.58; 2 studies; 69 participants), or dropouts for any reason (RR 1.12, 95% CI 0.54 to 2.36; 3 studies; 116 participants) (very low-quality evidence).There was no evidence of a difference between psychological therapies and either antidepressant alone or antidepressants plus benzodiazepines in terms of short-term remission (RR 0.86, 95% CI 0.71 to 1.05; 11 studies; 663 participants) and short-term response (RR 0.95, 95% CI 0.76 to 1.18; 12 studies; 800 participants) (low-quality evidence), and there was no evidence of a difference between psychological therapies and either antidepressants alone or antidepressants plus benzodiazepines in terms of treatment acceptability as measured by dropouts for any reason (RR 1.08, 95% CI 0.77 to 1.51; 13 studies; 909 participants; very low-quality evidence). The risk of selection bias and reporting bias was largely unclear. Preplanned subgroup and sensitivity analyses limited to trials with longer-term, quality-controlled, or individual psychological therapies suggested that antidepressants might be more effective than psychological therapies for some outcomes.There were no data to contribute to a comparison between psychological therapies and serotonin-norepinephrine reuptake inhibitors (SNRIs) and subsequent adverse effects. AUTHORS' CONCLUSIONS The evidence in this review was often imprecise. The superiority of either therapy over the other is uncertain due to the low and very low quality of the evidence with regard to short-term efficacy and treatment acceptability, and no data were available regarding adverse effects.The sensitivity analysis and investigation of the sources of heterogeneity indicated three possible influential factors: quality control of psychological therapies, the length of intervention, and the individual modality of psychological therapies.Future studies should examine the long-term effects after intervention or treatment continuation and should provide information on risk of bias, especially with regard to selection and reporting biases.
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Affiliation(s)
- Hissei Imai
- Kyoto University Graduate School of Medicine/School of Public HealthDepartment of Health Promotion and Human BehaviorKyotoJapan
| | - Aran Tajika
- Kyoto University Graduate School of Medicine/School of Public HealthDepartment of Health Promotion and Human BehaviorKyotoJapan
| | | | - Alessandro Pompoli
- Private practice, no academic affiliationsLe grotte 12MalcesineVeronaItaly37018
| | - Toshi A Furukawa
- Kyoto University Graduate School of Medicine/School of Public HealthDepartment of Health Promotion and Human BehaviorKyotoJapan
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Pompoli A, Furukawa TA, Imai H, Tajika A, Efthimiou O, Salanti G. Psychological therapies for panic disorder with or without agoraphobia in adults: a network meta-analysis. Cochrane Database Syst Rev 2016; 4:CD011004. [PMID: 27071857 PMCID: PMC7104662 DOI: 10.1002/14651858.cd011004.pub2] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
BACKGROUND Panic disorder is characterised by the presence of recurrent unexpected panic attacks, discrete periods of fear or anxiety that have a rapid onset and include symptoms such as racing heart, chest pain, sweating and shaking. Panic disorder is common in the general population, with a lifetime prevalence of 1% to 4%. A previous Cochrane meta-analysis suggested that psychological therapy (either alone or combined with pharmacotherapy) can be chosen as a first-line treatment for panic disorder with or without agoraphobia. However, it is not yet clear whether certain psychological therapies can be considered superior to others. In order to answer this question, in this review we performed a network meta-analysis (NMA), in which we compared eight different forms of psychological therapy and three forms of a control condition. OBJECTIVES To assess the comparative efficacy and acceptability of different psychological therapies and different control conditions for panic disorder, with or without agoraphobia, in adults. SEARCH METHODS We conducted the main searches in the CCDANCTR electronic databases (studies and references registers), all years to 16 March 2015. We conducted complementary searches in PubMed and trials registries. Supplementary searches included reference lists of included studies, citation indexes, personal communication to the authors of all included studies and grey literature searches in OpenSIGLE. We applied no restrictions on date, language or publication status. SELECTION CRITERIA We included all relevant randomised controlled trials (RCTs) focusing on adults with a formal diagnosis of panic disorder with or without agoraphobia. We considered the following psychological therapies: psychoeducation (PE), supportive psychotherapy (SP), physiological therapies (PT), behaviour therapy (BT), cognitive therapy (CT), cognitive behaviour therapy (CBT), third-wave CBT (3W) and psychodynamic therapies (PD). We included both individual and group formats. Therapies had to be administered face-to-face. The comparator interventions considered for this review were: no treatment (NT), wait list (WL) and attention/psychological placebo (APP). For this review we considered four short-term (ST) outcomes (ST-remission, ST-response, ST-dropouts, ST-improvement on a continuous scale) and one long-term (LT) outcome (LT-remission/response). DATA COLLECTION AND ANALYSIS As a first step, we conducted a systematic search of all relevant papers according to the inclusion criteria. For each outcome, we then constructed a treatment network in order to clarify the extent to which each type of therapy and each comparison had been investigated in the available literature. Then, for each available comparison, we conducted a random-effects meta-analysis. Subsequently, we performed a network meta-analysis in order to synthesise the available direct evidence with indirect evidence, and to obtain an overall effect size estimate for each possible pair of therapies in the network. Finally, we calculated a probabilistic ranking of the different psychological therapies and control conditions for each outcome. MAIN RESULTS We identified 1432 references; after screening, we included 60 studies in the final qualitative analyses. Among these, 54 (including 3021 patients) were also included in the quantitative analyses. With respect to the analyses for the first of our primary outcomes, (short-term remission), the most studied of the included psychological therapies was CBT (32 studies), followed by BT (12 studies), PT (10 studies), CT (three studies), SP (three studies) and PD (two studies).The quality of the evidence for the entire network was found to be low for all outcomes. The quality of the evidence for CBT vs NT, CBT vs SP and CBT vs PD was low to very low, depending on the outcome. The majority of the included studies were at unclear risk of bias with regard to the randomisation process. We found almost half of the included studies to be at high risk of attrition bias and detection bias. We also found selective outcome reporting bias to be present and we strongly suspected publication bias. Finally, we found almost half of the included studies to be at high risk of researcher allegiance bias.Overall the networks appeared to be well connected, but were generally underpowered to detect any important disagreement between direct and indirect evidence. The results showed the superiority of psychological therapies over the WL condition, although this finding was amplified by evident small study effects (SSE). The NMAs for ST-remission, ST-response and ST-improvement on a continuous scale showed well-replicated evidence in favour of CBT, as well as some sparse but relevant evidence in favour of PD and SP, over other therapies. In terms of ST-dropouts, PD and 3W showed better tolerability over other psychological therapies in the short term. In the long term, CBT and PD showed the highest level of remission/response, suggesting that the effects of these two treatments may be more stable with respect to other psychological therapies. However, all the mentioned differences among active treatments must be interpreted while taking into account that in most cases the effect sizes were small and/or results were imprecise. AUTHORS' CONCLUSIONS There is no high-quality, unequivocal evidence to support one psychological therapy over the others for the treatment of panic disorder with or without agoraphobia in adults. However, the results show that CBT - the most extensively studied among the included psychological therapies - was often superior to other therapies, although the effect size was small and the level of precision was often insufficient or clinically irrelevant. In the only two studies available that explored PD, this treatment showed promising results, although further research is needed in order to better explore the relative efficacy of PD with respect to CBT. Furthermore, PD appeared to be the best tolerated (in terms of ST-dropouts) among psychological treatments. Unexpectedly, we found some evidence in support of the possible viability of non-specific supportive psychotherapy for the treatment of panic disorder; however, the results concerning SP should be interpreted cautiously because of the sparsity of evidence regarding this treatment and, as in the case of PD, further research is needed to explore this issue. Behaviour therapy did not appear to be a valid alternative to CBT as a first-line treatment for patients with panic disorder with or without agoraphobia.
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Affiliation(s)
- Alessandro Pompoli
- Private practice, no academic affiliationsLe grotte 12MalcesineVeronaItaly37018
| | - Toshi A Furukawa
- Kyoto University Graduate School of Medicine/School of Public HealthDepartment of Health Promotion and Human BehaviorYoshida Konoe‐cho, Sakyo‐ku,KyotoJapan606‐8501
| | - Hissei Imai
- Kyoto University Graduate School of Medicine/School of Public HealthDepartment of Health Promotion and Human BehaviorYoshida Konoe‐cho, Sakyo‐ku,KyotoJapan606‐8501
| | - Aran Tajika
- Kyoto University Graduate School of Medicine/School of Public HealthDepartment of Health Promotion and Human BehaviorYoshida Konoe‐cho, Sakyo‐ku,KyotoJapan606‐8501
| | - Orestis Efthimiou
- University of Ioannina School of MedicineDepartment of Hygiene and EpidemiologyIoanninaEpirusGreece45500
| | - Georgia Salanti
- University of BernInstitute of Social and Preventive Medicine (ISPM) & Bern Institute of Primary Care (BIHAM)Finkenhubelweg 11BernSwitzerland3005
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Shinohara K, Tajika A, Imai H, Takeshima N, Hayasaka Y, Furukawa TA. Protocol registration and selective outcome reporting in recent psychiatry trials: new antidepressants and cognitive behavioural therapies. Acta Psychiatr Scand 2015; 132:489-98. [PMID: 26367129 DOI: 10.1111/acps.12502] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/18/2015] [Indexed: 12/21/2022]
Abstract
OBJECTIVE The selective reporting of favorable outcomes has a serious influence on our evidence base. However, this problem has not yet been systematically investigated in the field of psychiatry. Our study aimed to evaluate registration and outcome reporting in randomized controlled trials (RCTs) of standard treatments for depression: cognitive behavioural therapy (CBT) or new-generation antidepressants (ADs). METHOD We searched for reports of RCTs examining the efficacy of CBT or AD for depression that were published between 2011 and 2013. We then compared their primary outcomes in the trial registries and those in publications. RESULTS We identified 170 trials. Among them, 92 trials (54.1%) were registered, 43 trials (25.3%) were properly registered, and only 32 (18.8%) trials were both properly registered and reported (the primary outcomes as recorded in the registries were reported in publications). There was no statistically significant difference in the proportions of properly registered and reported trials for CBT or AD (relative risk: 0.51, 95% CI: 0.25-1.03). High impact factor journals, commercial funding, publication of protocol, and relatively large sample size were significant predictors of proper registration and reporting. CONCLUSION The prevalence of proper registration and reporting is still very low in depression trials.
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Affiliation(s)
- K Shinohara
- Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine/School of Public Health, Kyoto, Japan
| | - A Tajika
- Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine/School of Public Health, Kyoto, Japan
| | - H Imai
- Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine/School of Public Health, Kyoto, Japan
| | - N Takeshima
- Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine/School of Public Health, Kyoto, Japan
| | - Y Hayasaka
- Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine/School of Public Health, Kyoto, Japan
| | - T A Furukawa
- Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine/School of Public Health, Kyoto, Japan
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Takekita Y, Fabbri C, Kato M, Koshikawa Y, Tajika A, Kinoshita T, Serretti A. HTR1A Polymorphisms and Clinical Efficacy of Antipsychotic Drug Treatment in Schizophrenia: A Meta-Analysis. Int J Neuropsychopharmacol 2015; 19:pyv125. [PMID: 26568455 PMCID: PMC4886666 DOI: 10.1093/ijnp/pyv125] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [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: 09/18/2015] [Accepted: 11/11/2015] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND This meta-analysis was conducted to evaluate whether HTR1A gene polymorphisms impact the efficacy of antipsychotic drugs in patients with schizophrenia. METHODS Candidate gene studies that were published in English up to August 6, 2015 were identified by a literature search of PubMed, Web of Science, and Google scholar. Data were pooled from individual clinical trials considering overall symptoms, positive symptoms and negative symptoms, and standard mean differences were calculated by applying a random-effects model. RESULTS The present meta-analysis included a total of 1281 patients from 10 studies. Three polymorphisms of HTR1A (rs6295, rs878567, and rs1423691) were selected for the analysis. In the pooled data from all studies, none of these HTR1A polymorphisms correlated significantly with either overall symptoms or positive symptoms. However, C allele carriers of the rs6295 polymorphism showed a significantly greater negative symptoms improvement than G allele carriers (P=.04, standardized mean difference =-0.14, 95%CI = 0.01 to 0.28). CONCLUSIONS The results of our present analysis indicate that the HTR1A rs6295 polymorphism may impact negative symptoms improvement but not on either overall symptoms or positive symptoms improvement. However, this meta-analysis was based on a small number of studies and patients, and the effect size on negative symptoms was small. Given this limitation, the results should be confirmed by further investigations.
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Affiliation(s)
- Yoshiteru Takekita
- Department of Biomedical and NeuroMotor Sciences, University of Bologna, Bologna, Italy (Drs Takekita, Fabbri, and Serretti); Department of Neuropsychiatry, Kansai Medical University, Osaka, Japan (Drs Takekita, Kato, Koshikawa, and Kinoshita); Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine/School of Public Health, Kyoto, Japan (Dr Tajika).
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Suwa A, Nishida K, Utsunomiya K, Nonen S, Yoshimura M, Takekita Y, Wakeno M, Tajika A, Yoshino M, Koshikawa Y, Kato M, Kinoshita T. Neuropsychological Evaluation and Cerebral Blood Flow Effects of Apolipoprotein E4 in Alzheimer's Disease Patients after One Year of Treatment: An Exploratory Study. Dement Geriatr Cogn Dis Extra 2015; 5:414-23. [PMID: 26628900 PMCID: PMC4662280 DOI: 10.1159/000440714] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Background Alzheimer's disease (AD) is affected by apolipoprotein E (ApoE); however, its effects assessed by means of cognitive tests and by neuroimaging have not been sufficiently studied. Methods We administered the Alzheimer's Disease Assessment Scale (ADAS) and single-photon emission computed tomography imaging in patients with AD medicated with donepezil at baseline and after 1 year. Patients were classified as with or without ApoE4 and we evaluated the progress of AD. Results Analysis of covariance showed that cerebral blood flow after 1 year in subjects with ApoE4 is significantly reduced in some areas including the left lenticular nucleus, left thalamus, and right hippocampus compared with subjects without ApoE4. Paired t tests showed significantly reduced blood flow in several regions including the right hippocampus in subjects with ApoE4 and significant deterioration of ideational praxis in subjects without ApoE4. Conclusion This study provides evidence that supports the notion of ApoE4 playing an important role in the progress of AD.
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Affiliation(s)
- Azusa Suwa
- Department of Neuropsychiatry, Kansai Medical University, Osaka, Japan
| | - Keiichiro Nishida
- Department of Neuropsychiatry, Kansai Medical University, Osaka, Japan
| | - Keita Utsunomiya
- Department of Radiology, Kansai Medical University, Osaka, Japan
| | - Shinpei Nonen
- Department of Pharmacy, School of Pharmacy, Hyogo University of Health Sciences, Hyogo, Japan
| | | | - Yoshiteru Takekita
- Department of Neuropsychiatry, Kansai Medical University, Osaka, Japan ; Department of Biomedical and NeuroMotor Science, University of Bologna, Bologna, Italy
| | - Masataka Wakeno
- Department of Neuropsychiatry, Kansai Medical University, Osaka, Japan
| | - Aran Tajika
- Department of Neuropsychiatry, Kansai Medical University, Osaka, Japan
| | - Maki Yoshino
- Department of Neuropsychiatry, Kansai Medical University, Osaka, Japan
| | - Yosuke Koshikawa
- Department of Neuropsychiatry, Kansai Medical University, Osaka, Japan
| | - Masaki Kato
- Department of Neuropsychiatry, Kansai Medical University, Osaka, Japan
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Yonemoto N, Tanaka S, Furukawa TA, Kato T, Mantani A, Ogawa Y, Tajika A, Takeshima N, Hayasaka Y, Shinohara K, Miki K, Inagaki M, Shimodera S, Akechi T, Yamada M, Watanabe N, Guyatt GH. Strategic use of new generation antidepressants for depression: SUN(^_^) D protocol update and statistical analysis plan. Trials 2015; 16:459. [PMID: 26466684 PMCID: PMC4606498 DOI: 10.1186/s13063-015-0985-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Accepted: 09/30/2015] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND SUN(^_^)D, the Strategic Use of New generation antidepressants for Depression, is an assessor-blinded, parallel-group, multicenter pragmatic mega-trial to examine the optimum treatment strategy for the first- and second-line treatments for unipolar major depressive episodes. The trial has three steps and two randomizations. Step I randomization compares the minimum and the maximum dosing strategy for the first-line antidepressant. Step II randomization compares the continuation, augmentation or switching strategy for the second-line antidepressant treatment. Step III is a naturalistic continuation phase. The original protocol was published in 2011, and we hereby report its updated protocol including the statistical analysis plan. RESULTS We implemented two important changes to the original protocol. One is about the required sample size, reflecting the smaller number of dropouts than had been expected. Another is in the organization of the primary and secondary outcomes in order to make the report of the main trial results as pertinent and interpretable as possible for clinical practices. Due to the complexity of the trial, we plan to report the main results in two separate reports, and this updated protocol and the statistical analysis plan have laid out respective primary and secondary outcomes and their analyses. We will convene the blind interpretation committee before the randomization code is broken. CONCLUSION This paper presents the updated protocol and the detailed statistical analysis plan for the SUN(^_^)D trial in order to avoid reporting bias and data-driven results. TRIAL REGISTRATION ClinicalTrials.gov: NCT01109693 (registered on 21 April 2010).
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Affiliation(s)
- Naohiro Yonemoto
- Department of Neuropsychopharmacology, National Institute of Mental Health, National Center of Neurology and Psychiatry, 4-1-1 Ogawa-Higashi, Kodaira, Tokyo, 187-8553, Japan.
- Leuven Biostatistics and Statistical Bioinformatics Center, Katholic University of Leuven, Kapucijnenvoer 35, 3000, Leuven, Belgium.
| | - Shiro Tanaka
- Department of Pharmacoepidemiology, Kyoto University Graduate School of Medicine/of Public Health, Yoshida Konoe-cho, Sakyo-ku, Kyoto, 606-8501, Japan.
| | - Toshi A Furukawa
- Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine/School of Public Health, Yoshida Konoe-cho, Sakyo-ku, Kyoto, 606-8501, Japan.
- Department of Clinical Epidemiology, Kyoto University Graduate School of Medicine/School of Public Health, Yoshida Konoe-cho, Sakyo-ku, Kyoto, 606-8501, Japan.
| | - Tadashi Kato
- Aratama Mental Clinic, 1-49 Suyama-cho, Mizuho-ku, Nagoya, 467-0066, Japan.
| | - Akio Mantani
- Mantani Mental Clinic, 5-18 Itsukaichi Ekimae 1-chome, Saeki-ku, Hiroshima, 731-5125, Japan.
| | - Yusuke Ogawa
- Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine/School of Public Health, Yoshida Konoe-cho, Sakyo-ku, Kyoto, 606-8501, Japan.
| | - Aran Tajika
- Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine/School of Public Health, Yoshida Konoe-cho, Sakyo-ku, Kyoto, 606-8501, Japan.
| | - Nozomi Takeshima
- Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine/School of Public Health, Yoshida Konoe-cho, Sakyo-ku, Kyoto, 606-8501, Japan.
| | - Yu Hayasaka
- Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine/School of Public Health, Yoshida Konoe-cho, Sakyo-ku, Kyoto, 606-8501, Japan.
| | - Kiyomi Shinohara
- Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine/School of Public Health, Yoshida Konoe-cho, Sakyo-ku, Kyoto, 606-8501, Japan.
| | - Kazuhira Miki
- Miki Mental Clinic, 1-3 Hiranuma 1-chome, Nishi-ku, Yokohama, 220-0023, Japan.
| | - Masatoshi Inagaki
- Department of Neuropsychiatry, Okayama University Hospital, 2-5-1, Shikata-cho, Kita-ku, Okayama, 700-8558, Japan.
| | - Shinji Shimodera
- Department of Neuropsychiatry, Kochi Medical School, Kohasu, Okoh-cho, Nankoku, 783-8505, Japan.
| | - Tatsuo Akechi
- Department of Psychiatry and Cognitive-Behavioral Medicine, Nagoya City University Graduate School of Medical Sciences, Mizuho-cho, Mizuho-ku, Nagoya, 467-8601, Japan.
| | - Mitsuhiko Yamada
- Department of Neuropsychopharmacology, National Institute of Mental Health, National Center of Neurology and Psychiatry, 4-1-1 Ogawa-Higashi, Kodaira, Tokyo, 187-8553, Japan.
| | - Norio Watanabe
- Translational Medical Center, National Center of Mental Health, National Center of Neurology and Psychiatry, 4-1-1 Ogawa-Higashi, Kodaira, Tokyo, 187-8502, Japan.
| | - Gordon H Guyatt
- Department of Clinical Epidemiology and Biostatistics, McMaster University, West Hamilton, Ontario, L8N 3Z5, Canada.
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Tajika A, Ogawa Y, Takeshima N, Hayasaka Y, Furukawa TA. Replication and contradiction of highly cited research papers in psychiatry: 10-year follow-up. Br J Psychiatry 2015; 207:357-62. [PMID: 26159600 DOI: 10.1192/bjp.bp.113.143701] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2013] [Accepted: 11/17/2014] [Indexed: 11/23/2022]
Abstract
BACKGROUND Contradictions and initial overestimates are not unusual among highly cited studies. However, this issue has not been researched in psychiatry. Aims: To assess how highly cited studies in psychiatry are replicated by subsequent studies. METHOD We selected highly cited studies claiming effective psychiatric treatments in the years 2000 through 2002. For each of these studies we searched for subsequent studies with a better-controlled design, or with a similar design but a larger sample. RESULTS Among 83 articles recommending effective interventions, 40 had not been subject to any attempt at replication, 16 were contradicted, 11 were found to have substantially smaller effects and only 16 were replicated. The standardised mean differences of the initial studies were overestimated by 132%. Studies with a total sample size of 100 or more tended to produce replicable results. CONCLUSIONS Caution is needed when a study with a small sample size reports a large effect.
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Affiliation(s)
- Aran Tajika
- Aran Tajika, MD, Yusuke Ogawa, MD, MPH, PhD, Nozomi Takeshima, MD, Yu Hayasaka, MD, Toshi A. Furukawa, MD, PhD, Department of Health Promotion and Human Behaviour, Kyoto University Graduate School of Medicine/School of Public Health, Kyoto, Japan
| | - Yusuke Ogawa
- Aran Tajika, MD, Yusuke Ogawa, MD, MPH, PhD, Nozomi Takeshima, MD, Yu Hayasaka, MD, Toshi A. Furukawa, MD, PhD, Department of Health Promotion and Human Behaviour, Kyoto University Graduate School of Medicine/School of Public Health, Kyoto, Japan
| | - Nozomi Takeshima
- Aran Tajika, MD, Yusuke Ogawa, MD, MPH, PhD, Nozomi Takeshima, MD, Yu Hayasaka, MD, Toshi A. Furukawa, MD, PhD, Department of Health Promotion and Human Behaviour, Kyoto University Graduate School of Medicine/School of Public Health, Kyoto, Japan
| | - Yu Hayasaka
- Aran Tajika, MD, Yusuke Ogawa, MD, MPH, PhD, Nozomi Takeshima, MD, Yu Hayasaka, MD, Toshi A. Furukawa, MD, PhD, Department of Health Promotion and Human Behaviour, Kyoto University Graduate School of Medicine/School of Public Health, Kyoto, Japan
| | - Toshi A Furukawa
- Aran Tajika, MD, Yusuke Ogawa, MD, MPH, PhD, Nozomi Takeshima, MD, Yu Hayasaka, MD, Toshi A. Furukawa, MD, PhD, Department of Health Promotion and Human Behaviour, Kyoto University Graduate School of Medicine/School of Public Health, Kyoto, Japan
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50
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Watanabe N, Horikoshi M, Yamada M, Shimodera S, Akechi T, Miki K, Inagaki M, Yonemoto N, Imai H, Tajika A, Ogawa Y, Takeshima N, Hayasaka Y, Furukawa TA. Adding smartphone-based cognitive-behavior therapy to pharmacotherapy for major depression (FLATT project): study protocol for a randomized controlled trial. Trials 2015; 16:293. [PMID: 26149441 PMCID: PMC4501275 DOI: 10.1186/s13063-015-0805-z] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2015] [Accepted: 06/10/2015] [Indexed: 12/11/2022] Open
Abstract
Background Major depression is one of the most debilitating diseases in terms of quality of life. Less than half of patients suffering from depression can achieve remission after adequate antidepressant treatment. Another promising treatment option is cognitive-behavior therapy (CBT). However, the need for experienced therapists and substantive dedicated time prevent CBT from being widely disseminated. In the present study, we aim to examine the effectiveness of switching antidepressants and starting a smartphone-based CBT program at the same time, in comparison to switching antidepressants only, among patients still suffering from depression after adequate antidepressant treatment. Methods/design A multi-center randomized trial is currently being conducted since September 2014. The smartphone-based CBT program, named the “Kokoro-App,” for major depression has been developed and its feasibility has been confirmed in a previous open study. The program consists of an introduction, 6 sessions and an epilogue, and is expected to be completed within 9 weeks by patients. In the present trial, 164 patients with DSM-5 major depressive disorder and still suffering from depressive symptoms after adequate antidepressant treatment for more than 4 weeks will be allocated to the Kokoro-App plus switching antidepressant group or the switching antidepressant alone group. The participants allocated to the latter group will receive full components of the Kokoro-App after 9 weeks. The primary outcome is the change in the total score on the Patient Health Questionnaire through the 9 weeks of the program, as assessed at week 0, 1, 5 and 9 via telephone by blinded raters. The secondary outcomes include the change in the total score of the Beck Depression Inventory-II, change in side effects as assessed by the Frequency, Intensity and Burden of Side Effects Rating, and treatment satisfaction. Discussion An effective and reachable intervention may not only lead to healthier mental status among depressed patients, but also to reduced social burden from this illness. This paper outlines the background and methods of a trial that evaluates the possible additive value of a smartphone-based CBT program for treatment-resistant depression. Trial registration UMIN-CTR: UMIN000013693 (registered on 1 June 2014)
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Affiliation(s)
- Norio Watanabe
- Department of Clinical Epidemiology, Translational Medical Center, National Center of Neurology and Psychiatry, 4-1-1 Ogawa-Higashi, Kodaira, Tokyo, 187-8551, Japan.
| | - Masaru Horikoshi
- National Center for Cognitive Behavior Therapy and Research, National Center of Neurology and Psychiatry, 4-1-1 Ogawa-Higashi, Kodaira, Tokyo, 187-8551, Japan.
| | - Mitsuhiko Yamada
- Department of Neuropsychopharmacology, National Institute of Mental Health, National Center of Neurology and Psychiatry, 4-1-1 Ogawa-Higashi, Kodaira, Tokyo, 187-8551, Japan.
| | - Shinji Shimodera
- Department of Neuropsychiatry, Kochi Medical School, Kochi University, Kohasu, Okoh-cho, Nankokushi, Kochi, 783-8505, Japan.
| | - Tatsuo Akechi
- Department of Psychiatry and Cognitive-Behavioral Medicine, Nagoya City University Graduate School of Medical Sciences, Mizuho-cho, Mizuho-ku, Nagoya, 467-8601, Japan.
| | - Kazuhira Miki
- Miki Clinic, 1-1-3 Hiranuma, Nishi-ku, Yokohama, 220-0023, Japan.
| | - Masatoshi Inagaki
- Department of Neuropsychiatry, Okayama University Hospital, 2-5-1 Shikata-cho Kita-ku, Okayama, 700-8558, Japan.
| | - Naohiro Yonemoto
- Department of Neuropsychopharmacology, National Institute of Mental Health, National Center of Neurology and Psychiatry, 4-1-1 Ogawa-Higashi, Kodaira, Tokyo, 187-8551, Japan.
| | - Hissei Imai
- Department of Field Medicine, Kyoto University Graduate School of Medicine, 46 Shimoadachi-cho, Yoshida Sakyo-ku, Kyoto, 606-8501, Japan.
| | - Aran Tajika
- Departments of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine/School of Public Health, Yoshida Konoe-cho, Sakyo-ku, Kyoto, 606-8501, Japan.
| | - Yusuke Ogawa
- Departments of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine/School of Public Health, Yoshida Konoe-cho, Sakyo-ku, Kyoto, 606-8501, Japan.
| | - Nozomi Takeshima
- Departments of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine/School of Public Health, Yoshida Konoe-cho, Sakyo-ku, Kyoto, 606-8501, Japan.
| | - Yu Hayasaka
- Departments of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine/School of Public Health, Yoshida Konoe-cho, Sakyo-ku, Kyoto, 606-8501, Japan.
| | - Toshi A Furukawa
- Departments of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine/School of Public Health, Yoshida Konoe-cho, Sakyo-ku, Kyoto, 606-8501, Japan.
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