Non-pharmacological Treatments For Depression Research Articles

Pharmacological and Non-Pharmacological Treatments for Depression in Parkinson's Disease: An Updated Review.

Depression represents one of the most common non-motor disorders in Parkinson's disease (PD) and it has been related to worse life quality, higher levels of disability, and cognitive impairment, thereby majorly affecting not only the patients but also their caregivers. Available pharmacological therapeutic options for depression in PD mainly include selective serotonin reuptake inhibitors, serotonin and norepinephrine reuptake inhibitors, and tricyclic antidepressants; meanwhile, agents acting on dopaminergic pathways used for motor symptoms, such as levodopa, dopaminergic agonists, and monoamine oxidase B (MAO-B) inhibitors, may also provide beneficial antidepressant effects. Recently, there is a growing interest in non-pharmacological interventions, including cognitive behavioral therapy; physical exercise, including dance and mind-body exercises, such as yoga, tai chi, and qigong; acupuncture; therapeutic massage; music therapy; active therapy; repetitive transcranial magnetic stimulation (rTMS); and electroconvulsive therapy (ECT) for refractory cases. However, the optimal treatment approach for PD depression is uncertain, its management may be challenging, and definite guidelines are also lacking. It is still unclear which of these interventions is the most appropriate and for which PD stage under which circumstances. Herein, we aim to provide an updated comprehensive review of both pharmacological and non-pharmacological treatments for depression in PD, focusing on recent clinical trials, systematic reviews, and meta-analyses. Finally, we discuss the pharmacological agents that are currently under investigation at a clinical level, as well as future approaches based on the pathophysiological mechanisms underlying the onset of depression in PD.

Glutamatergic and GABAergic neurons in the vLGN mediate the nociceptive effects of green and red light on neuropathic pain

Phototherapy is an emerging non-pharmacological treatment for depression, circadian rhythm disruptions, and neurodegeneration, as well as pain conditions including migraine and fibromyalgia. However, the mechanism of phototherapy-induced antinociception is not well understood. Here, using fiber photometry recordings of population-level neural activity combined with chemogenetics, we found that phototherapy elicits antinociception via regulation of the ventral lateral geniculate body (vLGN) located in the visual system. Specifically, both green and red lights caused an increase of c-fos in vLGN, with red light increased more. In vLGN, green light causes a large increase in glutamatergic neurons, whereas red light causes a large increase in GABAergic neurons. Green light preconditioning increases the sensitivity of glutamatergic neurons to noxious stimuli in vLGN of PSL mice. Green light produces antinociception by activating glutamatergic neurons in vLGN, and red light promotes nociception by activating GABAergic neurons in vLGN. Together, these results demonstrate that different colors of light exert different pain modulation effects by regulating glutamatergic and GABAergic subpopulations in the vLGN. This may provide potential new therapeutic strategies and new therapeutic targets for the precise clinical treatment of neuropathic pain.

Effect of Relaxation Training Techniques on Anxiety and Depression among Breast Cancer Patients

Background and objectives: non-pharmacological treatment for depression and anxiety includes a variety of treatments, such as various types of psychotherapy, education, and supporting measures. Behavioral treatments such as progressive muscle relaxation and abdominal breathing exercises have been shown to be effective in the treatment of anxiety and depression in cancer patients. Therefor this study aimed to evaluate the effect of progressive muscle relaxation and abdominal breathing exercise techniques on anxiety and depression among breast cancer patients in Erbil City- Iraq. Methods: A quasi-experimental study was conducted at Rizgary Teaching Hospital-department of oncology and Nanakali Oncology Hospital at Erbil city-Iraq, Patients from both hospitals were selected as the intervention and control group respectively. Patients were assessed through; the demographic data questionnaire, Hospital anxiety and depression scale. Results: A total of 88 patients 44 from the control group and 44 patients from the study group participated. At the end of the study, there were significant improvements in anxiety and depression (p-value was 0.001) result was observed in both post-tests at 4-week and at 8-week. Conclusion: The women who got progressive muscle relaxation and abdominal breathing exercise techniques had lower anxiety and depression levels than those who only received routine nursing care, according to the findings. Oncology nurses should educate patients with breast cancer to use the progressive muscle relaxation technique to reduce their anxiety and depression. Keywords: Anxiety, Depression, Breast cancer and Relaxation.

Depressive symptoms in patients with epilepsy and clinically associated features in a single tertiary center

Although depressive symptoms are the most common psychiatric comorbidity in epilepsy, they remain underestimated and untreated in a large proportion of patients. The purpose of this study was to evaluate depression severity and related clinical features in people with epilepsy using a well-reliable self-report index of mood, the Beck Depression Inventory-II (BDI-II). One-hundred seventeen adult patients with epilepsy were recruited from a tertiary epilepsy center and completed the BDI-II. A single-item analysis of the 21 questions of the BDI-II was computed and differences between women and men in each depressive symptom were evaluated. Correlation and regression analyses were used to identify clinical features associated with the severity of depression. Results showed gender differences in some items, with women reporting overall higher depression severity than men. The most common symptoms regarded domains of sleeping patterns, tiredness, and loss of energy. Regression evidence suggested that being female, having an epilepsy duration < 10 years, as well as being treated with psychotropic drugs and reporting generalized seizure, were associated with higher depression severity. Despite its cross-sectional nature, this study reinforces the importance of investigating and possibly treating depressive symptoms in adult patients with epilepsy, since they negatively impact well-being, daytime activities, and sleep. Further studies identifying pharmacological and non-pharmacological treatments for depression in epilepsy need to be planned.

Barriers and opportunities for the treatment of mild-to-moderate depression with a watchful waiting approach

ObjectiveThe aim of this study is to explore barriers and opportunities in non-pharmacological treatment of depression in primary care (PC) from the perspective of family physicians (FPs). MethodsQualitative analysis was used to explore a sample of 36 FPs treating patients with depressive symptoms. Criteria to maximize variability were followed. Participants were identified by key informants. Six group interviews were developed following a semi-structured thematic script. All interviews were transcribed, analyzed and triangulated. Information was saturated. Principals of reflexivity and circularity were implemented. ResultsThe results obtained followed 3 main theoretical axes: the FP, the patient, the healthcare system, and the interaction between them. Barriers included poor alignment with clinical practice guidelines, inadequate FP training, patients’ preferences and structural challenges in PC. Among opportunities were good FP clinical interview skills, the beneficial bond of trust between patients and FPs and improved communication with mental healthcare services. ConclusionBased on FPs’ perceptions, non-pharmacological treatment of depression in PC is particularly limited by lack of structured training; patients’ preferences and treatment expectations; structural challenges in PC; and insufficient support from specialized mental health professionals. Practice implicationsResources for education, structural support in PC and modified back up from mental healthcare services are needed.

Usability and acceptability of a mobile application prototype for a combined behavioural activation and physical rehabilitation intervention in acute respiratory failure survivors

BackgroundAcute respiratory failure survivors experience depression symptoms and new impairments in physical function. Behavioural activation, an evidence-based nonpharmacological treatment for depression, combined with physical rehabilitation, is a promising intervention. Notably, mHealth applications (Apps) are potentially effective methods of delivering home-based interventions. ObjectivesThe objective of this study was to evaluate the usability and acceptability of a prototype App to deliver a combined, home-based behavioural activation and rehabilitation intervention to acute respiratory failure survivors. MethodsA prospective user-preference study was conducted with acute respiratory failure survivors and self-designated care partners. Survivors were adults with at least mild depression symptoms before hospital discharge who received mechanical ventilation in the intensive care unit for ≥24 h. Survivors and care partners reviewed the App during a single in-person home visit and completed the System Usability Scale (range: 0–100; score >73 considered “good”) and a semistructured interview. ResultsTen patient/care partner dyads completed study. The median [interquartile range] patient age was 50 [40–64] years, and 50% were female. The median System Usability Scale scores among patients and care partners were 76 [68–83] and 88 [75–94], respectively. Qualitative feedback supported usability and acceptability of the App, with three themes reported: (1) stigma associated with depression, (2) App as a motivator for recovery, and (3) App providing multidisciplinary support for survivor and care partner. ConclusionsA mobile App prototype designed to deliver a combined behavioural activation and rehabilitation intervention was usable and acceptable to survivors of acute respiratory failure and their care partners. Given the reported stigma associated with depression, the self-directed App may be particularly valuable for motivation and multidisciplinary support.

Effects of 5-hydroxytryptophan on distinct types of depression: a systematic review and meta-analysis.

Serotonergic dysfunction, including reduced central serotonin levels, is associated with different psychiatric syndromes, including depression. As a serotonin precursor, 5-hydroxytryptophan has long been used as a nonpharmacological treatment for depression. A systematic review and meta-analysis was conducted to determine the antidepressant effects of 5-hydroxytryptophan in depressed patients. MEDLINE (via PubMed) and Google Scholar were searched from inception to May 2018. Thirteen investigations were included in the systematic review (using PRISMA guidelines), and 7 in the full meta-analysis (pre-registered on PROSPERO: CRD42018104415). Analyses revealed a depression remission rate of 0.65 (95% confidence interval [CI], 0.55-0.78; remission rate [k] = 13), and this was confirmed by the questionnaire results, which revealed a large Hedges' g (1.11; 95%CI, 0.53-1.69). Methodological variability (in treatment duration, type of depression studied, experimental design, 5-hydroxytryptophan dosage) contributes to heterogeneity in the results (I2 = 76%, τ2 = 0.379). In addition, the OHAT (Office of Health Assessment and Translation risk of bias rating) tool suggested that, on the whole, current studies are relatively weak (few include placebo groups). Further trials should overcome these limitations by using placebo-controlled studies that include patients with well-defined depression diagnoses, along with strong characterization of psychological and physiological patient characteristics.

Childhood adversities, negative life events and outcomes of non-pharmacological treatments for depression in primary care: A secondary analysis of a randomized controlled trial

Non-pharmacological treatments for depression are effective and available in primary care, but useful prognostic factors are lacking. Childhood adversities (CA) and negative recent life events (RLE) increase the risk and severity of depression, though their effect on treatment outcomes remains understudied. Using a sample of 737 adult participants of a multicenter randomized controlled trial receiving physical exercise, internet based cognitive-behavioral therapy or treatment as usual, alone or in combination with antidepressants, this prospective study aimed to determine the impact of CA, RLE and their interaction as predictors of outcomes of non-pharmacological treatments for mild-moderate depression in primary care. Outcomes were depression severity (MADRS score) and response to treatment (≥50% reduction in MADRS score) after three months. Linear regression and modified Poisson regression were used, interaction was assessed with a product term (CA*RLE) and epidemiological measures of interaction. The number of CA and RLE were associated with higher depression severity at follow-up (CA: β = 0.79, 95% CI: 0.14 to 1.44 and RLE: β = 0.52, 95% CI: 0.14 to 0.72) and showed a trend towards lower rates of response to treatment (RR = 0.94, 95% CI: 0.86 to 1.03; and RLE: RR = 0.95, 95% CI: 0.90 to 0.99). Interaction between CA and RLE was not significant for depression severity (β = 0.10, 95% CI: −2.12 to 0.41) nor for response to treatment (RERI = −0.05, 95% CI = −0.33 to 0.24). CA and RLE are associated with worse outcomes of non-pharmacological treatments in primary care. Further studies to identify predictors of outcomes of non-pharmaological treatments for depression are needed.

Exercise as a Nonpharmacological Treatment for Depression

Exercise is an efficacious treatment approach for the prevention and management of depression. In this article, we review the efficacy of aerobic exercise and resistance training in the treatment of depression, including comparative efficacy to pharmacotherapy and psychotherapy. We describe existing exercise interventions for depression and provide recommendations for how to prescribe exercise for the treatment of depression, ways to maximize intervention adherence, and safety considerations. We also review clinical considerations relevant to exercise in a select subset of special circumstances, including bipolar depression, perinatal depression, and depression in the context of chronic pain conditions and substance use disorders. [ Psychiatr Ann. 2019;49(1):6–10.]

Exercise for depression treatment. Physiological mechanisms

This literature review considers meta-analyzes, systematic reviews and original research over the last decade addressing a comprehensive analysis of the antidepressant effect of targeted physical exercise and physical activity in general. Exercise is a promising non-pharmacological treatment for depression, showing effects that are comparable or may even exceed other first-line treatments of depression. The article introduces modern ideas about the mechanisms of depression and mechanisms of exercise effects on depression manifestations. The structures of the central nervous system, changing with the effective exercise-based treatment of depression, are indicated. Physical activity stimulates the secretion of growth factors, maintenance of angio-, synapto-, and neurogenesis. The regulation of antioxidant protection of neuronal mitochondria, a decrease in pro-inflammatory reactions and stress reactivity are also observed in response to regular exercise. Physical activity has a multimodal effect that stimulates biochemical pathways and restores neuronal structures disturbed in depression.

Non-Pharmacological Cognitive Remediation Strategies for Treatment of Depression and Cognitive Impairment

Major depression in the elderly often presents with cognitive impairment. Mild cognitive deficits in memory, processing speed, and cognitive control functioning are particularly common in late-life depression. For the almost 40% of elderly depressed patients with cognitive impairment, there is currently no efficacious intervention that adequately treats both mood and the cognitive deficits leaving many patients depressed and disabled [AJGP 9(3):269–74, 2001]. Recent advances in non-pharmacologic treatments for depression and cognitive impairment show promise for treating both cognitive and affective symptoms of the disorder. However, as with any rapid advancements in technology, claims of efficacy may outpace rigorous scientific scrutiny. Here, we describe advancements in computerized cognitive remediation (CCR) interventions for depression and cognitive impairment in the elderly. We discuss the parameters of the programs and methods of implementation likely to induce plasticity in the aging brain and suggest critical questions for clinicians, scientists, and patients to evaluate when assessing CCR interventions. CCR interventions for depression and cognitive impairment show promising though preliminary efficacy. Larger trials that include multiple neurobiological indices of neuroplasticity are necessary to elucidate mechanisms of this novel treatment modality and lead to superior treatments.

Perioperative management of patients with depression

One of the most common mental illnesses, occurring in more than 5 % of the adult population, is depression. In the management of patients with this concomitant pathology in the perioperative period, the anesthesiologist must take into account a number of characteristics. These may be possible difficulties in communication due to patient closure, the risk of developing a “withdrawal syndrome” of antidepressants, side effects, as well as undesirable interactions of these drugs with anesthetics. The article reviews the publications of Russian and foreign articles and manuals on the perioperative management of patients with depression. The characteristics of the main groups of modern drugs for the treatment of depression, the tactics of their withdrawal or continuation of admission before the operation, the features of anesthesia against the background of long-term intake of various groups of antidepressants are presented. The problem of such complication of therapy with these drugs, such as serotonin syndrome, its differential diagnosis is considered. The review also includes non-pharmacological treatments for depression, their complications and anesthesia in electroconvulsive therapy.

Non-pharmacological treatment of depression: a systematic review and evidence map

背景 抑郁症非药物治疗的疗效比较目前仍然不清楚。 方法 我们对一些系统性综述作了概述，回顾了随机对照试验（RCT），比较抑郁症非药物治疗的有效性和认知行为治疗（CBT）。对多个电子数据库在2016年2月之前发表的所有文献进行了检索，不限制语言。成对的评阅人进行资料纳入、数据提炼并评估偏倚的风险。在适用的时候进行了荟萃分析。 结果 我们收录了367项RCT，纳入了约2 000名患者，进行了11种治疗，导出17项独立的头对头比较。通过标准化的量表评估，发现CBT、自然疗法、行为干预与躯体活动干预可以降低抑郁的严重程度。然而，这些非药物干预的相对疗效仍然缺乏。这些干预对临床缓解和复发的效果不清楚。CBT的发生率比抗抑郁药物更低。 局限性 由于证据缺乏一致性、证据不清或偏倚风险高，导致证据的质量只是低到中等，限制了我们研究结果的可信度。 结论 抑郁症的非药物治疗能减少抑郁症状，在轻度到重度抑郁症患者中，应当合并抗抑郁药物治疗，一同进行。对于非药物治疗的选择，应当根据患者的价值观、偏好、临床和社会因素来与患者共同作出决定。

Management of Depression in Parkinson's Disease: A Systematic Review.

Depression is a frequent psychiatric condition in Parkinson's disease (PD). The treatment of depression has been examined in several randomized controlled trials and meta-analyses, but no clear guidelines are available. We carried out a systematic review of pharmacological and non-pharmacological treatments for depression in patients with PD using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We searched main medical databases up to December 12, 2016, and included randomized controlled trials, patient-control studies, and case series with data on treatment modality, outcome measures, and side effects. Selective serotonergic reuptake inhibitors and tricyclic antidepressants may have efficacy for the treatment of depression in patients with PD, although the evidence is not strong. The antidepressant efficacy of dopamine agonists is still controversial, and initial results were positive for pramipexole but not for rotigotine. Cognitive-behavioral therapy showed promising results in two recent randomized controlled trials, but further evidence is required. Studies using repetitive transcranial magnetic stimulation produced conflicting results, and the efficacy results for this treatment have been inconsistent. On the other hand, electroconclusive therapy produced strong positive results in patients with severe depression, but no randomized controlled trials are available. Selective serotonergic reuptake inhibitors and cognitive-behavioral therapy are currently first-line treatments for depression in patients with PD, although the evidence is still weak. The heterogeneity among contributory factors for depression in PD should be considered for the most effective treatment of depression in this condition.

Medical comorbidity and psychotropic medication fills in older adults with breast or prostate cancer.

Previous research has shown that as people age, distress decreases despite an increase in prevalence of medical comorbidity. This could be due to increased use of psychotropic medications with comorbidity. We tested this hypothesis in older adults. Information from medical records of older adults (65 to 99 years of age) in the following groups was collected: women with breast cancer (n = 2359), women without any cancer diagnosis (n = 27,161), men with prostate cancer (n = 2686), and men without any cancer diagnosis (n = 21,014). We collected fills of antidepressant or sedative medications, diagnosis of depression in the year of cancer diagnosis, and Charlson Comorbidity Index from the year before cancer. Women with breast cancer were more likely to fill psychotropic prescriptions (both ps < 0.02) or be diagnosed with depression (p < 0.001) than women without cancer. Men with prostate cancer were more likely to fill these prescriptions or receive a diagnosis of depression than men without cancer (ps < 0.05). Charlson was related to increased odds of filling both types of medication in women with breast cancer and men with prostate cancer (ps < 0.001). Comorbidity was related to greater odds of receiving a depression diagnosis in men with prostate cancer (p < 0.001) but not women with breast cancer (p > 0.15). Older adults with breast or prostate cancer are more likely to fill psychotropic medication prescriptions and receive a depression diagnosis than those without cancer. Comorbidity increased the likelihood of medication fills in older adults with cancer. As this population experiences polypharmacy, nonpharmacologic treatments for depression may need to be considered.

Non-pharmacological strategies for treatment of inpatient depression.

To examine the evidence for non-pharmacological interventions in the treatment of moderate to severe depression in an inpatient setting. An integrative review of original research papers was conducted. The electronic databases CINAHL, MEDLINE and PsychINFO were searched using the following search terms: depression, psychosocial, psychosocial intervention, therapy, and inpatient. Twelve studies were identified in the search for non-psychopharmacological interventions for depression commenced in an inpatient setting. The interventions included psychotherapies, behavioural activation, and chronotherapeutic interventions (controlled exposure to environmental stimuli). These studies suggest it is possible to engage severely depressed inpatients in structured interventions in an inpatient environment. The majority of studies reported favourable outcomes for the interventions compared to a control, but methodological issues were common. A diverse range of treatment strategies has been identified in this review. These studies provide evidence that non-pharmacological treatments for depression can be given to enhance outcomes and that research can be undertaken in inpatient settings. Whilst the evidence base has limitations, this review also highlights therapeutic and research opportunities in this area.

Nonpharmacologic treatments for depression related to reproductive events.

There is a growing body of evidence suggesting that nonpharmacological interventions have an appropriate place in the treatment of major depressive disorders (MDDs) as both stand-alone and supplemental treatments. Because women may be reluctant to use psychotropic medications due to strong values or treatment preferences during specific reproductive events, clinicians need to be able to offer empirically based alternatives to medication. In this review, we present recent findings from studies of acupuncture, bright light therapy, electroconvulsive therapy, omega fatty acid supplementation, physical activity, and psychosocial intervention for women experiencing depressive symptoms in the contexts of menstruation, pregnancy, postpartum, and menopause.

A meta-analysis of randomised placebo-controlled treatment trials for depression and anxiety in Parkinson's disease.

BackgroundPsychopharmacotherapy currently constitutes the first-line treatment for depression and anxiety in Parkinson’s disease (PD) however the efficacy of antidepressant treatments in PD is unclear. Several alternative treatments have been suggested as potentially more viable alternatives including dopamine agonists, repetitive transcranial magnetic stimulation, and cognitive behavioural therapy (CBT).MethodA meta-analysis of randomised placebo-controlled trials for depression and/or anxiety in PD was conducted to systematically examine the efficacy of current treatments for depression and anxiety in PD.ResultsNine trials were included. There was only sufficient data to calculate a pooled effect for antidepressant therapies. The pooled effect of antidepressants for depression in PD was moderate but non-significant (d = .71, 95% CI = −1.33 to 3.08). The secondary effect of antidepressants on anxiety in PD was large but also non-significant (d = 1.13, 95% CI = −.67 to 2.94). Two single-trials of non-pharmacological treatments for depression in PD resulted in significant large effects; Omega-3 supplementation (d = .92, 95% CI = .15 to 1.69) and CBT (d = 1.57, 95% CI = 1.06 to 2.07), and warrant further exploration.ConclusionsThere remains a lack of controlled trials for both pharmacological and non-pharmacological treatments for depression and anxiety in PD which limits the conclusions which can be drawn. While the pooled effects of antidepressant therapies in PD were non-significant, the moderate to large magnitude of each pooled effect is promising. Non-pharmacological approaches show potential for depression in PD however more research is required.

Psychological interventions for depression in adolescent and adult congenital heart disease.

Adult and adolescent congenital heart disease is increasing in prevalence as better medical care means more children are surviving to adulthood. People with chronic disease often also experience depression. There are several non-pharmacological treatments that might be effective in treating depression and improving quality of life for adults and young adults with congenital heart disease. The aim of this review was to assess the effects of treatments such as psychotherapy, cognitive behavioural therapies and talking therapies for treating depression in this population. To update the previous review on the effects (both harms and benefits) of psychological interventions for treating depression in young adults and adults with congenital heart disease. Psychological interventions include cognitive behavioural therapy, psychotherapy, or 'talking/counselling' therapy for depression. We updated the searches of the Cochrane Central Register of Controlled Trials (CENTRAL) on The Cochrane Library (Issue 1, 2013), MEDLINE (OVID, 1946 to January week 4 2013), EMBASE (OVID, 1980 to 2013 week 05), PsycINFO (OVID, 1806 to January week 5 2013), the Database of Abstracts of Reviews of Effectiveness (DARE) on The Cochrane Library (Issue 1, 2013), BIOSIS (Thomson Reuters, 1969 to 21 February 2013), and CINAHL (January 1980 to February 2013) on 5 February 2013. We did not search abstracts from national and international cardiology and psychology conferences and dissertation abstracts for this update. No language restrictions were applied. Randomised controlled trials comparing psychological interventions with no intervention for people over 15 years with depression who have congenital heart disease. Two review authors independently screened titles and abstracts of studies that were potentially relevant to the review. We rejected studies that were clearly ineligible. Two review authors independently assessed the abstracts or full papers for inclusion criteria. We sought further information from the authors where papers contained insufficient information to make a decision about eligibility. We did not identify any randomised controlled trials that met the inclusion criteria. Depression is common in people with congenital heart disease and can exacerbate the physical consequences of the illness. There are effective pharmacological and non-pharmacological treatments for depression, but we have not been able to identify any trials showing the effectiveness of non-pharmacological treatments. A well-designed randomised controlled trial is needed to assess the effects of psychological interventions for depression in congenital heart disease.

Geschlechtsunterschiede in der multimodalen Therapie depressiver Störungen mit komorbider Schmerzsymptomatik

Although gender differences are increasingly the focus of current research, gender aspects in the response to pharmacological and non-pharmacological treatment of depression still remain unclear. The aim of this study was to analyze the impact of gender on the outcome of a CBT-orientated multimodal treatment in depressed outpatients with chronic pain. A total of 298 patients (154 women) underwent a standardized five-week CBT-orientated multimodal treatment. Depressive symptoms were measured at the beginning and end of the treatment with the German version of the Center for Epidemiological Studies Depression Scale (CES-D). The improvement of depressive symptoms showed an effect size (ES) of 0.81 in the total sample. However, women improved considerably more (ES 0.96) than did men (ES 0.65) and these gender differences are seen in the complete sample (t = 2.757, df = 296, p = 0.006) as well as in the group without received antidepressants (t = 2.325, df = 151, p = 0.021). Women with a depressive disorder and chronic pain benefit significantly more from a CBT-orientated multimodal treatment and exhibit a considerably greater reduction of depressive symptoms than do men. These distinctions are not due to differences in received antidepressant medication, psychiatric comorbidities or educational background.