-
Journal of Behavioral Medicine Dec 2019Cognitive-behavioral therapy (CBT) is well supported for treating depressive and anxiety disorders. Trials of CBT for anxiety and depression in primary care have... (Meta-Analysis)
Meta-Analysis Review
Cognitive-behavioral therapy (CBT) is well supported for treating depressive and anxiety disorders. Trials of CBT for anxiety and depression in primary care have increased over the past decade, yet only one meta-analysis, published in 2015, examined this topic and the scope of that review is relatively narrow. This study conducted a systematic review and meta-analysis of primary care based CBT for depression and anxiety. A search of seven electronic databases, six professional websites, and reference lists from articles meeting inclusion criteria was conducted for studies published between 1900 and November 2018. Fifty-seven eligible studies (including 10,701 participants; 221 effect sizes) of randomized controlled trials were eligible and included for meta-analysis using robust variance estimation in meta-regression. Outcome indicators were depression and anxiety measures. An overall significant treatment effect, d = 0.400, 95% CI (0.235, 0.566), p < 0.001, of CBT for depression and anxiety disorders in primary care was identified. Subgroup analyses indicated significant treatment effect for: (1) depressive (d = 0.425, p < 0.001) and anxiety (d = 0.393, p < 0.01) outcomes, (2) studies conducted inside primary care (d = 0.412, p < 0.001), (3) studies using individual-based CBT (d = 0.412, p < 0.001), (4) studies without primary care physician involvement (d = 0.395, p < 0.001), and (5) studies using both tele-health (d = 0.563, p < 0.001) and in-person CBT (d = 0.363, p < 0.001). The percentage of White participants, treatment composition (CBT only versus CBT + other approaches), and treatment duration were significant moderators. Implications for clinical practice are discussed based on both moderator and subgroup analysis results.
Topics: Anxiety; Anxiety Disorders; Cognitive Behavioral Therapy; Databases, Factual; Depression; Depressive Disorder; Humans; Primary Health Care; Treatment Outcome
PubMed: 31004323
DOI: 10.1007/s10865-019-00046-z -
Current Psychiatry Reports Nov 2019We give an overview of recent developments on psychological treatments of depression in primary care. (Review)
Review
PURPOSE OF REVIEW
We give an overview of recent developments on psychological treatments of depression in primary care.
RECENT FINDINGS
In recent years, it has become clear that psychotherapies can effectively be delivered through e-health applications. Furthermore, several studies in low and middle income countries have shown that lay health counselors can effectively deliver psychological therapies. Behavioral activation, a relatively simple form of therapy, has been found to be as effective as cognitive behavior therapy. Treatment of subthreshold depression has been found to not only reduce depressive symptoms but also prevent the onset of major depression. In addition, therapies are effective in older adults, patients with general medical disorders and in perinatal depression. Psychological therapies are effective in the treatment of depression in primary care, have longer lasting effects than drugs, are preferred by the majority of patients, and can be applied flexibly with different formats and across different target groups.
Topics: Cognitive Behavioral Therapy; Depression; Depressive Disorder, Major; Humans; Primary Health Care; Psychotherapy
PubMed: 31760505
DOI: 10.1007/s11920-019-1117-x -
Current Neuropharmacology 2015
Review
Topics: Animals; Depression; Depressive Disorder; Humans; Sleep
PubMed: 26412067
DOI: 10.2174/1570159x1304150831123535 -
Psychological Bulletin Aug 2017In 2 meta-analyses on gender differences in depression in nationally representative samples, we advance previous work by including studies of depression diagnoses and... (Meta-Analysis)
Meta-Analysis
In 2 meta-analyses on gender differences in depression in nationally representative samples, we advance previous work by including studies of depression diagnoses and symptoms to (a) estimate the magnitude of the gender difference in depression across a wide array of nations and ages; (b) use a developmental perspective to elucidate patterns of gender differences across the life span; and (c) incorporate additional theory-driven moderators (e.g., gender equity). For major depression diagnoses and depression symptoms, respectively, we meta-analyzed data from 65 and 95 articles and their corresponding national data sets, representing data from 1,716,195 and 1,922,064 people in over 90 different nations. Overall, odds ratio (OR) = 1.95, 95% confidence interval (CI) [1.88, 2.03], and d = 0.27 [0.26, 0.29]. Age was the strongest predictor of effect size. The gender difference for diagnoses emerged earlier than previously thought, with OR = 2.37 at age 12. For both meta-analyses, the gender difference peaked in adolescence (OR = 3.02 for ages 13-15, and d = 0.47 for age 16) but then declined and remained stable in adulthood. Cross-national analyses indicated that larger gender differences were found in nations with greater gender equity, for major depression, but not depression symptoms. The gender difference in depression represents a health disparity, especially in adolescence, yet the magnitude of the difference indicates that depression in men should not be overlooked. (PsycINFO Database Record
Topics: Adolescent; Adult; Aged; Depression; Depressive Disorder, Major; Female; Gender Identity; Humans; Male; Middle Aged; Sex Factors; Young Adult
PubMed: 28447828
DOI: 10.1037/bul0000102 -
Anales Del Sistema Sanitario de Navarra Apr 2019
Topics: Depression; Depressive Disorder; Humans
PubMed: 30936571
DOI: 10.23938/ASSN.0591 -
Ginekologia Polska 2017Infertility is a significant problem for millions of couples. Recently more attention is being paid to the relationship between infertility treatment with the use of... (Review)
Review
Infertility is a significant problem for millions of couples. Recently more attention is being paid to the relationship between infertility treatment with the use of Assisted Reproductive Techniques and the presence of mental disturbances, of which anxiety and depression are the most common. We present a review of recent studies evaluating the influence of anxiety and depression on fertility treatment outcomes and the effect of Assisted Reproductive Techniques treatment on the presence of anxiety and depression among women. The studies show conflicting results concerning the effect of anxiety on Assisted Reproductive Techniques treatment outcomes, but most reveal that Assisted Reproductive Techniques treatment leads to an increased level of anxiety, especially in cases of treatment failure and longer durations of treatment. Most studies do not show a relationship between depression and Assisted Reproductive Techniques treatment outcomes, but it seems that severe depression can lead to lower rates of pregnancy during infertility treatment with Assisted Reproductive Techniques. Moreover, women who become pregnant after Assisted Reproductive Techniques treatment seem to have an increased risk of depression in later life.
Topics: Anxiety; Anxiety Disorders; Depression; Depressive Disorder; Female; Humans; Infertility; Reproductive Techniques, Assisted
PubMed: 28326521
DOI: 10.5603/GP.a2017.0019 -
Maturitas Dec 2016Depression is one of the leading causes of disease-related disability in women, and they are nearly twice as likely as men to suffer from an episode of depression. The... (Review)
Review
Depression is one of the leading causes of disease-related disability in women, and they are nearly twice as likely as men to suffer from an episode of depression. The difference begins in early life and persists through to mid-life, and as such, these reproductive years have been labelled by some as a 'window of vulnerability'. The prevalence has been reported to be particularly high during the menopausal transition, but there is no consensus supporting a direct association with reproductive status. This may be partly due to methodological limitations and inconsistencies in the available studies, resulting from a large number of confounding factors. In addition, relationships between sex hormones and the neurotransmitters purported to be responsible for depression are complex. What appears to be universally accepted is that treatment, with oestrogen, for low mood in women during midlife years may be beneficial, and should be considered.
Topics: Adult; Depression; Depressive Disorder; Estrogens; Female; Humans; Menopause; Middle Aged; Prevalence
PubMed: 27823736
DOI: 10.1016/j.maturitas.2016.09.004 -
Journal of Clinical Child and... 2017Depression in youth is prevalent and disabling and tends to presage a chronic and recurrent course of illness and impairment in adulthood. Clinical trial research in... (Review)
Review
Depression in youth is prevalent and disabling and tends to presage a chronic and recurrent course of illness and impairment in adulthood. Clinical trial research in youth depression has a 30-year history, and evidence-based treatment reviews appeared in 1998 and 2008. The current review of 42 randomized controlled trials (RCTs) updates these reviews to include RCTs published between 2008 and 2014 (N = 14) and reevaluates previously reviewed literature. Given the growing maturity of the field, this review utilized a stringent set of methodological criteria for trial inclusion, most notable for excluding trials based in subclinical samples of youth that had been included in previous reviews (N = 12) and including well-designed RCTs with null and negative findings (N = 8). Findings from the current review suggest that evidence for child treatments is notably weaker than for adolescent interventions, with no child treatments achieving well-established status and the evidentiary basis of treatments downgraded from previous reports. Cognitive behavioral therapy (CBT) for clinically depressed children appears to be possibly efficacious, with mixed findings across trials. For depressed adolescents, both CBT and interpersonal psychotherapy are well-established interventions, with evidence of efficacy in multiple trials by independent investigative teams. This positive conclusion is tempered by the small size of the interpersonal psychotherapy literature (N = 6) and concern that CBT effects may be attenuated in clinically complicated samples and when compared against active control conditions. Data on predictors, moderators, and mediators are examined and priorities for future research discussed.
Topics: Adaptation, Psychological; Adolescent; Child; Cognitive Behavioral Therapy; Depression; Depressive Disorder; Evidence-Based Medicine; Humans; Male; Psychotherapy; Secondary Prevention
PubMed: 27870579
DOI: 10.1080/15374416.2016.1220310 -
The European Journal of Neuroscience Jan 2021Major depressive disorder (MDD) is a chronic and recurrent psychiatric condition characterized by depressed mood, social isolation and anhedonia. It will affect 20% of... (Review)
Review
Major depressive disorder (MDD) is a chronic and recurrent psychiatric condition characterized by depressed mood, social isolation and anhedonia. It will affect 20% of individuals with considerable economic impacts. Unfortunately, 30-50% of depressed individuals are resistant to current antidepressant treatments. MDD is twice as prevalent in women and associated symptoms are different. Depression's main environmental risk factor is chronic stress, and women report higher levels of stress in daily life. However, not every stressed individual becomes depressed, highlighting the need to identify biological determinants of stress vulnerability but also resilience. Based on a reverse translational approach, rodent models of depression were developed to study the mechanisms underlying susceptibility vs resilience. Indeed, a subpopulation of animals can display coping mechanisms and a set of biological alterations leading to stress resilience. The aetiology of MDD is multifactorial and involves several physiological systems. Exacerbation of endocrine and immune responses from both innate and adaptive systems are observed in depressed individuals and mice exhibiting depression-like behaviours. Increasing attention has been given to neurovascular health since higher prevalence of cardiovascular diseases is found in MDD patients and inflammatory conditions are associated with depression, treatment resistance and relapse. Here, we provide an overview of endocrine, immune and vascular changes associated with stress vulnerability vs. resilience in rodents and when available, in humans. Lack of treatment efficacy suggests that neuron-centric treatments do not address important causal biological factors and better understanding of stress-induced adaptations, including sex differences, could contribute to develop novel therapeutic strategies including personalized medicine approaches.
Topics: Adaptation, Psychological; Animals; Antidepressive Agents; Depression; Depressive Disorder, Major; Female; Humans; Male; Mice; Neurobiology; Stress, Psychological
PubMed: 31421056
DOI: 10.1111/ejn.14547 -
Nutrients Aug 2016It has been reported that gut probiotics play a major role in the bidirectional communication between the gut and the brain. Probiotics may be essential to people with... (Meta-Analysis)
Meta-Analysis Review
It has been reported that gut probiotics play a major role in the bidirectional communication between the gut and the brain. Probiotics may be essential to people with depression, which remains a global health challenge, as depression is a metabolic brain disorder. However, the efficacy of probiotics for depression is controversial. This study aimed to systematically review the existing evidence on the effect of probiotics-based interventions on depression. Randomized, controlled trials, identified through screening multiple databases and grey literature, were included in the meta-analysis. The meta-analysis was performed using Review Manager 5.3 software using a fixed-effects model. The meta-analysis showed that probiotics significantly decreased the depression scale score (MD (depressive disorder) = -0.30, 95% CI (-0.51--0.09), p = 0.005) in the subjects. Probiotics had an effect on both the healthy population (MD = -0.25, 95% CI (-0.47--0.03), p = 0.03) and patients with major depressive disorder (MDD) (MD = -0.73, 95% CI (-1.37--0.09), p = 0.03). Probiotics had an effect on the population aged under 60 (MD = -0.43, 95% CI (-0.72--0.13), p = 0.005), while it had no effect on people aged over 65 (MD = -0.18, 95% CI (-0.47-0.11), p = 0.22). This is the first systematic review and meta-analysis with the goal of determining the effect of probiotics on depression. We found that probiotics were associated with a significant reduction in depression, underscoring the need for additional research on this potential preventive strategy for depression.
Topics: Adult; Age Factors; Animals; Depression; Depressive Disorder, Major; Dysbiosis; Evidence-Based Medicine; Global Health; Humans; Probiotics; Randomized Controlled Trials as Topic; Risk
PubMed: 27509521
DOI: 10.3390/nu8080483