| 1. |
- Brådvik, Louise, et al.
(author)
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Long-term treatment and suicidal behavior in severe depression: ECT and antidepressant pharmacotherapy may have different effects on the occurrence and seriousness of suicide attempts.
- 2006
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In: Depression and Anxiety. - : Hindawi Limited. - 1091-4269 .- 1520-6394. ; 23:Nov 28, s. 34-41
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Journal article (peer-reviewed)abstract
- Our objective in this article is to assess the relation between long-term treatments of depressive episodes and attempted or completed suicide in patients who had had a severe depression at index admission. A blind record evaluation of 96 suicides with a primary severe depression and matched controls has been performed. Out of those, 57 and 33, respectively, bad made suicide attempts. Occurrence of attempt was less common after electroconvulsive therapy (ECT). However, seriousness of suicide attempt appeared to be reduced in those with at least 4 weeks of antidepressant medication compared to no treatment and ECT The theory of a suicidal syndrome independent of depression seems supported. Continuation treatment after ECT is recommended.
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| 2. |
- Cuijpers, Pim, et al.
(author)
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Personalized treatment of adult depression : medication, psychotherapy, or both? A systematic review
- 2012
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In: Depression and anxiety (Print). - : John Wiley & Sons. - 1091-4269 .- 1520-6394. ; 29:10, s. 855-864
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Journal article (peer-reviewed)abstract
- BACKGROUND: Personalized medicine aims to identify which characteristics of an individual predict the outcome of a specific treatment, in order to get a better match between the individual and the treatment received. We conducted a systematic review and meta-analysis of randomized trials comparing two treatments directly in a group of patients with a specific characteristic.METHODS: We searched relevant studies from bibliographical databases and included trials comparing (1) medication with psychotherapy, (2) medication with combined treatment, and (3) psychotherapy with combined treatment, in specific target groups (a) with a predefined sociodemographic characteristic, (b) a specific type of depression, (c) a comorbid mental or somatic disorder, or (d) from a specific setting (outpatients, primary care).RESULTS: We included 52 studies with 4,734 depressed patients. In these studies, 20 characteristics of the target groups were examined. The results showed that medication is probably the best treatment for dysthymia, and combined treatments are more effective in depressed outpatients, as well as in depressed older adults. However, in order to examine the 20 characteristics in the three categories of comparisons, 254 studies would be needed for having sufficient statistical power to show an effect size of g = 0.5. Currently, only 20.1% of these studies have been conducted.CONCLUSIONS: Although a considerable number of studies have compared medication, psychotherapy, and combined treatments, and some preliminary results are useful for deciding which treatment is best for which patient, the development of personalized treatment of depression has only just begun.
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| 3. |
- Cuijpers, Pim, et al.
(author)
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Psychotherapy versus the combination of psychotherapy and pharmacotherapy in the treatment of depression : A meta-analysis
- 2009
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In: Depression and anxiety (Print). - : Hindawi Limited. - 1091-4269 .- 1520-6394. ; 26:3, s. 279-288
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Journal article (peer-reviewed)abstract
- Background: A large number of studies have shown that psychological treatments have significant effects on depression. Although several studies have examined the relative effects of psychological and combined treatments, this has not been studied satisfactorily in recent statistical meta-analyses. Method: We conducted a meta-analysis of randomized studies in which a psychological treatment was compared to a combined treatment consisting of the same psychological treatment with a pharmacological therapy. For each of these studies we calculated the effect size indicating the difference between the psychological and the combined treatment. Results: All inclusion criteria were met by 18 studies, with a total of 1,838 subjects. The mean effect, size indicating the difference between psychological and combined treatment was 0.35 (95% CL 0.24 similar to 0.45; P<0.001), with low heterogeneity. Subgroup analyses indicated that the difference between psychological and combined treatments was significantly smaller in studies in which cognitive behavior therapy was examined. Me also found a trend (P<0.1) indicating that the difference between psychological and combined treatment was somewhat larger in studies aimed at specific populations (older adults, chronic depression, HIV patients) than in studies with adults, and in studies in which Trycyclic antidepressants or SSRIs were examined, compared to studies in which a medication protocol or another antidepressant was used. At follow-up, no difference between psychological and combined treatments was found. Conclusion: We conclude that combined treatment is more effective than psychological treatment alone. However, it is not clear whether this difference is relevant from a clinical perspective.
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| 4. |
- Ekeblad, Annika, et al.
(author)
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Randomized Trial of Interpersonal Psychotherapy and Cognitive Behavioral Therapy for Major Depressive Disorder in a Community-Based Psychiatric Outpatient Clinic
- 2016
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In: Depression and anxiety (Print). - : WILEY-BLACKWELL. - 1091-4269 .- 1520-6394. ; 33:12, s. 1090-1098
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Journal article (peer-reviewed)abstract
- BackgroundInterpersonal psychotherapy (IPT) and cognitive behavioral therapy (CBT) are both evidence-based treatments for major depressive disorder (MDD). Several head-to-head comparisons have been made, mostly in the United States. In this trial, we compared the two treatments in a small-town outpatient psychiatric clinic in Sweden. The patients had failed previous primary care treatment and had extensive Axis-II comorbidity. Outcome measures were reduction of depressive symptoms and attrition rate. MethodsNinety-six psychiatric patients with MDD (DSM-IV) were randomized to 14 sessions of CBT (n = 48) or IPT (n = 48). A noninferiority design was used with the hypothesis that IPT would be noninferior to CBT. A three-point difference on the Beck Depression Inventory-II (BDI-II) was used as noninferiority margin. ResultsIPT passed the noninferiority test. In the ITT group, 53.5% (23/43) of the IPT patients and 51.0% (24/47) of the CBT patients were reliably improved, and 20.9% (9/43) and 19.1% (9/47), respectively, were recovered (last BDI score amp;lt;10). The dropout rate was significantly higher in CBT (40%; 19/47) compared to IPT (19%; 8/43). Statistically controlling for antidepressant medication use did not change the results. ConclusionsIPT was noninferior to CBT in a sample of depressed psychiatric patients in a community-based outpatient clinic. CBT had significantly more dropouts than IPT, indicating that CBT may be experienced as too demanding. Since about half the patients did not recover, there is a need for further treatment development for these patients. The study should be considered an effectiveness trial, with strong external validity but some limitations in internal validity.
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| 7. |
- Gidén, Karin, et al.
(author)
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Remission or Persistence? : A Prediction Tool to Identify Women at Risk for Long-Term Depressive Symptoms Postpartum
- 2024
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In: Depression and anxiety (Print). - : John Wiley & Sons. - 1091-4269 .- 1520-6394. ; 2024
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Journal article (peer-reviewed)abstract
- Background. Peripartum depression is a common complication with potential long-term adverse effects on the woman and her family. Approximately 30%-50% of newly delivered women experience prolonged depressive symptoms at 6-12 months postpartum. Early detection may facilitate preventive and treatment interventions. Aim. To investigate correlates for and create a tool for predicting long-term symptomatology in women experiencing depressive symptoms at 6 weeks postpartum.Materials and Methods. Data from the Biology, Affect, Stress, Imaging, and Cognition study was used, to identify women who scored high (>= 12) on the Edinburgh Postnatal Depression Scale (EPDS) at 6 weeks postpartum (n = 697). Further, we collected data from medical records and included 40 variables based on earlier studies and clinical experience. A total of 654 women were included. Elastic net linear regression analysis was performed to identify predictors of continued symptoms at 6 months postpartum. An equation predicting the EPDS score at 6 months postpartum based on weighted variables was developed.Results. High education level and sleep for more than 6 hr per night in pregnancy week 17 were protective factors. Parity, pregnancy complications, stressful events, attention deficit hyperactivity disorder/attention deficit disorder, history of depression, depressive symptoms, and anxiety during pregnancy were predictive factors of prolonged depressive symptoms. A prediction tool with area under curve 0.73 and positive predictive value of 79%-83% depending on chosen EPDS cutoff was developed for clinical use.Conclusions. Our prediction tool offers a method to identify women at risk for persisting depressive symptoms postnatally, based on their significant depressive symptoms during the first weeks after delivery. Screening in order to identify these women can already start in the antenatal setting.
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| 8. |
- Halonen, Jaana, et al.
(author)
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Pathways from parental mental disorders to offspring's work disability due to depressive or anxiety disorders in early adulthood—The 1987 Finnish Birth Cohort
- 2019
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In: Depression and anxiety (Print). - : Hindawi Limited. - 1091-4269 .- 1520-6394. ; 36:4, s. 305-312
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Journal article (peer-reviewed)abstract
- Background: Parental mental disorders have been shown to predict offspring's mental health problems. We examined whether pathways from parental mental disorders to offspring's psychiatric work disability in early adulthood are mediated through offspring's mental disorders and social disadvantage in adolescence.Methods: Study population consisted of the 1987 Finnish Birth Cohort. Data on parents’ psychiatric care or work disability due to mental diagnosis between 1987 and 2000 and the cohort participants’ health and social factors between 2001 and 2005 were derived from administrative national registers. From 2006 through 2015, 52,182 cohort participants were followed for admittance of psychiatric work disability due to depressive or anxiety disorders. First, we applied a pathway analysis to examine the occurrence of each path. We then used mediation analysis to assess the proportion of association between parental mental disorders and work disability mediated by offspring's health and social disadvantage.Results: The pathway model indicated that the association from parental mental disorders to offspring's work disability due to depressive or anxiety disorder is through mental disorders and social disadvantage in adolescence. Odds Ratio for the total effect of parental mental disorders on offspring's psychiatric work disability was 1.85 (95% confidence interval [CI] 1.46–2.34) in the model including offspring's mental disorders that mediated this association by 35%. Corresponding results were 1.86 (95% CI 1.47–2.35) and 28% for social disadvantage in adolescence.Conclusions: These findings suggest that intergenerational determination of work disability due to mental disorders could be addressed by actions supporting mental health and social circumstances in adolescence.
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| 9. |
- Holmquist, Sofie, et al.
(author)
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Low physical activity as a key differentiating factor in the potential high-risk profile for depressive symptoms in older adults
- 2017
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In: Depression and anxiety (Print). - : Hindawi Limited. - 1091-4269 .- 1520-6394. ; 34:9, s. 817-825
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Journal article (peer-reviewed)abstract
- BACKGROUND: The identification of potential high-risk groups for depression is of importance. The purpose of the present study was to identify high-risk profiles for depressive symptoms in older individuals, with a focus on functional performance.METHODS: The population-based Healthy Ageing Initiative included 2,084 community-dwelling individuals (49% women) aged 70. Explorative cluster analysis was used to group participants according to functional performance level, using measures of basic mobility skills, gait variability, and grip strength. Intercluster differences in depressive symptoms (measured by the Geriatric Depression Scale [GDS]-15), physical activity (PA; measured objectively with the ActiGraph GT3X+), and a rich set of covariates were examined.RESULTS: The cluster analysis yielded a seven-cluster solution. One potential high-risk cluster was identified, with overrepresentation of individuals with GDS scores >5 (15.1 vs. 2.7% expected; relative risk = 6.99, P < .001); the prevalence of depressive symptoms was significantly lower in the other clusters (all P < .01). The potential high-risk cluster had significant overrepresentations of obese individuals (39.7 vs. 17.4% expected) and those with type 2 diabetes (24.7 vs. 8.5% expected), and underrepresentation of individuals who fulfilled the World Health Organization's PA recommendations (15.6 vs. 59.1% expected; all P < .01), as well as low levels of functional performance.CONCLUSIONS: The present study provided a potential high-risk profile for depressive symptoms among elderly community-dwelling individuals, which included low levels functional performance combined with low levels of PA. Including PA in medical screening of the elderly may aid in identification of potential high-risk individuals for depressive symptoms.
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| 10. |
- Iliadis, Stavros I, et al.
(author)
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Mid-pregnancy corticotropin-releasing hormone levels in association with postpartum depressive symptoms
- 2016
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In: Depression and anxiety (Print). - : Hindawi Limited. - 1091-4269 .- 1520-6394. ; 33:11, s. 1023-1030
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Journal article (peer-reviewed)abstract
- Background: Peripartum depression is a common cause of pregnancy and postpartum related morbidity. The production of corticotropin-releasing hormone (CRH) from the placenta alters the profile of hypothalamus-pituitary-adrenal axis hormones and may be associated with postpartum depression. The purpose of this study was to assess, in non-depressed pregnant women, the possible association between CRH levels in pregnancy and depressive symptoms postpartum.Methods: A questionnaire containing demographic data and the Edinburgh Postnatal Depression Scale was filled in gestational weeks 17 and 32, and six weeks postpartum. Blood samples were collected in week 17 for assessment of CRH. A logistic regression model was constructed, using postpartum Edinburgh Postnatal Depression Scale score as the dependent variable and log transformed CRH levels as the independent variable. Confounding factors were included in the model. Sub-analyses after exclusion of study subjects with preterm birth, small for gestational age newborns, and women on corticosteroids were performed.Results: 535 women without depressive symptoms during pregnancy were included. Logistic regression showed an association between high CRH levels in gestational week 17 and postpartum depressive symptoms, before and after controlling for several confounders (unadjusted Odds Ratio = 1.11; 95% CI 1.01 – 1.22, adjusted Odds Ratio = 1.13; 95% CI 1.02 – 1.26, per 0.1 unit increase in log corticotropin-releasing hormone). Exclusion of women with preterm birth and newborns small for gestational age as well as women who used inhalation corticosteroids during pregnancy did not alter the results.Conclusions: This study suggests an association between high CRH levels in gestational week 17 and the development of postpartum depressive symptoms, among women without depressive symptoms during pregnancy.
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