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Journal of Affective Disorders Jan 2016Depression is common, frequently resistant to antidepressant treatment, and associated with impairments in cognition and everyday functioning. Computerized cognitive... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
Depression is common, frequently resistant to antidepressant treatment, and associated with impairments in cognition and everyday functioning. Computerized cognitive training (CCT) paradigms offer potential to improve cognition, mood and everyday functioning, but their effectiveness is not well established. The goal of this article was to conduct a systematic review and meta-analysis to determine the efficacy of CCT in depressive disorders.
METHOD
A search was conducted to identify high quality randomized controlled CCT trials per PRISMA guidelines using PsycINFO and MEDLINE with the keywords "Cognitive training" or "Cognitive remediation" or "Cognitive rehabilitation" and "Depression". 9 randomized trials for depressed adults met inclusion criteria. Effect sizes (Hedge's g) were calculated for key outcome measures of mood symptom severity, daily functioning, and cognition. A 3-level Bayesian hierarchical linear model was used to estimate effect sizes for each domain and study. Publication bias was assessed using Classic Fail Safe N's and homogeneity was evaluated using Q and I(2) indexes.
RESULTS
Significant small-moderate effects for Symptom Severity (0.43) and Daily Functioning (0.72), and moderate-large effects for Attention (0.67), Working Memory (0.72), and Global Functioning (1.05) were found. No significant effects were found for Executive Functioning or Verbal Memory. Moderator variable analysis revealed decreased effect of CCT with age. Gender and concurrent medication treatment did not affect the results.
LIMITATIONS
Small sample size, short duration, pseudo-specificity, and high heterogeneity for Verbal Memory measures.
CONCLUSIONS
CCT is associated with improvement in depressive symptoms and everyday functioning, though produces inconsistent effects on cognition.
Topics: Bayes Theorem; Cognition Disorders; Cognitive Behavioral Therapy; Depressive Disorder, Major; Humans; Therapy, Computer-Assisted; Treatment Outcome
PubMed: 26437233
DOI: 10.1016/j.jad.2015.09.022 -
Expert Review of Pharmacoeconomics &... Feb 2018Leading cause of disability worldwide, depression is the most prevalent mental disorder with growing societal costs. As mental health services demand often outweighs... (Comparative Study)
Comparative Study Meta-Analysis Review
INTRODUCTION
Leading cause of disability worldwide, depression is the most prevalent mental disorder with growing societal costs. As mental health services demand often outweighs provision, accessible treatment options are needed. Our systematic review and meta-analysis evaluated the clinical efficacy and economic evidence for the use of online cognitive behavioral therapy (oCBT) as an accessible treatment solution for depression.
AREAS COVERED
Electronic databases were searched for controlled trials published between 2006 and 2016. Of the reviewed 3,324 studies, 29 met the criteria for inclusion in the efficacy meta-analysis. The systematic review identified five oCBT economic evaluations. Therapist-supported oCBT was equivalent to face-to-face CBT at improving depressive symptoms and superior to treatment-as-usual, waitlist control, and attention control. Depression severity, number of sessions, or support did not affect efficacy. From a healthcare provider perspective, oCBT tended to show greater costs with greater benefits in the short term, relative to comparator treatments.
EXPERT COMMENTARY
Although efficacious, further economic evidence is required to support the provision of oCBT as a cost-effective treatment for depression. Economic evaluations that incorporate a societal perspective will better account for direct and indirect treatment costs. Nevertheless, oCBT shows promise of effectively improving depressive symptoms, considering limited mental healthcare resources.
Topics: Cognitive Behavioral Therapy; Cost-Benefit Analysis; Depressive Disorder, Major; Health Care Costs; Humans; Internet; Severity of Illness Index; Treatment Outcome
PubMed: 29145746
DOI: 10.1080/14737167.2018.1407245 -
Progress in Neuro-psychopharmacology &... Feb 2024Major Depressive Disorder (MDD) has, as a conventional treatment, pharmacological therapy with selective monoamine reuptake inhibitors. However, the medication does not... (Meta-Analysis)
Meta-Analysis Review
Use of nitrous oxide in the treatment of major depressive disorder and treatment-resistant major depressive disorder: A systematic review and meta-analysis nitrous oxide in depressive disorders.
Major Depressive Disorder (MDD) has, as a conventional treatment, pharmacological therapy with selective monoamine reuptake inhibitors. However, the medication does not always have a rapid action for exacerbated cases, and moreover, it is estimated that 15 to 30% of patients do not respond effectively to conventional treatment, leading to 'treatment-resistant depressive mood disorder' (TRD). Thus, it is necessary to search for new therapeutic methods for exacerbated and resistant cases. The objective of the study was to evaluate the therapeutic effects of nitrous oxide (N2O) in patients with MDD and TRD. The study was characterized as a systematic review of randomized clinical trials. Search strategy was developed using the keywords "nitrous oxide," "treatment-resistant depression," "Depression disorder," and their synonyms, searched in the databases MEDLINE, EMBASE, LILACS, and American Psychological Association. Four articles were included in the systematic review, with two of them being utilized for the meta-analysis, which comprised a total of 23 patients with MDD and 86 with TRD. A standardized mean difference (SMD) for the HDRS score at 24 h of -2.36 was found, with a 95% confidence interval (CI) of -3.37 to -1.34 (p < 0.0001; I2 = 46%). For the evaluation of the score after one week, an SMD of -0.60, 95% CI of -1.13 to -0.07 (p = 0.03; I2 = 0%) was found. In conclusion, N2O has a rapid action for managing decompensated patients, with a potential therapeutic effect for TRD. However, more studies needed to determine N2O's effectiveness duration.
Topics: Humans; Depressive Disorder, Major; Antidepressive Agents; Nitrous Oxide; Depressive Disorder, Treatment-Resistant; Affect
PubMed: 37813146
DOI: 10.1016/j.pnpbp.2023.110869 -
Depression and Anxiety Aug 2014We aimed to synthesize the available evidence on the relative efficacy and acceptability of specific treatments for persistent depressive disorder. (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
We aimed to synthesize the available evidence on the relative efficacy and acceptability of specific treatments for persistent depressive disorder.
METHODS
We searched several databases up to January 2013 and included randomized controlled trials that compared acute pharmacological, psychotherapeutic, and combined interventions with each other or placebo. The outcome measures were the proportion of patients who responded to (efficacy) or dropped out from (acceptability) the allocated treatment. Data synthesis was performed with network meta-analysis.
RESULTS
A network of 45 trials that tested 28 drugs included data from 5,806 and 5,348 patients concerning efficacy and acceptability, respectively. A second network of 15 trials that tested five psychotherapeutic and five combined interventions included data from 2,657 and 2,719 patients concerning efficacy and acceptability, respectively. Among sufficiently tested treatments, fluoxetine (odds ratio (OR) 2.94), paroxetine (3.79), sertraline (4.47), moclobemide (6.98), imipramine (4.53), ritanserin (2.35), amisulpride (5.63), and acetyl-l-carnitine (5.67) were significantly more effective than placebo. Pairwise comparisons showed advantages of moclobemide (2.38) and amisulpride (1.92) over fluoxetine. Sertraline (0.57) and amisulpride (0.53) showed a lower dropout rate than imipramine. Interpersonal psychotherapy with medication outperformed medication alone in chronic major depression but not in dysthymia. Evidence on cognitive behavioral analysis system of psychotherapy plus medication was partly inconclusive. Interpersonal psychotherapy was less effective than medication (0.48) and cognitive behavioral analysis system of psychotherapy (0.45). Several other treatments were tested in single studies.
CONCLUSIONS
Several evidence-based acute pharmacological, psychotherapeutic, and combined treatments for persistent depressive disorder are available with significant differences between them.
Topics: Depressive Disorder, Treatment-Resistant; Humans; Patient Compliance; Treatment Outcome
PubMed: 24448972
DOI: 10.1002/da.22236 -
Journal of Psychiatric Practice Mar 2016A large and extensive body of research has examined comorbid anxiety and depression in adults. Children and adolescents also frequently present with comorbid anxiety and... (Review)
Review
BACKGROUND
A large and extensive body of research has examined comorbid anxiety and depression in adults. Children and adolescents also frequently present with comorbid anxiety and depression; however, research and treatment require unique environmental and neurodevelopmental considerations in children. As a result, our understanding of comorbid anxiety and depression in children and adolescents is limited.
OBJECTIVE
The goal of this systematic review was to examine the current literature focused on comorbid anxiety and depression in children and adolescents. The review included theoretical conceptualizations as well as diagnostic, neurobiological, prevention, and treatment considerations. In addition, a proposed algorithm for the treatment of comorbid anxiety and depression in children/adolescents is provided.
METHODS
This systematic literature review included 3 discrete searches in Ovid SP Medline, PsycInfo, and PubMed.
RESULTS
The review included and synthesized 115 articles published between 1987 and 2015. The available evidence suggests that anxiety and depression are common in clinical populations of children and adolescents, and that comorbidity is likely underestimated in children and adolescents. Children and adolescents with comorbid anxiety and depression have unique presentations, greater symptom severity, and treatment resistance compared with those who have either disease in isolation. A dimensional approach may be necessary for the future development of diagnostic strategies and treatments for this population. Nascent neuroimaging work suggests that anxiety and depression each represents a distinct neurobiological phenotype.
CONCLUSIONS
The literature that is currently available suggests that comorbid anxiety and depression is a common presentation in children and adolescents. This diagnostic picture underscores the importance of comprehensive dimensional assessments and multimodal evidence-based approaches given the high disease severity. Future research on the neurobiology and the treatment of these common clinical conditions is warranted.
Topics: Adolescent; Algorithms; Anxiety Disorders; Child; Comorbidity; Depressive Disorder; Humans; Severity of Illness Index
PubMed: 27138077
DOI: 10.1097/PRA.0000000000000132 -
The World Journal of Biological... Mar 2010The purpose of this systematic literature review is to examine previous studies that investigated the relation between depression and binge eating disorder (BED).... (Review)
Review
The purpose of this systematic literature review is to examine previous studies that investigated the relation between depression and binge eating disorder (BED). Medline/PubMed published data from 1980 through 2006 was tracked using the following keywords: "binge eating disorder and depression", "periodic binge eating and depression", "binge eating disorder" and "periodic binge eating". The findings of 14 studies were successfully highlighted: one cohort, four cross-sectional and nine case-control studies. Most studies (7/14) were conducted in the United States, with missing data varying between 2.3 and 44.32%, and seven studies emphasizing the most important variables. The majority of the studies (10/14) showed an association between depression and binge eating disorder, but carefully designed studies are required to minimize the limitations found in these studies.
Topics: Binge-Eating Disorder; Bulimia; Depressive Disorder; Humans; Psychiatric Status Rating Scales
PubMed: 20218783
DOI: 10.3109/15622970802563171 -
The British Journal of Psychiatry.... 1998Although there have been many changes in the diagnosis of anxiety and depressive disorders in the past 20 years there have been few comparative enquiries into the... (Review)
Review
BACKGROUND
Although there have been many changes in the diagnosis of anxiety and depressive disorders in the past 20 years there have been few comparative enquiries into the clinical outcome of greater diagnostic categories. We therefore compared the outcome of all studies which compared the outcome of specific anxiety and depressive disorders using the standard procedures of systematic review.
METHOD
A Medline search was carried out of all studies comparing the outcome of anxiety and depressive disorders or mixed anxiety--depressive disorders in which information was available separately for each disorder.
RESULTS
Eight studies satisfied the search criteria (all involving a period of observation of two years or greater); only one of these included randomisation of treatment and comparison between specific anxiety disorder outcome. There was a somewhat better outcome in patients with depressive disorders compared with anxiety ones, and strong evidence that both anxiety and depressive disorders singly had better outcomes than comorbid mixed disorders.
CONCLUSION
Comorbid anxiety--depressive disorders have a poor outcome compared with single anxiety and depressive disorders, and there is some evidence that anxiety disorders have a worse outcome than depressive ones.
Topics: Anxiety Disorders; Depressive Disorder; Humans; Prognosis; Treatment Outcome
PubMed: 9829015
DOI: No ID Found -
The International Journal of... Oct 2023The clinical heterogeneity in major depressive disorder (MDD), variable treatment response, and conflicting findings limit the ability of genomics toward the discovery...
BACKGROUND
The clinical heterogeneity in major depressive disorder (MDD), variable treatment response, and conflicting findings limit the ability of genomics toward the discovery of evidence-based diagnosis and treatment regimen. This study attempts to curate all genetic association findings to evaluate potential variants for clinical translation.
METHODS
We systematically reviewed all candidates and genome-wide association studies for both MDD susceptibility and antidepressant response, independently, using MEDLINE, particularly to identify replicated findings. These variants were evaluated for functional consequences using different in silico tools and further estimated their diagnostic predictability by calculating positive predictive values.
RESULTS
A total of 217 significantly associated studies comprising 1200 variants across 545 genes and 128 studies including 921 variants across 412 genes were included with MDD susceptibility and antidepressant response, respectively. Although the majority of associations were confirmed by a single study, we identified 31 and 18 replicated variants (in at least 2 studies) for MDD and antidepressant response. Functional annotation of these 31 variants predicted 20% coding variants as deleterious/damaging and 80.6% variants with regulatory effect. Similarly, the response-related 18 variants revealed 25% coding variant as damaging and 88.2% with substantial regulatory potential. Finally, we could calculate the diagnostic predictability of 19 and 5 variants whose positive predictive values ranges from 0.49 to 0.66 for MDD and 0.36 to 0.66 for response.
CONCLUSIONS
The replicated variants presented in our data are promising for disease diagnosis and improved response outcomes. Although these quantitative assessment measures are solely directive of available observational evidence, robust homogenous validation studies are required to strengthen these variants for molecular diagnostic application.
Topics: Humans; Depressive Disorder, Major; Genome-Wide Association Study; Antidepressive Agents
PubMed: 36655406
DOI: 10.1093/ijnp/pyad001 -
General Hospital Psychiatry 2010Comorbid depression in diabetes is highly prevalent, negatively impacting well-being and diabetes control. How depression in diabetes is best treated is unknown. (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Comorbid depression in diabetes is highly prevalent, negatively impacting well-being and diabetes control. How depression in diabetes is best treated is unknown.
OBJECTIVE
This systematic review and meta-analysis aims to establish the effectiveness of existing anti-depressant therapies in diabetes.
DATA SOURCES
PubMed, Psycinfo, Embase and Cochrane library. Study eligibility criteria, participants, interventions: randomized controlled trials (RCTs) evaluating the outcome of treatment by psychotherapy, pharmacotherapy or collaborative care of depression in persons with Type 1 and Type 2 diabetes mellitus.
STUDY APPRAISAL
risk of bias assessment; data extraction. Synthesis methods: data synthesis, random model meta analysis and publication bias analysis.
RESULTS
Meta analysis of 14 RCTs with a total of 1724 patients show that treatment is effective in terms of reduction of depressive symptoms: -0.512; 95% CI -0.633 to -0.390. The combined effect of all interventions on clinical impact is moderate, -0.370; 95% CI -0.470 to -0.271; it is large for psychotherapeutic interventions that are often combined with diabetes self management: -0.581; 95% CI -0.770 to -0.391, n=310 and moderate for pharmacological treatment: -0.467; 95% CI -0.665 to -0.270, n=281. Delivery of collaborative care, which provided a stepped care intervention with a choice of starting with psychotherapy or pharmacotherapy, to a primary care population, yielded an effect size of -0.292; 95% CI -0.429 to -0.155, n=1133; indicating the effect size that can be attained on a population scale. Pharmacotherapy and collaborative care aimed at and succeeded in the reduction of depressive symptoms but, apart from sertraline, had no effect on glycemic control.
LIMITATIONS
amongst others, the number of RCTs is small.
CONCLUSION
The treatment of depression in people with diabetes is a necessary step, but improvement of the general medical condition including glycemic control is likely to require simultaneous attention to both conditions. Further research is needed.
Topics: Antidepressive Agents; Blood Glucose; Depressive Disorder, Major; Diabetes Complications; Diabetes Mellitus, Type 1; Diabetes Mellitus, Type 2; Humans; Psychotherapy; Treatment Outcome
PubMed: 20633742
DOI: 10.1016/j.genhosppsych.2010.03.011 -
Medical Science Monitor : International... Oct 2019BACKGROUND Depressive symptoms are a pervasive mental health problem in Chinese adolescents. The aim of this article was to systematically assess the trend of depressive... (Meta-Analysis)
Meta-Analysis
BACKGROUND Depressive symptoms are a pervasive mental health problem in Chinese adolescents. The aim of this article was to systematically assess the trend of depressive symptoms in China among adolescents (1988 to 2018). MATERIAL AND METHODS A systematic and comprehensive literature search was conducted in both English and Chinese databases, including PubMed, EMBASE, Cochrane CENTRAL, CNKI, and Wan Fang Database, to identify relevant studies published between 1988 and 2018. Batteries of analyses in this meta-analysis were undertaken using Stata version 12.0 statistical software. RESULTS Sixty-two related reports involving 232 586 participants finally met our inclusion and exclusion criteria. The results suggest the prevalence of depressive symptoms has generally increased over time. The prevalence estimates before 2000 were 18.4% (95% CI, 14.5-22.3%), and were 26.3% (95% CI, 21.9-30.8%) after 2016. The pooled prevalence of depressive symptoms among children and adolescents was 22.2% (95% CI: 19.9-24.6%, I²=99.6%, p<0.001). More subgroup analyses classified by screening instrument, gender, and region were carried out in this meta-analysis. CONCLUSIONS Results of our meta-analysis suggest that depressive symptoms have become more prevalent among Chinese adolescents. This trend emphasizes the need for effective prevention strategies and greater availability of screening tools for this vulnerable population.
Topics: Adolescent; Asian People; Child; China; Databases, Factual; Depression; Depressive Disorder; Female; Humans; Male; Mass Screening; Prevalence
PubMed: 31586039
DOI: 10.12659/MSM.916774