Prevention Of Major Depression Research Articles

Association between a selective 5-HT4 receptor agonist and incidence of major depressive disorder: emulated target trial.

The serotonin 4 receptor (5-HT4R) is a promising target for the treatment of depression. Highly selective 5-HT4R agonists, such as prucalopride, have antidepressant-like and procognitive effects in preclinical models, but their clinical effects are not yet established. To determine whether prucalopride (a 5-HT4R agonist and licensed treatment for constipation) is associated with reduced incidence of depression in individuals with no past history of mental illness, compared with anti-constipation agents with no effect on the central nervous system. Using anonymised routinely collected data from a large-scale USA electronic health records network, we conducted an emulated target trial comparing depression incidence over 1 year in individuals without prior diagnoses of major mental illness, who initiated treatment with prucalopride versus two alternative anti-constipation agents that act by different mechanisms (linaclotide and lubiprostone). Cohorts were matched for 121 covariates capturing sociodemographic factors, and historical and/or concurrent comorbidities and medications. The primary outcome was a first diagnosis of major depressive disorder (ICD-10 code F32) within 1 year of the index date. Robustness of the results to changes in model and population specification was tested. Secondary outcomes included a first diagnosis of six other neuropsychiatric disorders. Treatment with prucalopride was associated with significantly lower incidence of depression in the following year compared with linaclotide (hazard ratio 0.87, 95% CI 0.76-0.99; P = 0.038; n = 8572 in each matched cohort) and lubiprostone (hazard ratio 0.79, 95% CI 0.69-0.91; P < 0.001; n = 8281). Significantly lower risks of all mood disorders and psychosis were also observed. Results were similar across robustness analyses. These findings support preclinical data and suggest a role for 5-HT4R agonists as novel agents in the prevention of major depression. These findings should stimulate randomised controlled trials to confirm if these agents can serve as a novel class of antidepressant within a clinical setting.

The Molecular Mechanism of Exercise for Treatment of Patients with Major Depression: A Preliminary Report on the Dynamics of Metabolites of Nitric Oxide and Catecholamines.

There has been increasing evidence that exercise therapy is effective in the treatment and prevention of major depression (MD). However, the basic molecular mechanisms underlying the effects of exercise on MD remain unclear. We conducted a preliminary study to clarify the effect of exercise therapy on MD, focusing on the dynamics of nitric oxide (NO) and catecholamine metabolites, which have been found to be associated with MD. Eleven outpatients with mild to moderate MD and 37 healthy controls (HC) were included in the study. The participants' clinical records and questionnaires were screened for their past medical history. For their exercise therapy, the participants were instructed to walk the equivalent of 17.5 kcal/kg/week for 8 weeks. Blood samples were collected from all participants at baseline, 4 weeks, and 8 weeks after the start of exercise therapy, and plasma metabolites of NO (NOx), homovanillic acid (HVA), and 3-methoxy-4-hydroxyphenylglycol (MHPG) were analyzed. We also assessed the 17-item Hamilton Rating Scale for Depression (HRSD-17) in patients with MD. A mixed-effects regression model was used to compare the mean values by time (baseline, 4, and 8 weeks) for the three corresponding groups (NOx, MHPG, and HVA). HRSD-17 scores decreased significantly in the MD group after 8 weeks of exercise therapy. NOx and MHPG increased, but there was no significant change in HVA in the MD group after the exercise therapy. NOx decreased after exercise, and HVA increased significantly from baseline after 4 weeks of exercise but decreased after 8 weeks of exercise in the HC group. The effects of exercise on NOx, MHPG, and HVA may differ between MD and HC. The potential mechanisms for the benefits of walking exercise in MD patients will be the subject for future research.

Effects of Combined Sertraline and Magnesium in Rat Atrium.

The objective of this study is to determine the synergistic effects of an antioxidant ion Mg+2, combined with selective serotonin reuptake inhibitor sertraline, in treatment or prevention of major depression and regulation of inotropic effect in the early postoperative period. Adult male 40 Wistar albino rats were randomly divided into 6 groups. Three to 4-mm long atrium strips were placed in organ bath, tension was adjusted to 2 g. Isometric contractions were induced with 10-3 M adrenaline. Group 1 was the control group, cumulative sertraline was given to group 2, cumulative MgSO4 to group 3, combined cumulative sertraline and MgSO4 to group 4, intraperitoneal sertraline injection for 29 days to group 5, and intraperitoneal MgSO4 injection for 14 days to group 6. Changes in weight, tensions, bleeding/clotting time, and biochemical findings were evaluated statistically. Isometric tension relationship between groups 1 and 3 was statistically significant after 4 mmol/L MgSO4 (p < 0.05). A rapid inhibition of contraction was observed in group 4. Inhibition of spontaneous contractions of groups 5 and 6 was found to be statistically significant at close values, p < 0.05. When blood clotting times were compared, a statistically marked decrease was found in group 6, p < 0.05. Compared to control group, there was a significant decrease in blood lipids in group 4. While LDH and CK-MB increased from plasma enzymes in groups 5 and 6, no significant change was observed in NT-proBNP. Combined treatment of high dose MgSO4 with antidepressants for pre or post-operative depression may cause fatal risks. Shortening clotting time may increase the risk of embolism and stroke. In order to reduce the risk of post-operative depression preoperatively, care should be taken when using magnesium combined with antidepressants and more studies are needed to be considered.

Comparing the effectiveness of home visiting paraprofessionals and mental health professionals delivering a postpartum depression preventive intervention: a cluster-randomized non-inferiority clinical trial.

To determine whether pregnant women receiving the Mothers and Babies group-based intervention exhibited greater depressive symptom reductions and fewer new cases of major depression than women receiving usual community-based services, and to examine whether groups run by paraprofessional home visitors and mental health professionals yielded similar depressive symptom reductions and prevention of major depression. Using a cluster-randomized design, 37 home visiting programs were randomized to usual home visiting, Mothers and Babies delivered via home visiting paraprofessionals, or Mothers and Babies delivered via mental health professionals. Baseline assessments were conducted prenatally with follow-up extending to 24weeks postpartum. Eligibility criteria were ≥ 16years old, ≤ 33 gestation upon referral, and Spanish/English speaking. Depressive symptoms at 24weeks postpartum was the primary outcome. Eight hundred seventy-four women were enrolled. Neither intervention arm was superior to usual care in decreasing depressive symptoms across the sample (p = 0.401 home visiting paraprofessional vs. control; p = 0.430 mental health professional vs. control). Post hoc analyses suggest a positive intervention effect for women exhibiting mild depressive symptoms at baseline. We have evidence of non-inferiority, as the model-estimated mean difference in depressive symptoms between intervention arms (0.01 points, 95% CI: -0.79, 0.78) did not surpass our pre-specified margin of non-inferiority of two points. Although we did not find statistically significant differences between intervention and control arms, non-inferiority analyses found paraprofessional home visitors generated similar reductions in depressive symptoms as mental health professionals. Additionally, Mothers and Babies appears to reduce depressive symptoms among women with mild depressive symptoms when delivered by mental health professionals. This trial is registered on ClinicalTrials.gov (initial post: December 1, 2016; identifier: NCT02979444).

Association between saturated fatty acid intake and depressive symptoms in midlife women: A prospective study

BackgroundThis prospective investigation examined relations between baseline dietary saturated fatty acid (SFA) intake of women at midlife and prevalence of depressive symptoms 4 years later. MethodsWomen enrolled in the Study of Women's Health Across the Nation (SWAN) had measures of CES-D depression scores 4 years later and SFA intake at baseline. Logistic regression models were used to study prospective associations between SFA intake and depressive symptoms. ResultsA total of 2400 women aged 42–52 years were included in the present study. The ORs of depressive symptoms in model 1 adjustment for baseline CES-D score indicated that baseline SFA intake was positively associated with depressive symptoms. After additional adjustment for age, race/ethnicity, education, financial strain, physical activity, smoking currently, BMI, menopausal status, VMS, chronic stress and use of antidepressant in model 2, the results were similar to those of the model 1. This association remained statistically significant and changed little when additional controlling for SHBG and FSH in fully adjusted model 3. The fully adjusted OR of depressive symptoms in model 3 was 2.423 (1.142–5.143) in quartile 4 (the highest) versus quartile 1 (the lowest) of the baseline SFA intake. LimitationsAssessment of depression and SFA intake was based on a self-report scale. ConclusionsBaseline SFA intake is a predictor for depressive symptoms assessed 4 years later in midlife women. This underlines the importance of targeting SFA intake in the prevention of major depression in midlife women.

Prospective association between trans fatty acid intake and depressive symptoms: Results from the study of women's health across the nation

BackgroundThis prospective investigation examined relations between dietary trans fatty acid intake of women at midlife in baseline and prevalence of depressive symptoms 5 years later. MethodsWomen enrolled in the Study of Women's Health Across the Nation (SWAN) had measures of CES-D depression scores 5 years later and trans fatty acid intake at baseline. Logistic regression models were used to study prospective associations between trans fatty acid intake and depressive symptoms. ResultsIn overall 2376 women, baseline trans fatty acid intake did not predict depressive symptoms (p = 0.139) in model 1 adjusting for total caloric intake. However, after additional adjustment for age, race/ethnicity, education, financial strain, physical activity, BMI, menopausal status, VMS, chronic stress and use of antidepressant in model 2, baseline trans fatty acid intake predicted depressive symptoms 5 years later. This association remained statistically significant when additional controlling for SHBG, testosterone and estradiol in fully adjusted model 3. The fully adjusted OR of depressive symptoms was 1.637 (1.087–2.467) in quartile 4 (the highest) versus quartile 1 (the lowest) of the trans fatty acid intake. Sensitivity analyses performed in women with baseline CES-D score <16 showed that this association remained statistically significant. LimitationsAssessment of depression and trans fatty acid intake was based on a self-report scale. ConclusionsTrans fatty acid intake is a predictor for depressive symptoms 5 years later in midlife women independent health and psychosocial profiles. This underlines the importance of targeting trans fatty acid in the prevention of major depression in midlife women.

Family physicians' views on participating in prevention of major depression. The predictD-EVAL qualitative study.

BackgroundThe predictD intervention, a multicomponent intervention delivered by family physicians (FPs), reduced the incidence of major depression by 21% versus the control group and was cost-effective. A qualitative methodology was proposed to identify the mechanisms of action of these complex interventions.PurposeTo seek the opinions of these FPs on the potential successful components of the predictD intervention for the primary prevention of depression in primary care and to identify areas for improvement.MethodQualitative study with FPs who delivered the predictD intervention at 35 urban primary care centres in seven Spanish cities. Face-to-face semi-structured interviews adopting a phenomenological approach. The data was triangulated by three investigators using thematic analysis and respondent validation was carried out.ResultsSixty-seven FPs were interviewed and they indicated strategies used to perform the predictD intervention, including specific communication skills such as empathy and the activation of patient resources. They perceived barriers such as lack of time and facilitators such as prior acquaintance with patients. FPs recognized the positive consequences of the intervention for FPs, patients and the doctor-patient relationship. They also identified strategies for future versions and implementations of the predictD intervention.ConclusionsThe FPs who carried out the predictD intervention identified factors potentially associated with successful prevention using this program and others that could be improved. Their opinions about the predictD intervention will enable development of a more effective and acceptable version and its implementation in different primary health care settings.

Effect of a Lay Counselor Intervention on Prevention of Major Depression in Older Adults Living in Low- and Middle-Income Countries

Preventing depression in older adults living in low- and middle-income countries is important because of the scarcity of treatment resources and the risk of disability, suicide, and dementia. To assess whether an intervention for depression prevention provided by lay counselors is effective in older adults from low- and middle-income countries. This parallel-group randomized clinical trial with masked outcome assessment was performed in 181 older adults (≥60 years) with subsyndromal depressive symptoms at rural and urban primary care clinics in Goa, India. The first participant entered the trial on March 31, 2015, and the last exited on June 2, 2017. Data analysis used the intention-to-treat approach. Lay counselors provided problem-solving therapy, brief behavioral treatment for insomnia, education in self-care of common medical disorders such as diabetes, and assistance in accessing medical and social programs. The main outcome was incidence of major depressive episodes. The study also assessed symptom change during 12 months (12-item General Health Questionnaire [GHQ-12]; score range of 0 to 12, with higher scores indicating greater symptoms of depression and anxiety), functional status (World Health Organization Disability Assessment Schedule 2.0; score range of 12 to 60, with higher scores indicating greater disability), cognition (Hindi Mini-Mental State Examination; score range of 0 to 30, with higher scores indicating better cognitive functioning), blood pressure, and body mass index to provide further clinical context. The study enrolled 181 participants (mean [SD] age, 69.6 [7.2] years; 114 [63.0%] female): 91 to the intervention arm (depression in later life [DIL] intervention) and 90 to care as usual (CAU). Incident episodes of major depression were lower in the DIL intervention than in the CAU group (4.40% vs 14.44%; log-rank P = .04; number needed to treat, 9.95; 95% CI, 5.12-182.43). The 12-month Kaplan-Meier estimates of percentage of depression-free participants were 95.1% (95% CI, 90.5%-99.9%) in the DIL group vs 87.4% (95% CI, 80.4%-95.1%) in the CAU group. The incidence of depressive symptoms (GHQ-12) was also less (12-month mean difference, -1.18; 95% CI, -2.03 to -0.31; group × time interaction P < .001). There were no changes in measures of disability or cognition. The DIL intervention was associated with a significantly greater lowering of systolic blood pressure (12-month mean difference, -6.98; 95% CI, -11.96 to -2.01; group × time interaction P < .001) and change in body mass index (12-month mean difference, 0.23; 95% CI, -0.97 to 1.43; P = .04). The DIL intervention is effective for preventing episodes of major depression in older persons with subsyndromal symptoms. If replicated, the DIL intervention may be effective in older adults living in low- and middle-income countries. ClinicalTrials.gov Identifier: NCT02145429.

Estimation of a Relative Risk Effect Size when Using Continuous Outcomes Data: An Application of Methods in the Prevention of Major Depression and Eating Disorders.

The raw mean difference (RMD) and standardized mean difference (SMD) are continuous effect size measures that are not readily usable in decision-analytic models of health care interventions. This study compared the predictive performance of 3 methods by which continuous outcomes data collected using psychiatric rating scales can be used to calculate a relative risk (RR) effect size. Three methods to calculate RR effect sizes from continuous outcomes data are described: the RMD, SMD, and Cochrane conversion methods. Each conversion method was validated using data from randomized controlled trials (RCTs) examining the efficacy of interventions for the prevention of depression in youth (aged ≤17 years) and adults (aged ≥18 years) and the prevention of eating disorders in young women (aged ≤21 years). Validation analyses compared predicted RR effect sizes to actual RR effect sizes using scatterplots, correlation coefficients ( r), and simple linear regression. An applied analysis was also conducted to examine the impact of using each conversion method in a cost-effectiveness model. The predictive performances of the RMD and Cochrane conversion methods were strong relative to the SMD conversion method when analyzing RCTs involving depression in adults (RMD: r = 0.89-0.90; Cochrane: r = 0.73; SMD: r = 0.41-0.67) and eating disorders in young women (RMD: r = 0.89; Cochrane: r = 0.96). Moderate predictive performances were observed across the 3 methods when analyzing RCTs involving depression in youth (RMD: r = 0.50; Cochrane: r = 0.47; SMD: r = 0.46-0.46). Negligible differences were observed between the 3 methods when applied to a cost-effectiveness model. The RMD and Cochrane conversion methods are both valid methods for predicting RR effect sizes from continuous outcomes data. However, further validation and refinement are required before being applied more broadly.

Effectiveness and cost-effectiveness of a guided Internet- and mobile-based intervention for the indicated prevention of major depression in patients with chronic back pain\u2014study protocol of the PROD-BP multicenter pragmatic RCT

BackgroundReducing the disease burden of major depressive disorder (MDD) is of major public health relevance. The prevention of depression is regarded as one possible approach to reach this goal. People with multiple risk factors for MDD such as chronic back pain and subthreshold depressive symptoms may benefit most from preventive measures. The Internet as intervention setting allows for scaling up preventive interventions on a public mental health level.MethodsThis study is a multicenter pragmatic randomized controlled trial (RCT) of parallel design aiming to investigate the (cost-) effectiveness of an Internet- and mobile-based intervention (IMI) for the prevention of depression in chronic back pain patients (PROD-BP) with subthreshold depressive symptoms. eSano BackCare-DP is a guided, chronic back pain-specific depression prevention intervention based on cognitive behavioral therapy (CBT) principles comprising six weekly plus three optional modules and two booster sessions after completion of the intervention. Trained psychologists provide guidance by sending feedback messages after each module. A total of 406 patients with chronic back pain and without a depressive disorder at baseline will be recruited following orthopedic rehabilitation care and allocated to either intervention or treatment-as-usual (TAU). Primary patient-relevant endpoint of the trial is the time to onset of MDD measured by the telephone-administered Structured Clinical Interview for DSM (SCID) at baseline and 1-year post-randomization. Key secondary outcomes are health-related quality of life, depression severity, pain intensity, pain-related disability, ability to work, intervention satisfaction and adherence as well as side effects of the intervention. Online assessments take place at baseline and 9 weeks as well as 6 and 12 months post-randomization. Cox regression survival analysis will be conducted to estimate hazard ratio at 12-month follow-up. Moreover, an economic analysis will be conducted from a societal and public health perspective.DiscussionThis is the first study examining an IMI for depression prevention in a sample of chronic pain patients. If this implementation of a depression prevention IMI into orthopedic aftercare proves effective, the intervention could be integrated into routine care with minimal costs and extended for use with other chronic diseases. Results will have implications for researchers, health care providers and public health policy makers.Trial registrationThe trial is registered at the WHO International Clinical Trials Registry Platform via the German Clinical Studies Trial Register (DRKS): DRKS00007960. Registered 12 August 2015.

Stress-related Risk Factors for the Maintenance of Major Depression in Adolescent Girls

Background: Major depressive disorder is a highly prevalent disorder in adolescence that entails significant lifetime risk for repeated episodes of depression and other disorders Furthermore, it can have a negative impact on academic and psycho-social functioning with long-lasting effects. Thus, identification of the most relevant risk factors for the continuation of major depressive disorder is important. Method: Seventy one female adolescents between 10 and 18 years who were identified from a community sample as having major depressive disorder were assessed regarding stress vulnerability, stress symptoms, coping behavior and physical complaints. These variables were tested as risk factors for the persistence of major depression six months later. Results: Factors having the highest predictive power for the continuation of major depression were avoidant coping, stress vulnerability and stress related psychic symptoms. Conclusions: Stress symptoms, stress vulnerability, and a strategy of avoidant coping behavior are risk factors for the prolonged existence of major depression and should particularly be considered in prevention of major depression and intervention for depressive symptoms. Keywords: Adolescents, coping, major depression, risk factors, stress.

Evaluating the efficacy and cost-effectiveness of web-based indicated prevention of major depression: design of a randomised controlled trial

BackgroundMajor depressive disorder (MDD) imposes a considerable disease burden on individuals and societies. Web-based interventions have shown to be effective in reducing depressive symptom severity. However, it is not known whether web-based interventions may also be effective in preventing the onset of MDD. The aim of this study is to evaluate the (cost-) effectiveness of an indicated web-based guided self-help intervention (GET.ON Mood Enhancer Prevention) on the onset of MDD.Methods/DesignA randomised controlled trial (RCT) will be conducted to compare the (cost-) effectiveness of the GET.ON Mood Enhancer Prevention training with a control condition exclusively receiving online-based psychoeducation on depression. Adults with subthreshold depression (N = 406) will be recruited from the general population and randomised to one of the two conditions. The primary outcome is time to onset of MDD within a 12-months follow-up period. MDD will be assessed according to DSM-IV criteria as assessed by the telephone-administered Structured Clinical Interview for DSM-IV (SCID). Time to onset of MDD will be assessed using life charts. Secondary outcomes include changes on various indicators of depressive symptom severity, anxiety and quality of life from baseline to post-treatment, to a 6-month and a 12-month follow up. Additionally, an economic evaluation using a societal perspective will be conducted to examine the intervention’s cost-effectiveness.DiscussionThis is one of the first randomised controlled trials that examines the effect of an indicated guided self-help web-based intervention on the incidence of major depression. If shown to be effective, the intervention will contribute to reducing the disease burden due to MDD in the general population.Trial registrationGerman Clinical Trial Registration DRKS00004709.

Value of Information Analysis from a Societal Perspective: A Case Study in Prevention of Major Depression

ObjectivesProductivity losses usually have a considerable impact on cost-effectiveness estimates while their estimated values are often relatively uncertain. Therefore, parameters related to these indirect costs play a role in setting priorities for future research from a societal perspective. Until now, however, value of information analyses have usually applied a health care perspective for economic evaluations. Hence, the effect of productivity losses has rarely been investigated in such analyses. The aim of the current study therefore was to investigate the effects of including or excluding productivity costs in value of information analyses. MethodsExpected value of information analysis (EVPI) was performed in cost-effectiveness evaluation of prevention from both societal and health care perspectives, to give us the opportunity to compare different perspectives. Priorities for future research were determined by partial EVPI. The program to prevent major depression in patients with subthreshold depression was opportunistic screening followed by minimal contact psychotherapy. ResultsThe EVPI indicated that regardless of perspective, further research is potentially worthwhile. Partial EVPI results underlined the importance of productivity losses when a societal perspective was considered. Furthermore, priority setting for future research differed according to perspective. ConclusionsThe results illustrated that advise for future research will differ for a health care versus a societal perspective and hence the value of information analysis should be adjusted to the perspective that is relevant for the decision makers involved. The outcomes underlined the need for carefully choosing the suitable perspective for the decision problem at hand.

Subsyndromal depression and anxiety in older adults: Health related, functional, cognitive and diagnostic implications

Subsyndromal depression in later life is common in primary care. Comorbid anxiety disorders could exacerbate the negative effect of subsyndromal depression on functioning, health-related quality of life, comorbidity and/or cognition. We examined anxiety disorders co-existing with subsyndromal depression in participants ≥ age 50 in an NIH trial of Problem Solving Therapy for Primary Care for indicated prevention of major depression. There were 247 participants, with Centers for Epidemiologic Studies – Depression scores ≥11. Participants could have multiple psychiatric diagnoses: 22% of the sample had no DSM IV diagnosis; 39% of the sample had only 1 DSM IV diagnosis; 28% had 2 diagnoses; 6% had 3 DSM IV diagnoses; 4% had 4 DSM IV diagnoses; and 1% had 5 diagnoses. Furthermore, 34% of participants had a current comorbid DSM IV diagnosis of a syndromal anxiety disorder. We hypothesized that those with subsyndromal depression, alone relative to those with co-existing anxiety disorders, would report better health-related quality of life, less disability, less medical comorbidity and less cognitive impairment. However, there were no differences in quality of life based on the SF 12 nor in disability based on Late Life Function and Disability Instrument scores. There were no differences in medical comorbidity based on the Cumulative Illness Scale–Geriatrics scale scores nor in cognitive function based on the Executive Interview (EXIT), Hopkins Verbal Learning Test-Revised and Mini-Mental Status Exam. Our findings suggest that about one third of participants 50 years and older with subsyndromal depression have comorbid anxiety disorders; however, this does not appear to be associated with worse quality of life, functioning, disability, cognitive function or medical comorbidity.

Cost-Effectiveness of Opportunistic Screening and Minimal Contact Psychotherapy to Prevent Depression in Primary Care Patients

BackgroundDepression causes a large burden of disease worldwide. Effective prevention has the potential to reduce that burden considerably. This study aimed to investigate the cost-effectiveness of minimal contact psychotherapy, based on Lewinsohn's ‘Coping with depression’ course, targeted at opportunistically screened individuals with sub-threshold depression.Methods and ResultsUsing a Markov model, future health effects and costs of an intervention scenario and a current practice scenario were estimated. The time horizon was five years. Incremental cost-effectiveness ratios were expressed in euro per Disability Adjusted Life Year (DALY) averted. Probabilistic sensitivity analysis was employed to study the effect of uncertainty in the model parameters. From the health care perspective the incremental cost-effectiveness ratio was € 1,400 per DALY, and from the societal perspective the intervention was cost-saving. Although the estimated incremental costs and effects were surrounded with large uncertainty, given a willingness to pay of € 20,000 per DALY, the probability that the intervention is cost-effective was around 80%.ConclusionThis modelling study showed that opportunistic screening in primary care for sub-threshold depression in combination with minimal contact psychotherapy may be cost-effective in the prevention of major depression.

Therapy for prevention of post-stroke depression

Introduction: Depression is the most common psychiatric disorder after stroke that adversely affects stroke outcomes. It is often underdiagnosed and inadequately treated. Hence, there is growing interest in interventions to prevent depression in stroke patients, which is in concert with emerging data that indicate prevention of major depression in selective high-risk populations may be effective.Areas covered: This article reviews the state of the current literature on pharmacologic and psychosocial preventive intervention strategies for depression in stroke patients.Expert opinion: The emerging data indicate that antidepressants and psychological therapies may be effective and safe in preventing post-stroke depression. More well-designed preventive trials are required to determine the efficacy and cost-effectiveness of preventive interventions targeting stroke patients, who are a high-risk group for depression.

Predictors of incident major depression in diabetic outpatients with subthreshold depression

The objective of the study was to determine rates and risks of major depression in diabetes outpatients with subthreshold depression. This study is based on data of a stepped care-based intervention study in which diabetic patients with subthreshold depression were randomly allocated to low-intensity stepped care, aimed at reducing depressive symptoms, or to care as usual. Patients had a baseline Center for Epidemiologic Studies Depression Scale (CES-D) score ≥ 16, but no baseline major depression according to the Mini International Neuropsychiatric Interview (MINI). Demographic, biological and psychological characteristics were collected at baseline. The MINI was used to determine whether participants had major depression during 2-year follow-up. Predictors of major depression were studied using logistic regression models. Of the 114 patients included at baseline, 73 patients were available at 2-year follow-up. The 2-year incidence of major depression was 42% (n=31). Higher baseline anxiety levels [odds ratio (OR)=1.25; 95% confidence interval (CI), 1.04-1.50; P=0.018] and depression severity levels (OR=1.09; 95% CI, 1.00-1.18; P=0.045) were predictors of incident major depression. Stepped care allocation was not related to incident major depression. In multivariable models, similar results were found. Having a higher baseline level of anxiety and depression appeared to be related to incident major depression during 2-year follow-up in diabetic patients with subthreshold depression. A stepped care intervention aimed at depression alone did not prevent the onset of depression in these patients. Besides level of depression, anxiety might be taken into account in the prevention of major depression in diabetic patients with subthreshold depression.

Prevention of Major Depression

Before the 1980s, no randomized controlled trials had been carried out to test whether major depressive episodes could be prevented. In the past 30 years, several trials have reported success in reducing the incidence (the number of new cases) of major depressive episodes. These studies suggest that major depression can be prevented. Given the large burden of disease caused by major depression, it is time for substantial systematic efforts to replicate these studies, carry out multisite trials, and widely disseminate prevention interventions found to be effective. The present review examines the conceptual and practical differences between treatment and prevention trials and the importance of identifying groups at high short-term risk for major depressive episodes to make prevention trials feasible. We also list the randomized controlled prevention trials that have been carried out to date and discuss the need for prevention interventions that go beyond the limits of traditional face-to-face interventions.

Prevention of Major Depression in Complex Medically Ill Patients: Preliminary Results From a Randomized, Controlled Trial

Depression is highly prevalent in patients with physical illness and is associated with a diminished quality of life and poorer medical outcomes. The authors evaluated whether a multifaceted intervention conducted by a psychiatric consultation-liaison nurse could reduce the incidence of major depression in rheumatology inpatients and diabetes outpatients with a high level of case complexity. Of 247 randomized patients, the authors identified 100 patients with a high level of case complexity at baseline and without major depression (65 rheumatology and 35 diabetes patients). Patients were randomized to usual care (N=53) or to a nurse-led intervention (N=47). Main outcomes were the incidence of major depression and severity of depressive symptoms during a 1-year follow-up, based on quarterly assessments with standardized psychiatric interviews. The incidence of major depression was 63% in usual-care patients and 36% in the intervention group. Effects of intervention on depressive symptoms were observed in outpatients with diabetes but not in rheumatology inpatients. These preliminary results based on subgroup analysis suggest that a multifaceted nurse-led intervention may prevent the occurrence of major depression in complex medically ill patients and reduce depressive symptoms in diabetes outpatients.

A Randomized, Placebo-Controlled Trial of Citalopram for the Prevention of Major Depression During Treatment for Head and Neck Cancer

A Randomized, Placebo-Controlled Trial of Citalopram for the Prevention of Major Depression During Treatment for Head and Neck Cancer