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International Journal of Environmental... Dec 2019Mind-body exercise has been generally recognized as a beneficial strategy to improve mental health in those with Chronic Obstructive Pulmonary Disease (COPD). However,... (Meta-Analysis)
Meta-Analysis
OBJECTIVES
Mind-body exercise has been generally recognized as a beneficial strategy to improve mental health in those with Chronic Obstructive Pulmonary Disease (COPD). However, to date, no attempt has been made to collate this literature. The aim of the present study was to systematically analyze the effects of mind-body exercise for COPD patients with anxiety and depression and provide scientific evidence-based exercise prescription.
METHODS
both Chinese and English databases (PubMed, the Cochrane Library, EMBASE, Web of Science, Google Scholar, Chinese National Knowledge Infrastructure, Wanfang, Baidu Scholar) were used as sources of data to search randomized controlled trials (RCT) relating to mind-body exercise in COPD patients with anxiety and depression that were published between January 1982 to June 2019. 13 eligible RCT studies were finally used for meta-analysis.
RESULTS
Mind-body exercise (tai chi, health qigong, yoga) had significant benefits on COPD patients with anxiety (SMD= -0.76, 95% CI -0.91 to -0.60, =0.04, I=47.4%) and depression (SMD= -0.86, 95% CI -1.14 to -0.58, =0.000, I=71.4%). Sub-group analysis indicated that, for anxiety, 30-60 min exercise session for 24 weeks of health qigong or yoga had a significant effect on patients with COPD who are more than 70 years and have more than a 10-year disease course. For depression, 2-3 times a week, 30-60 min each time of health qigong had a significant effect on patients with COPD patients who are more than 70 years old and have less than a 10-year disease course.
CONCLUSIONS
Mind-body exercise could reduce levels of anxiety and depression in those with COPD. More robust RCT are required on this topic.
Topics: Aged; Anxiety; Depression; Depressive Disorder; Exercise Therapy; Humans; Mind-Body Therapies; Pulmonary Disease, Chronic Obstructive; Quality of Life
PubMed: 31861418
DOI: 10.3390/ijerph17010022 -
British Journal of Anaesthesia Jun 2023Adverse childhood experiences have been linked to increased multimorbidity, with physical and mental health consequences throughout life. Chronic pain is often... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Adverse childhood experiences have been linked to increased multimorbidity, with physical and mental health consequences throughout life. Chronic pain is often associated with mood disorders, such as major depressive disorder (MDD); both have been linked to adverse childhood experiences. It is unclear how the effect of adverse childhood experiences on neural processing impacts on vulnerability to chronic pain, MDD, or both, and whether there are shared mechanisms. We aimed to assess evidence for central neural changes associated with adverse childhood experiences in subjects with chronic pain, MDD, or both using systematic review and meta-analysis.
METHODS
Electronic databases were systematically searched for neuroimaging studies of adverse childhood experiences, with chronic pain, MDD, or both. Two independent reviewers screened title, abstracts, and full text, and assessed quality. After extraction of neuroimaging data, activation likelihood estimate meta-analysis was performed to identify significant brain regions associated with these comorbidities.
RESULTS
Forty-nine of 2414 studies were eligible, of which 43 investigated adverse childhood experiences and MDD and six investigated adverse childhood experiences and chronic pain. None investigated adverse childhood experiences, chronic pain, and MDD together. Functional and structural brain abnormalities were identified in the superior frontal, lingual gyrus, hippocampus, insula, putamen, superior temporal, inferior temporal gyrus, and anterior cerebellum in patients with MDD exposed to adverse childhood experiences. In addition, brain function abnormalities were identified for patients with MDD or chronic pain and exposure to adverse childhood experiences in the cingulate gyrus, inferior parietal lobule, and precuneus in task-based functional MRI studies.
CONCLUSIONS
We found that adverse childhood experiences exposure can result in different functional and structural brain alterations in adults with MDD or chronic pain compared with those without adverse childhood experiences.
SYSTEMATIC REVIEW PROTOCOL
PROSPERO CRD42021233989.
Topics: Adult; Humans; Depressive Disorder, Major; Chronic Pain; Adverse Childhood Experiences; Depression; Likelihood Functions; Magnetic Resonance Imaging; Brain
PubMed: 37087334
DOI: 10.1016/j.bja.2023.03.008 -
Journal of Alzheimer's Disease : JAD 2017Depression is common in people with Alzheimer's disease (AD) affecting overall outcomes and decreasing quality of life. Although depression in AD is primarily treated... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Depression is common in people with Alzheimer's disease (AD) affecting overall outcomes and decreasing quality of life. Although depression in AD is primarily treated with antidepressants, there are few randomized controlled trials (RCTs) assessing efficacy and results have been conflicting.
OBJECTIVES
To systematically review evidence on efficacy of antidepressant treatments for depression in AD.
METHODS
Systematic review and meta-analysis of double blind RCTs comparing antidepressants versus placebo for depression in AD. We searched MEDLINE, CINAHL, EMBASE, PsycINFO, the Cochrane Controlled Trials Register and on line national and international registers. Primary outcomes were treatment response and depressive symptoms. Secondary outcomes were cognition, acceptability, and tolerability. Risk of bias was also assessed.
RESULTS
Seven studies met inclusion criteria. Three compared sertraline with placebo; one compared both sertraline and mirtazapine to placebo; imipramine, fluoxetine, and clomipramine were evaluated in one study each. In terms of response to treatment (6 studies, 297 patients treated with antidepressants and 223 with placebo), no statistically significant difference between antidepressants and placebo was found (odds ratio (OR) 1.95, 95% CI 0.97-3.92). We found no significant drug-placebo difference for depressive symptoms (5 studies, 311 patients, SMD -0.13; 95% CI -0.49 to 0.24). Overall quality of the evidence was moderate because of methodological limitations in studies and the small number of trials.
CONCLUSION
Despite the importance of depression in people with AD, few RCTs are available on efficacy of antidepressants, limiting clear conclusions of their potential role. There is a need for further high quality RCTs.
Topics: Alzheimer Disease; Antidepressive Agents; Depressive Disorder; Humans; Randomized Controlled Trials as Topic
PubMed: 28505970
DOI: 10.3233/JAD-161247 -
Psychiatria Polska Dec 2017The aim of the systematic review was to evaluate the use of EEG Biofeedback/Neurofeedback in patients treated for mental disorders. The review covered publications... (Review)
Review
The aim of the systematic review was to evaluate the use of EEG Biofeedback/Neurofeedback in patients treated for mental disorders. The review covered publications analyzing influences and effects of therapy in patients receiving psychiatric treatment based on EEG Biofeedback/Neurofeedback. Selection of publications was made by searching PubMed and Scopus databases. 328 records concerning applications of the presented method were identified in total, including 84 records for patients diagnosed with mental disorders. The analysis of studies indicates that EEG Biofeedback/Neurofeedback is used for treatment of neurological, somatic and mental disorders. Its psychiatric applications for clinically diagnosed disorders include treatmentof depression, anorexia, dyslexia, dysgraphia, ADD, ADHD, schizophrenia, abuse of substances, neuroses, PTSD, and Alzheimer's disease. Research results imply that the neuromodulating effect of the therapy positively influences cognitive processes, mood, and anxiety levels. Positive effects of EEG Biofeedback confirm usefulness of this method as a main or auxiliary method in treatment of people with mental disorders. On the basis of conducted studies, it is worthwhile to consider inclusion of this method into the comprehensive neurorehabilitation activities.
Topics: Anxiety Disorders; Attention Deficit Disorder with Hyperactivity; Behavior, Addictive; Brain Injuries; Depressive Disorder; Electroencephalography; Electromyography; Female; Humans; Male; Mental Disorders; Neurofeedback; Substance-Related Disorders
PubMed: 29432505
DOI: 10.12740/PP/68919 -
JAMA Psychiatry Mar 2021The sequential model emerged from the awareness that the persistence of residual symptoms and the frequent occurrence of psychiatric comorbidity were both associated... (Meta-Analysis)
Meta-Analysis
IMPORTANCE
The sequential model emerged from the awareness that the persistence of residual symptoms and the frequent occurrence of psychiatric comorbidity were both associated with poor long-term outcome of major depressive disorder (MDD).
OBJECTIVE
To conduct an updated meta-analysis to examine the association of the sequential combination of pharmacotherapy and psychotherapy with reduced risk of relapse and recurrence in MDD.
DATA SOURCES
Keyword searches were conducted in PubMed, PsycInfo, Web of Science, and the Cochrane Library from inception of each database through November 2019. Reference lists from relevant studies were examined using the following keywords: sequential treatment, drugs and psychotherapy, combined treatment, continuation or maintenance, relapse or recurrence and prevention, and depress* or major depress*, selecting adults and randomized controlled trials as additional limits. Authors of selected articles were contacted if needed.
STUDY SELECTION
Randomized clinical trials examining the effectiveness of the sequential use of psychotherapy following response to acute-phase pharmacotherapy in the treatment of adult remitted patients with MDD were selected independently by 2 reviewers.
DATA EXTRACTION AND SYNTHESIS
The methods used fulfilled the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guideline. Data extraction and methodologic quality assessment were conducted independently by the reviewers. Examination of the pooled results was performed based on the random-effects model. Heterogeneity between study results and likelihood of significant publication bias were assessed. Sensitivity analyses and meta-regressions were also run.
MAIN OUTCOMES AND MEASURES
The primary outcome measures were relapse or recurrence rates of MDD, as defined by study investigators, at the longest available follow-up.
RESULTS
Seventeen randomized clinical trials met criteria for inclusion in the meta-analysis, with 1 study yielding 2 comparisons (2283 patients overall, with 1208 patients in a sequential treatment arm and 1075 in a control arm). The pooled risk ratio for relapse/recurrence of MDD was 0.84 (95% CI, 0.74-0.94), suggesting a relative advantage in preventing relapse/recurrence for the sequential combination of treatments compared with control conditions.
CONCLUSIONS AND RELEVANCE
The results of this systematic review and meta-analysis indicate that the sequential integration of psychotherapy following response to acute-phase pharmacotherapy, alone or combined with antidepressant medication, was associated with reduced risk of relapse and recurrence in MDD. The preventive value of the sequential strategy relies on abatement of residual symptoms and/or increase in psychological well-being. The steps for implementing the sequential approach in remitted patients with recurrent MDD are provided.
Topics: Antidepressive Agents; Combined Modality Therapy; Depressive Disorder, Major; Humans; Outcome and Process Assessment, Health Care; Psychotherapy; Time Factors
PubMed: 33237285
DOI: 10.1001/jamapsychiatry.2020.3650 -
BMJ (Clinical Research Ed.) Nov 2020To evaluate the Edinburgh Postnatal Depression Scale (EPDS) for screening to detect major depression in pregnant and postpartum women. (Meta-Analysis)
Meta-Analysis
Accuracy of the Edinburgh Postnatal Depression Scale (EPDS) for screening to detect major depression among pregnant and postpartum women: systematic review and meta-analysis of individual participant data.
OBJECTIVE
To evaluate the Edinburgh Postnatal Depression Scale (EPDS) for screening to detect major depression in pregnant and postpartum women.
DESIGN
Individual participant data meta-analysis.
DATA SOURCES
Medline, Medline In-Process and Other Non-Indexed Citations, PsycINFO, and Web of Science (from inception to 3 October 2018).
ELIGIBILITY CRITERIA FOR SELECTING STUDIES
Eligible datasets included EPDS scores and major depression classification based on validated diagnostic interviews. Bivariate random effects meta-analysis was used to estimate EPDS sensitivity and specificity compared with semi-structured, fully structured (Mini International Neuropsychiatric Interview (MINI) excluded), and MINI diagnostic interviews separately using individual participant data. One stage meta-regression was used to examine accuracy by reference standard categories and participant characteristics.
RESULTS
Individual participant data were obtained from 58 of 83 eligible studies (70%; 15 557 of 22 788 eligible participants (68%), 2069 with major depression). Combined sensitivity and specificity was maximised at a cut-off value of 11 or higher across reference standards. Among studies with a semi-structured interview (36 studies, 9066 participants, 1330 with major depression), sensitivity and specificity were 0.85 (95% confidence interval 0.79 to 0.90) and 0.84 (0.79 to 0.88) for a cut-off value of 10 or higher, 0.81 (0.75 to 0.87) and 0.88 (0.85 to 0.91) for a cut-off value of 11 or higher, and 0.66 (0.58 to 0.74) and 0.95 (0.92 to 0.96) for a cut-off value of 13 or higher, respectively. Accuracy was similar across reference standards and subgroups, including for pregnant and postpartum women.
CONCLUSIONS
An EPDS cut-off value of 11 or higher maximised combined sensitivity and specificity; a cut-off value of 13 or higher was less sensitive but more specific. To identify pregnant and postpartum women with higher symptom levels, a cut-off of 13 or higher could be used. Lower cut-off values could be used if the intention is to avoid false negatives and identify most patients who meet diagnostic criteria.
REGISTRATION
PROSPERO (CRD42015024785).
Topics: Depression, Postpartum; Depressive Disorder, Major; Female; Humans; Pregnancy; Pregnancy Complications; Prenatal Care; Psychometrics; Sensitivity and Specificity
PubMed: 33177069
DOI: 10.1136/bmj.m4022 -
BMC Public Health Nov 2019The use of computers/TV has become increasingly common worldwide after entering the twenty-first century and depression represents a growing public health burden.... (Meta-Analysis)
Meta-Analysis
BACKGROUND
The use of computers/TV has become increasingly common worldwide after entering the twenty-first century and depression represents a growing public health burden. Understanding the association between screen time-based sedentary behavior (ST-SB) and the risk of depression is important to the development of prevention and intervention strategies.
METHODS
We searched the electronic databases of Medline, Embase and the Cochrane Library. The odds ratio (OR) with corresponding 95% confidence intervals (CIs) was adopted as the pooled measurement. Subgroup analyses were investigated by stratified meta-analyses based on age, gender and reference group (reference category of screen time, e.g. 2 h/day, 4 h/day).
RESULTS
There were 12 cross-sectional studies and 7 longitudinal studies met the inclusion criteria. Overall, the pooled OR was 1.28 with high heterogeneity (I = 89%). Compared to those who reported less SB, persons reporting more SB had a significantly higher risk of depression. When the gender was stratified, the pooled OR was 1.18 in female groups while no significant association was observed in males. Among the 19 studies, 5 studies used a reference group with ST = 2 h/days (pooled OR = 1.46), 9 studies used ≥4 h as a reference group (pooled OR = 1.38), 2 studies used 1 h as a reference group (pooled OR = 1.07) and for the remaining 3 studies, hours of ST were calculated as a continuous variable (pooled OR = 1.04).
CONCLUSIONS
ST-SB is associated with depression risk and the effects vary in different populations. In addition, valid objective measures of SB should be developed in future studies.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Computers; Cross-Sectional Studies; Depression; Depressive Disorder; Exercise; Female; Humans; Male; Mental Health; Middle Aged; Screen Time; Sedentary Behavior; Television; Young Adult
PubMed: 31727052
DOI: 10.1186/s12889-019-7904-9 -
Annals of Internal Medicine Feb 2023Primary care patients and clinicians may prefer alternative options to second-generation antidepressants for major depressive disorder (MDD). (Meta-Analysis)
Meta-Analysis Review
Nonpharmacologic and Pharmacologic Treatments of Adult Patients With Major Depressive Disorder: A Systematic Review and Network Meta-analysis for a Clinical Guideline by the American College of Physicians.
BACKGROUND
Primary care patients and clinicians may prefer alternative options to second-generation antidepressants for major depressive disorder (MDD).
PURPOSE
To compare the benefits and harms of nonpharmacologic treatments with second-generation antidepressants as first-step interventions for acute MDD, and to compare second-step treatment strategies for patients who did not achieve remission after an initial attempt with antidepressants.
DATA SOURCES
English-language studies from several electronic databases from 1 January 1990 to 8 August 2022, trial registries, gray literature databases, and reference lists to identify unpublished research.
STUDY SELECTION
2 investigators independently selected randomized trials of at least 6 weeks' duration.
DATA EXTRACTION
Reviewers abstracted data about study design and conduct, participants, interventions, and outcomes. They dually rated the risk of bias of studies and the certainty of evidence for outcomes of interest.
DATA SYNTHESIS
65 randomized trials met the inclusion criteria; eligible data from nonrandomized studies were not found. Meta-analyses and network meta-analyses indicated similar benefits of most nonpharmacologic treatments and antidepressants as first-step treatments. Antidepressants had higher risks for discontinuation because of adverse events than most other treatments. For second-step therapies, different switching and augmentation strategies provided similar symptomatic relief. The certainty of evidence for most comparisons is low; findings should be interpreted cautiously.
LIMITATIONS
Many studies had methodological limitations or dosing inequalities; publication bias might have affected some comparisons. In some cases, conclusions could not be drawn because of insufficient evidence.
CONCLUSION
Although benefits seem to be similar among first- and second-step MDD treatments, the certainty of evidence is low for most comparisons. Clinicians and patients should focus on options with the most reliable evidence and take adverse event profiles and patient preferences into consideration.
PRIMARY FUNDING SOURCE
American College of Physicians. (PROSPERO: CRD42020204703).
Topics: Humans; Adult; Depressive Disorder, Major; Network Meta-Analysis; Antidepressive Agents; Antidepressive Agents, Second-Generation; Physicians
PubMed: 36689750
DOI: 10.7326/M22-1845 -
Medicina (Kaunas, Lithuania) May 2019Pregnancy is a unique period in the life of every woman. The lifestyle of a pregnant woman has a significant impact on her and her child's health. Regular physical...
Pregnancy is a unique period in the life of every woman. The lifestyle of a pregnant woman has a significant impact on her and her child's health. Regular physical activity is one of the elements that help maintain normal mental and physical well-being. In pregnant women who regularly have moderate physical activity, there is a lower risk of developing obesity and overweight. Physical exercises have an impact on maintaining proper muscular tonus, reduce pain and prepare for the exertion during labour. Based on the available literature, the aim of this study was to present the impact of physical activity on depressive disorders in pregnant women. A review of the literature was carried out in the Medline PubMed database. The basic search terms were: "pregnancy" AND "physical activity AND depression". The work included only English-language publications published in the years 2000-2018. A total of 408 references were found. On the basis of an analysis of titles, abstracts and the language of publication (other than English), 354 articles were rejected, and 54 articles were fully read, of which five were rejected due to lack of access to the full version. Finally, 17 references were included in the review. Physical activity, at least once a week, significantly reduces the symptoms of depression in pregnant women and may be an important factor in the prevention of depression in this period.
Topics: Depressive Disorder; Exercise; Female; Healthy Lifestyle; Humans; Pregnancy; Pregnancy Complications; Pregnant Women
PubMed: 31130705
DOI: 10.3390/medicina55050212 -
Nutrients Dec 2021A growing number of studies in rodents indicate a connection between the intestinal microbiota and the brain, but comprehensive human data is scarce. Here, we...
A growing number of studies in rodents indicate a connection between the intestinal microbiota and the brain, but comprehensive human data is scarce. Here, we systematically reviewed human studies examining the connection between the intestinal microbiota and major depressive and bipolar disorder. In this review we discuss various changes in bacterial abundance, particularly on low taxonomic levels, in terms of a connection with the pathophysiology of major depressive and bipolar disorder, their use as a diagnostic and treatment response parameter, their health-promoting potential, as well as novel adjunctive treatment options. The diversity of the intestinal microbiota is mostly decreased in depressed subjects. A consistent elevation of phylum Actinobacteria, family Bifidobacteriaceae, and genus , and a reduction of family Ruminococcaceae, genus , and genus was reported. Probiotics containing and/or spp. seemed to improve depressive symptoms, and novel approaches with different probiotics and synbiotics showed promising results. Comparing twin studies, we report here that already with an elevated risk of developing depression, microbial changes towards a "depression-like" microbiota were found. Overall, these findings highlight the importance of the microbiota and the necessity for a better understanding of its changes contributing to depressive symptoms, potentially leading to new approaches to alleviate depressive symptoms via alterations of the gut microbiota.
Topics: Adult; Animals; Bacteroides; Bifidobacterium; Bipolar Disorder; Brain-Gut Axis; Depressive Disorder, Major; Faecalibacterium; Female; Gastrointestinal Microbiome; Humans; Lactobacillus; Male; Middle Aged; Probiotics; Synbiotics; Young Adult
PubMed: 35010912
DOI: 10.3390/nu14010037