Disorders - depressive disorders
Calear, Alison L., Christensen, Helen, Mackinnon, Andrew, Griffiths, Kathleen M., O'Kearney,
Richard
The aim in the current study was to investigate the
effectiveness of an online, self-directed cognitive–behavioral therapy program (MoodGYM) in preventing and reducing the symptoms of anxiety and
depression in an adolescent school-based population. A cluster randomized controlled trial was conducted with 30 schools (N = 1,477) from across
Australia, with each school randomly allocated to the intervention or wait-list control condition. At postintervention and 6-month follow-up,
participants in the intervention condition had significantly lower levels of anxiety than did participants in the wait-list control condition (Cohen
’s d = 0.15–0.25). The effects of the MoodGYM program on depressive symptoms were less strong, with only male participants in the intervention
condition exhibiting significant reductions in depressive symptoms at postintervention and 6-month follow-up (Cohen’s d = 0.27–0.43). Although
small to moderate, the effects obtained in the current study provide support for the utility of universal prevention programs in schools. The
effectiveness of booster sessions should be explored in future research. (PsycINFO Database Record (c) 2010 APA, all rights reserved) (journal
abstract)
Journal of Consulting & Clinical Psychology, 77(6) : 1021-
1032
- Year: 2009
- Problem: Anxiety Disorders (any), Depressive Disorders
- Type: Controlled clinical trials
-
Stage: Universal prevention
-
Treatment and intervention: Service Delivery & Improvement, Psychological Interventions
(any), Cognitive & behavioural therapies (CBT), Technology, interventions delivered using technology (e.g. online, SMS)
Asarnow, J. R., Emslie, G., Clarke, G., Wagner, K. D., Spirito,
A., Vitiello, B., Iyengar, S., Shamseddeen, W., et-al
Objective: To advance knowledge regarding strategies for treating selective serotonin reuptake inhibitor (SSRI)-resistant depression in
adolescents, we conducted a randomized controlled trial evaluating alternative treatment strategies. In primary analyses, cognitive-behavioral
therapy (CBT) combined with medication change was associated with higher rates of positive response to short-term (12-week) treatment than medication
alone. This study examines predictors and moderators of treatment response, with the goal of informing efforts to match youths to optimal treatment
strategies. Method: Youths who had not improved during an adequate SSRI trial (N= 334) were randomized to an alternative SSRI, an alternative SSRI
plus CBT, venlafaxine, or venlafaxine plus CBT. Analyses examined predictors and moderators of treatment response. Results: Less severe depression,
less family conflict, and absence of nonsuicidal self-injurious behavior predicted better treatment response status. Significant moderators of
response to CBT + medication (combined) treatment were number of comorbid disorders and abuse history; hopelessness was marginally significant. The
CBT/combined treatment superiority over medication alone was more evident among youths who had more cornorbid disorders (particularly attention-
deficit/hyperactivity disorder and anxiety disorders), no abuse history, and lower hopelessness. Further analyses revealed a stronger effect of
combined CBT + medication treatment among youths who were older and white and had no nonsuicidal self-injurious behavior and longer prestudy
pharmacotherapy. Conclusions: Combined treatment with CBT and antidepressant medication may be more advantageous for adolescents whose depression is
comorbid with other disorders. Given the additional costs of adding CBT to medication, consideration of moderators in clinical decision making can
contribute to a more personalized and effective approach to treatment.
Journal of the American Academy of Child & Adolescent Psychiatry, 48(3) : 330-
339
- Year: 2009
- Problem: Depressive Disorders
- Type: Randomised controlled trials
-
Stage: Treatment resistant/treatment refractory
-
Treatment and intervention: Biological Interventions
(any), Selective serotonin reuptake inhibitors (SSRIs), Serotonin-norepinephrine reuptake inhibitors
(SNRIs), Psychological Interventions
(any), Cognitive & behavioural therapies (CBT)
Asarnow, Joan Rosenbaum, Jaycox, Lisa H., Tang, Lingqi, Duan, Naihua, LaBorde, Anne P., Zeledon, Luis
R., Anderson,
Martin, Murray, Pamela J., Landon,
Christopher, Rea, Margaret M., Wells, Kenneth B.
Objective: Quality improvement programs for depressed youths in primary care
settings have been shown to improve 6-month clinical outcomes, but longer term outcomes are unknown. The authors examined 6-, 12-, and 18-month
outcomes of a primary care quality improvement intervention. Method: Primary care patients 13 - 21 years of age with current depressive symptoms were
randomly assigned to a 6-month quality improvement intervention (N = 211) or to treatment as usual enhanced with provider training (N = 207). The
quality improvement intervention featured expert leader teams to oversee implementation of the intervention; clinical care managers trained in
cognitive-behavioral therapy for depression to support patient evaluation and treatment; and support for patient and provider choice of treatments.
Results: The quality improvement intervention, relative to enhanced treatment as usual, lowered the likelihood of severe depression (Center for
Epidemiological Studies Depression Scale score ≥24) at 6 months; a similar trend at 18 months was not statistically significant. Path analyses
revealed a significant indirect intervention effect on long-term depression due to the initial intervention improvement at 6 months. Conclusions: In
this randomized effectiveness trial of a primary care quality improvement intervention for depressed youths, the main effect of the intervention on
outcomes was to decrease the likelihood of severe depression at the 6- month outcome assessment. These early intervention-related improvements
conferred additional long-term protection through a favorable shift in illness course through 12 and 18 months. (PsycINFO Database Record (c) 2010
APA, all rights reserved) (journal abstract)
American Journal of Psychiatry, 166(9) : 1002-1010
- Year: 2009
- Problem: Depressive Disorders
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention), Disorder established (diagnosed disorder)
-
Treatment and intervention: Service Delivery & Improvement, Other service delivery and improvement
interventions
Antypa, N., VanDerDoes, A. J. W., Smelt, A. H. M., Rogers, R. D.
Omega-3 polyunsaturated fatty acid (n-3 PUFA) supplementation may be beneficial in the treatment of several psychiatric disorders, including
depression. A small number of studies have suggested that there may also be cognitive and mood effects in healthy samples. The purpose of the present
study was to investigate the effects of n-3 PUFA on depression-relevant cognitive functioning in healthy individuals. Fifty-four healthy university
students were randomized to receive either n-3 PUFA supplements or placebo for 4 weeks in a double-blind design. The test battery included measures
of cognitive reactivity, attention, response inhibition, facial emotion recognition, memory and risky decision-making. Results showed few effects of
n-3 PUFAs on cognition and mood states. The n-3 PUFA group made fewer risk-averse decisions than the placebo group. This difference appeared only in
non-normative trials of the decision-making test, and was not accompanied by increased impulsiveness. N-3 PUFAs improved scores on the
control/perfectionism scale of the cognitive reactivity measure. No effects were found on the other cognitive tasks and no consistent effects on mood
were observed. The present findings indicate that n-3 PUFA supplementation may have a selective effect on risky decision making in healthy
volunteers, which is unrelated to impulsiveness. (copyright) 2009 British Association for Psychopharmacology.
Journal of Psychopharmacology, 23(7) : 831-840
- Year: 2009
- Problem: Depressive Disorders
- Type: Randomised controlled trials
-
Stage: Universal prevention
-
Treatment and intervention: Complementary & Alternative
Interventions (CAM), Fish oil (Omega-3 fatty acids), Omega 3 fatty
acids (e.g. fish oil, flax oil)
Arnarson, E. O., Craighead, W. E.
Major depression and dysthymia are frequent, debilitating, and
chronic disorders, whose highest rate of initial onset is during the late adolescent years. The effectiveness of a program designed to prevent an
initial episode of major depression or dysthymia among adolescents was investigated. Participants were 171 fourteen-year-old \"at risk\" Icelandic
adolescents who were randomly assigned to a prevention program or a treatment-as-usual assessment only control group. They were identified as \"at
risk\" by reporting the presence of depressive symptoms or a negative attributional style. The program was based on a developmental psychosocial
model of enhancement of resilience to factors associated with the occurrence of mood disorders. The results indicated that the prevention program
resulted in a significantly lower rate of major depression and dysthymia than did the control group. The study demonstrated that school personnel in
the school setting can implement such prevention programs. (copyright) 2009.
Behaviour Research & Therapy, 47(7) : 577-
585
- Year: 2009
- Problem: Depressive Disorders
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Psychological Interventions
(any), Other Psychological Interventions
Brent, D. A., Greenhill, L. L., Compton, S., Emslie, G., Wells, K., Walkup, J. T., Vitiello, B., et-al
Objective: To identify the predictors of suicidal events and attempts in adolescent suicide attempters with
depression treated in an open treatment trial. Method: Adolescents who had made a recent suicide attempt and had unipolar depression (n =124) were
either randomized (n = 22) or given a choice (n = 102) among three conditions. Two participants withdrew before treatment assignment. The remaining
124 youths received a specialized psychotherapy for suicide attempting adolescents (n = 17), a medication algorithm (n = 14), or the combination (n =
93). The participants were followed up 6 months after intake with respect to rate, timing, and predictors of a suicidal event (attempt or acute
suicidal ideation necessitating emergency referral). Results: The morbid risks of suicidal events and attempts on 6-month follow-up were 0.19 and
0.12, respectively, with a median time to event of 44 days. Higher self-rated depression, suicidal ideation, family income, greater number of
previous suicide attempts, lower maximum lethality of previous attempt, history of sexual abuse, and lower family cohesion predicted the occurrence,
and earlier time to event, with similar findings for the outcome of attempts. A slower decline in suicidal ideation was associated with the
occurrence of a suicidal event. Conclusions: In this open trial, the 6-month morbid risks for suicidal events and for reattempts were lower than
those in other comparable samples, suggesting that this intervention should be studied further. Important treatment targets include suicidal
ideation, family cohesion, and sequelae of previous abuse. Because 40% of events occurred with 4 weeks of intake, an emphasis on safety planning and
increased therapeutic contact early in treatment may be warranted. J. Am. Acad. Child Adolesc. Psychiatry, 2009;48(10):987-996. (copyright) 2009
American Academy of Child and Adolescent Psychiatry.
Journal of the American Academy of Child & Adolescent Psychiatry, 48(10) : 987-
996
- Year: 2009
- Problem: Depressive Disorders, Suicide or self-harm behaviours (excluding non-suicidal self-harm), Suicide or self-harm with comorbid mental disorder
- Type: Controlled clinical trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions
(any), Psychological Interventions
(any), Cognitive & behavioural therapies (CBT)
America, A., Milling, L. S.
Over-the-counter vitamins have become increasingly popular as a natural remedy for reducing or
preventing depression symptoms and enhancing the emotional well-being of healthy individuals in the general population. This placebo-controlled,
single-blind trial evaluated the effect of vitamins on depression symptoms experienced by a nonclinical sample of participants. One hundred and
fourteen healthy young adults were randomly assigned to multivitamin, B-complex vitamin, placebo vitamin, or no-treatment control conditions. At the
end of a 6-week regimen, participants administered vitamins reported significant reductions in depression symptoms as measured by the Beck Depression
Inventory compared to those who received no treatment. There was no difference between the multivitamin, the B-vitamin, and the placebo. The effect
of each of the vitamin regimens on depression symptoms was partially mediated by response expectancies. The results do not support the efficacy of
vitamins as a natural remedy for reducing or preventing depression symptoms among healthy people in the general population. (copyright) 2007 Springer
Science+Business Media, LLC.
Journal of Behavioral Medicine, 31(2) : 157-
167
- Year: 2008
- Problem: Depressive Disorders
- Type: Randomised controlled trials
-
Stage: Universal prevention
-
Treatment and intervention: Complementary & Alternative
Interventions (CAM), Vitamins and supplements
Alvarez, L.M., Sotres, J.F.C., Leon., S.O., Estrella, J., Sosa, J.J.S
Abstract: Introduction:
A depressed patient presents cognitive impairment that remains in spite of depression's remission. This study intends to evaluate the impact of
cognitive training in the treatment of depression, and also of the impairment that depression causes. Method: A program for cognitive training
(Alcor) was designed for and applied to a group of patients (n =10) with non-medicated MDD; a group (N =10) with MDD that was treated with the
program and with anti-depressants, and to another group (n =11) that was given anti-depressors only. The impact of this intervention was assessed by
applying the following instruments: Beck Depression Inventory, WAIS, Spielberger State-Trait Anxiety Inventory, Externalized Problems Assessment
Scale for Adolescents and Young Adults, and Attention Problems Assessment Scale. The program was applied to University students with MDD twice a
week, until they had reached adequate levels of execution. Results: The patients of all three groups showed MDD event remission. Those who received
cognitive training showed a substantial increase of intellectual performance. The cognitive treatment group increased IQ in 12.9 units and the
combined group increase in 13.3 units. There was a slight decrease of 1.9 units within the anti-depressant treatment group. The changes in attention
and in externalized problems showed the same trends. [Copyright &y& Elsevier]
Computers in Human Behavior, 24(3) : 816-826
- Year: 2008
- Problem: Depressive Disorders
- Type: Controlled clinical trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions
(any), Antidepressants
(any), Psychological Interventions
(any), Other Psychological Interventions, Technology, interventions delivered using technology (e.g. online, SMS)
Brent, D., Emslie, G., Clarke, G., Wagner, K.
D., Asarnow, J.
R., Keller, M., Vitiello, B., et-al
Context: Only about 60% of adolescents with depression will show an adequate clinical response to an initial treatment trial
with a selective serotonin reuptake inhibitor (SSRI). There are no data to guide clinicians on subsequent treatment strategy. Objective: To evaluate
the relative efficacy of 4 treatment strategies in adolescents who continued to have depression despite adequate initial treatment with an SSRI.
Design, Setting, and Participants: Randomized controlled trial of a clinical sample of 334 patients aged 12 to 18 years with a primary diagnosis of
major depressive disorder that had not responded to a 2-month initial treatment with an SSRI, conducted at 6 US academic and community clinics from
2000-2006. Interventions: Twelve weeks of: (1) switch to a second, different SSRI (paroxetine, citalopram, or fluoxetine, 20-40 mg); (2) switch to a
different SSRI plus cognitive behavioral therapy; (3) switch to venlafaxine (150-225 mg); or (4) switch to venlafaxine plus cognitive behavioral
therapy. Main Outcome Measures: Clinical Global Impressions- Improvement score of 2 or less (much or very much improved) and a decrease of at least
50% in the Children's Depression Rating Scale-Revised (CDRS-R); and change in CDRS-R over time. Results: Cognitive behavioral therapy plus a switch
to either medication regimen showed a higher response rate (54.8%; 95% confidence interval [CI], 47%-62%) than a medication switch alone (40.5%; 95%
CI, 33%-48%; P = .009), but there was no difference in response rate between venlafaxine and a second SSRI (48.2%; 95% CI, 41%-56% vs 47.0%; 95% CI,
40%-55%; P = .83). There were no differential treatment effects on change in the CDRS-R, self-rated depressive symptoms, suicidal ideation, or on the
rate of harm-related or any other adverse events. There was a greater increase in diastolic blood pressure and pulse and more frequent occurrence of
skin problems during venlafaxine than SSRI treatment. Conclusions: For adolescents with depression not responding to an adequate initial treatment
with an SSRI, the combination of cognitive behavioral therapy and a switch to another antidepressant resulted in a higher rate of clinical response
than did a medication switch alone. However, a switch to another SSRI was just as efficacious as a switch to venlafaxine and resulted in fewer
adverse effects. Trial Registration: clinicaltrials.gov Identifier: NCT00018902. (copyright)2008 American Medical Association. All rights
reserved.
JAMA, 299(8) : 901-
913
- Year: 2008
- Problem: Depressive Disorders
- Type: Randomised controlled trials
-
Stage: Treatment resistant/treatment refractory
-
Treatment and intervention: Biological Interventions
(any), Selective serotonin reuptake inhibitors (SSRIs), Serotonin-norepinephrine reuptake inhibitors
(SNRIs), Psychological Interventions
(any), Cognitive & behavioural therapies (CBT)
Cheung,
A., Kusumakar, V., Kutcher, S., Dubo, E., Garland, J., Weiss,
M., Kiss, A., Levitt, A.
Objective:
Although recent studies and meta-analyses confirm the efficacy of antidepressants in the acute phase of treatment for adolescent depression, there
are few data available to allow assessment of the value of continued use of antidepressants in depressed adolescents after acute response. This study
examines the benefit of maintenance treatment with sertraline in adolescents aged 13-19 years with major depression using a multi-site randomized
placebo controlled discontinuation design. Methods: Subjects with a diagnosis of depression who responded to open-label treatment with sertraline in
a 12-week acute phase and did not relapse with open-label continuation treatment for 24 weeks were randomized to placebo or continued treatment with
sertraline for 52 weeks. Results: Twenty-two subjects were randomized to maintenance treatment with sertraline (n = 13) versus placebo (n = 9). A
higher proportion of subjects treated with sertraline (38%) remained well as compared to those on placebo (0%). Survival analyses found no
significant differences between the groups (p = 0.17). Conclusions: This is the first study to examine the outcome to maintenance treatment for
adolescents with major depression. Although the sample size was small, the findings suggest a possible benefit of maintenance treatment with
sertraline over placebo. A larger clinical trial with adequate power is required to confirm or disconfirm these findings. (copyright) 2008 Mary Ann
Liebert, Inc.
Journal of Child &
Adolescent Psychopharmacology, 18(4) : 389-394
- Year: 2008
- Problem: Depressive Disorders
- Type: Randomised controlled trials
-
Stage: Relapse prevention
-
Treatment and intervention: Biological Interventions
(any), Selective serotonin reuptake inhibitors (SSRIs)
Azar, D., Ball, K., Salmon, J., Cleland, V.
Objective: This review synthesises results of studies examining the association between
physical activity (PA) and depressive symptoms and the effects of PA intervention studies on depression among young women. Methods: A search of
electronic databases and bibliographic searches of observational and intervention studies was conducted that included women between the ages of 18
and 35. Results: A total of eight observational and five intervention studies were identified. Evidence from observational studies indicated that
physical activity was inversely associated with depressive symptoms in young women. Even a small amount of physical activity was found to be
associated with reduced depressive symptoms. No clear dose-response relationship was shown. Evidence from intervention studies indicated that
physical activity reduced depressive symptoms. Direct study comparisons were difficult due to variations in study methods and measures. The studies
provided little or no information on understanding dose-response effects or on the mechanisms involved. Conclusion: The limited number of studies
examining physical activity and depressive symptoms in young women and the methodological problems identified in a number of these studies, make it
difficult to draw firm conclusions. However, this review suggests that engaging in even low levels of physical activity may be protective against
depressive symptoms in young women. There is a need for objective measures of physical activity in future studies, particularly with a focus on those
with clinical depression in non-student populations. Crown Copyright (copyright) 2008.
Mental Health
& Physical Activity, 1(2) : 82-88
- Year: 2008
- Problem: Depressive Disorders
- Type: Systematic reviews
-
Stage: Universal prevention, At risk (indicated or selected prevention), Disorder established (diagnosed disorder)
-
Treatment and intervention: Complementary & Alternative
Interventions (CAM), Physical activity, exercise
Dietz, L. J., Mufson, L., Irvine, H., Brent, D.
A.
Aim:
To conduct an open-treatment trial to evaluate the feasibility, acceptability and clinical outcomes of using a family-based adaptation of
Interpersonal Psychotherapy for Depressed Adolescents with a sample of preadolescents (ages 9-12) presenting for outpatient treatment for depression.
Methods: Sixteen preadolescents who met criteria for a depressive disorder according to Diagnostic and Statistical Manual of Mental Disorders, Fourth
Edition participated in this open-treatment trial of family-based interpersonal psychotherapy (FB-IPT). Parents chose whether their preadolescents
should receive FB-IPT only (n = 10) or FB-IPT with antidepressant medication (n = 6). Pre- and post-treatment assessments included clinician-
administered measures of depression and global functioning, and parent- and child-reported anxiety symptoms. Results: FB-IPT was associated with high
treatment compliance rates (88%) and was associated with significant decreases in preadolescents' depressive and anxiety symptoms. Preadolescents
who received FB-IPT only were as likely as those receiving FB-IPT and medication to have significant reductions in depressive symptoms and anxiety
symptoms, and to experience significant improvement in global functioning. Parents were more likely to choose combination treatment when their
depressed preadolescents had a comorbid anxiety disorder. Conclusions: Further research on FB-IPT is needed to establish its efficacy as compared
with usual outpatient treatment, its ability to be disseminated to child clinicians with varying levels of training and in adequately powered
randomized controlled trials that can detect group differences. (copyright) 2008 The Authors Journal compilation (copyright) 2008 Blackwell
Publishing Asia Pty Ltd.
Early Intervention in Psychiatry, 2(3) : 154-
161
- Year: 2008
- Problem: Depressive Disorders
- Type: Controlled clinical trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions
(any), Antidepressants
(any), Psychological Interventions
(any), Interpersonal therapy (IPT)