Reduction In Depressive Symptoms Research Articles

Impact of Ocrelizumab on Disease Progression, Memory Improvement, and Quality of Life in Patients with Relapsing-Remitting Multiple Sclerosis: A Longitudinal MRI and Clinical Criteria Analysis.

Multiple sclerosis (MS) is a chronic, progressive neurological disorder that significantly impacts quality of life and functionality. Ocrelizumab, a monoclonal antibody targeting CD20-positive B cells, has emerged as a treatment for relapsing-remitting MS (RRMS). This study aimed to assess the impact of ocrelizumab on disease progression and quality of life over a longitudinal course, utilizing clinical criteria and magnetic resonance imaging (MRI) analyses. Conducted at the Neurology Department of Pius Brinzeu Clinical Emergency Hospital in Western Romania from 2020 to 2023, this observational study enrolled 93 patients with RRMS who commenced ocrelizumab therapy. The study employed the Expanded Disability Status Scale (EDSS) and MRI to evaluate disease progression, while quality of life was assessed using the World Health Organisation Quality of Life (WHOQOL) questionnaire, Beck Depression Index (BDI), and MOCA scales. Significant improvements were observed post-treatment. EDSS scores decreased from 4.61 to 4.08 (p = 0.038), indicating reduced disability. MRI analyses showed a substantial decrease in expansive lesions (from 67.74% to 26.88%, p < 0.001) and an increase in stationary lesions (from 32.26% to 73.12%, p < 0.001). Quality of life improvements were notable in the physical (from 58.42 to 64.84, p = 0.005) and environmental domains (from 63.21 to 68.44, p = 0.033). Cognitive functions, assessed via Montreal Cognitive Assessment (MOCA), showed a significant total score increase from 20.38 to 22.30 (p < 0.001). Subgroup analysis revealed more pronounced effects in females and younger patients, with a significant reduction in depressive symptoms measured by BDI scores (from 14.35 to 11.62, p = 0.003). Ocrelizumab significantly reduced disease activity and disability in RRMS patients, as demonstrated by improvements in EDSS scores and MRI findings. Quality of life and cognitive functions also showed considerable enhancements. These findings support ocrelizumab's efficacy in not only managing MS symptoms but also improving overall patient well-being.

Examining the Bioactive Elements of Urtica urens Hydroalcoholic Extract and Its Possible Antidepressant Effects in Mice

The majority of antidepressant medications reduce depression symptoms, but they also have a number of undesirable side effects. The hunt is on for medications that are both more effective and well-tolerated. In light of this, the current investigation set out to assess the hydroalcoholic extract of Urtica Urens L.'s aerial parts' (HAUU) antidepressant potential in mice. The Tail Suspension Test (TST) and the Forced Swimming Test (FST) on mice were used to assess it. For 14 days, the HAUU (250 and 500 mg/kg, po) was given orally to distinct groups of 20–25-weight Swiss albino mice in order to conduct TST and FST testing. The presence of alkaloids, glycosides, phenols, flavonoids, and tannins was discovered through phytochemical examination. The HAUU demonstrated a dose-dependent decrease in the amount of time that mice were immobile. Mice's immobility duration was considerably shortened in both the FST and TST when 500 mg/kg of HAUU was administered. The extract's effectiveness was discovered to be on par with fluoxetine (20 mg mg/kg, po). It was discovered that when given orally at a dose of 2000 mg/kg, it was toxicologically safe and did not cause any mouse deaths. The results of the current investigation indicate that the HAUU is toxicologically safe and has strong antidepressant activity, as demonstrated by the TST and FST tests. Keywords: Urtica Urens L, Depression, Tail suspension test, Forced swimming test, Fluoxetine

Online acceptance and commitment therapy (iACT) for adults with persistent physical symptoms – 3-month follow-up study of a randomized controlled trial

ObjectivePersistent physical symptoms (PPS) represent a major health problem affecting daily functioning. This RCT aimed to examine whether a guided Internet-based treatment based on acceptance and commitment therapy (ACT) provided additional benefits compared to Treatment as Usual (TAU) in reducing somatic complaints and psychological distress in adults with PPS. MethodsA total of 103 adults with PPS related to indoor environments, chronic fatigue or both conditions were assigned to receive either either a 14-week intervention (video-based case conceptualization + Internet-based ACT) combined with TAU (iACT + TAU; n = 50) or TAU alone (n = 53). Somatic symptoms, depression, anxiety, insomnia, and psychological flexibility were assessed from pre-intervention to a 3-month follow-up. Additionally, the association between changes in psychological flexibility from pre- to post-intervention and changes in symptoms from pre to 3-month follow-up was explored. Analyses were conducted using a multigroup method with full information maximum likelihood estimator. ResultsThe results revealed a significant interaction effect, indicating reductions in somatic symptoms and symptoms of depression and anxiety with moderate to large between-group effects (d = 0.71–1.09). No significant interaction effect was observed in insomnia and measures of psychological flexibility. ConclusionInternet-based ACT, when combined with Treatment as Usual, demonstrated efficacy for individuals with PPS associated with indoor environments and chronic fatigue. These findings are pertinent for primary healthcare providers, suggesting that the current treatment model could serve as a low-threshold first-line treatment option.The clinical trial registration number: NCT04532827

Integration of passive sensing technology to enhance delivery of psychological interventions for mothers with depression: the StandStrong study

Psychological interventions delivered by non-specialist providers have shown mixed results for treating maternal depression. mHealth solutions hold the possibility for unobtrusive behavioural data collection to identify challenges and reinforce change in psychological interventions. We conducted a proof-of-concept study using passive sensing integrated into a depression intervention delivered by non-specialists to twenty-four adolescents and young mothers (30% 15–17 years old; 70% 18–25 years old) with infants (< 12 months old) in rural Nepal. All mothers showed a reduction in depression symptoms as measured with the Beck Depression Inventory. There were trends toward increased movement away from the house (greater distance measured through GPS data) and more time spent away from the infant (less time in proximity measured with the Bluetooth beacon) as the depression symptoms improved. There was considerable heterogeneity in these changes and other passively collected data (speech, physical activity) throughout the intervention. This proof-of-concept demonstrated that passive sensing can be feasibly used in low-resource settings and can personalize psychological interventions. Care must be taken when implementing such an approach to ensure confidentiality, data protection, and meaningful interpretation of data to enhance psychological interventions.

The role of symptom reduction in improving health-related quality of life through brief cognitive behavioral therapy

Objective Brief cognitive behavior therapy (bCBT) is effective in reducing symptoms of depression and anxiety disorders and improving health-related quality of life (HRQoL). However, the mechanisms through which cognitive behavior therapy impact HRQoL are not well understood. This study evaluated whether anxiety and depression symptom reduction is a mechanism of treatment for HRQoL outcomes. Method: Using secondary data from a multisite, pragmatic, randomized trial, this study evaluated bCBT vs enhanced usual care in 16 VA community-based outpatient clinics. Ordinary least-squares path analysis testing multiple mediators was used to evaluate the role of change in depression and anxiety symptoms in the relationship between treatment condition and HRQoL. Results: Receiving bCBT (vs. enhanced usual care) was significantly negatively associated with change (reduction) in depression and anxiety scores. The indirect effect of treatment on mental HRQoL was significant with change in depression scores as mediator. A similar pattern was observed for physical HRQoL and change in anxiety scores as mediator. Conclusion: Findings suggest reduction of depression and anxiety symptoms as a mechanism through which bCBT for depression promoted improvements in HRQoL, with important implications for understanding how CBT impacts functioning, as well as the utility of bCBT in nontraditional mental health settings. Trial registration: ClinicalTrials.gov identifier: NCT02466126.

Longitudinal Neuroanatomical Increases from Early to One-Year Postpartum.

Preclinical studies have provided causal evidence that the postpartum period involves regional neuroanatomical changes in 'maternal' brain regions to support the transition to offspring caregiving. Few studies, in humans, have examined neuroanatomical changes from early to one-year postpartum with longitudinal neuroimaging data and their association with postpartum mood changes. In this study, we examined longitudinal changes in surface morphometry (cortical thickness and surface area) in regions previously implicated in the transition to parenthood. We also examined longitudinal volumetric neuroanatomical changes in three subcortical regions of the maternal brain: the hippocampus, amygdala, and ventral diencephalon. Twenty-four participants underwent longitudinal structural magnetic resonance imaging at 2-4 weeks and 1 year postpartum. Cortical thickness increased from early to one-year postpartum in the left (p = .003, Bonferroni corrected) and right (p = .02, Bonferroni corrected) superior frontal gyrus. No significant increases (or decreases) were observed in these regions for surface area. Volumetric increases, across the postpartum period, were found in the left amygdala (p = .001, Bonferroni corrected) and right ventral diencephalon (p = .01, Bonferroni corrected). An exploratory analysis of depressive symptoms found reductions in depressive symptoms from early postpartum to one-year postpartum were associated with greater cortical thickness in the superior frontal gyrus for both the left (p = .02) and right (p = .02) hemispheres. The findings expand our evidence of the neuroanatomical changes that occur across the postpartum period in humans and motivate future studies to examine how mood changes across this period are associated with cortical thickness of the superior frontal gyrus.

Music therapy group for women outpatients with major depressive disorder under treatment as usual in a psychiatric institution: non-randomized pilot trial

Major Depressive Disorder (MDD) is a prevalent mental illness in the world. Pharmacological treatment is typically the first choice, but Humanistic Music Therapy (HMT) may offer additional benefits when added to Treatment As Usual (TAU). This single-arm pilot study aimed to assess the effectiveness of Group HMT as an intervention for adult women diagnosed with MDD, in a psychiatric institution. The study comprised 12 outpatient women with MDD who received more than one year of pharmacological treatment. A pre-test/post-test design using the Hamilton Depression (HAM-D-21), Personal and Social Performance (PSP), and Global Assessment of Functioning (GAF) scales were employed to evaluate symptom severity and patient changes. Results indicated a significant decrease in HAM-D scores from 15.7 to 6.6 (p ≤ .005), a notable improvement in personal and social functioning (PSP scale) (p ≤ .05), and an increase in global activity level (GAF scale) (p ≤ .05). In conclusion, adult women with MDD receiving TAU in a psychiatric institution experienced a significant reduction in depressive symptoms and enhancement in global activity, personal, and social functioning when HMT was added to their treatment regimen. This study is limited by being non-randomized, unblinded, and, with a small population. A randomized controlled trials are required to confirm the benefits of HMT.

Adapting Cognitive Behavioral Therapy for Depression After Traumatic Brain Injury: A Case Study

This case study describes a cognitive-behavioral treatment for depression adapted for individuals with traumatic brain injury (CBT-TBI) and provides a case description of a patient who experienced meaningful symptom reduction. CBT-TBI includes several adaptations to traditional CBT for depression structure, content and process aimed at meeting the unique needs of individuals with TBI sequelae. The patient, a single, White, college-educated, cisgender female in her late 30s who sustained a complicated mild TBI and endorsed symptoms of depression, anxiety, and persistent post-concussive symptoms, completed 12 individual, in-person sessions of CBT-TBI in the context of a randomized, waitlist-controlled trial. Clinician and self-rated measures, as well as neuropsychological assessments, were completed at baseline and posttreatment, and depressive symptoms were assessed weekly by self-report (Beck Depression Inventory-II). Symptom improvement was analyzed using the Reliable Change Index (RCI) and demonstrated a clinically significant reduction in depression and anxiety symptoms, as well as improvement in coping abilities and adaptive thinking. In addition to the adapted content of the intervention, this case example highlights the importance of therapist flexibility, continual assessment, collaboration, and elicitation of feedback in the delivery of CBT for depression for individuals with TBI.

Non-pharmacological interventions for depression in Kenya: a scoping review

IntroductionDepression management is affected by restricted budgets for mental health care in sub-Saharan Africa countries. There is need for integration of non-pharmacological interventions in primary care. This scoping review aimed to summarize research on available non-pharmacological interventions and their effectiveness against depression in Kenya.MethodsWe searched PubMed, ScienceDirect, AJOL, EBSCOhost, ProQuest and Cochrane Library databases for articles reporting non-pharmacological interventions in Kenya published in English between 2000 and May 2023.FindingsTwenty-four articles that reported psychosocial (n = 20) and socioeconomic (n = 4) interventions were included in the review. Most interventions were delivered by lay professionals. Clinical outcomes included significant reduction in depression scores and symptom severity posttreatment and reduction in likelihood of having depression symptoms. Interventions were also found to be feasible and acceptable.ConclusionNon-pharmacological interventions can be upscaled for the management of depression in Kenya.

G-CBT for Reducing Depression Symptoms in Individuals from Dysfunctional Family

Individuals from dysfunctional family have various risks of mental health deterioration including depression. To solve this family problem actually it is the best to conduct family therapy to the family. But unfortunately not all dysfunctional family are willing to cooperate in family therapy. Therefore individual therapy is considered important to protect individual of dysfunctional family from depression. The aim of this research is to examine the effectivity of Gratitude Cognitive Behavior Therapy in reducing depressive simptoms in individuals from dysfunctional family. Method used in this research is single case quasy experiment with A-B-A design. Findings from this research tells us that G-CBT is efective in reducing depression in individuals from dysfunctional family. Participants get some positive effect of this intervention including wider perspective, ability to see other points of view, appreciate every positive little thing, acknowlede one’s strenght, and increase sense of gratitude to God.

Cost-Effectiveness of Digital Mental Health Versus Usual Care During Humanitarian Crises in Lebanon: Pragmatic Randomized Trial.

There is evidence from meta-analyses and systematic reviews that digital mental health interventions for depression, anxiety, and stress-related disorders tend to be cost-effective. However, no such evidence exists for guided digital mental health care in low and middle-income countries (LMICs) facing humanitarian crises, where the needs are highest. Step-by-Step (SbS), a digital mental health intervention for depression, anxiety, and stress-related disorders, proved to be effective for Lebanese citizens and war-affected Syrians residing in Lebanon. Assessing the cost-effectiveness of SbS is crucial because Lebanon's overstretched health care system must prioritize cost-effective treatment options in the face of continuing humanitarian and economic crises. This study aims to assess the cost-effectiveness of SbS in a randomized comparison with enhanced usual care (EUC). The cost-effectiveness analysis was conducted alongside a pragmatic randomized controlled trial in 2 parallel groups comparing SbS (n=614) with EUC (n=635). The primary outcome was cost (in US $ for the reference year 2019) per treatment response of depressive symptoms, defined as >50% reduction of depressive symptoms measured using the Patient Health Questionnaire (PHQ). The secondary outcome was cost per remission of depressive symptoms, defined as a PHQ score <5 at last follow-up (5 months post baseline). The evaluation was conducted first from the health care perspective then from the societal perspective. Taking the health care perspective, SbS had an 80% probability to be regarded as cost-effective compared with EUC when there is a willingness to pay US $220 per additional treatment response or US $840 per additional remission. Taking the wider societal perspective, SbS had a >75% probability to be cost-saving while gaining response or remission. To our knowledge, this study is the first cost-effectiveness analysis based on a large randomized controlled trial (n=1249) of a guided digital mental health intervention in an LMIC. From the principal findings, 2 implications flowed, from the (1) health care perspective and (2) wider societal perspective. First, our findings suggest that SbS is associated with greater health benefits, albeit for higher costs than EUC. It is up to decision makers in health care to decide if they find the balance between additional health gains and additional health care costs acceptable. Second, as seen from the wider societal perspective, there is a substantial likelihood that SbS is not costing more than EUC but is associated with cost-savings as SBS participants become more productive, thus offsetting their health care costs. This finding may suggest to policy makers that it is in the interest of both population health and the wider Lebanese economy to implement SbS on a wide scale. In brief, SbS may offer a scalable, potentially cost-saving response to humanitarian emergencies in an LMIC. ClinicalTrials.gov NCT03720769; https://clinicaltrials.gov/ct2/show/NCT03720769. RR2-10.2196/21585.

Results of esketamine administration in a Greek population: a case series.

Esketamine is a non-selective, competitive antagonist of the N-methyl-D-aspartate (NMDA) receptor in the brain. Through NMDA receptor antagonism, esketamine causes a transient increase in glutamate release, leading to increases in neurotrophic signaling and restoration of synaptic function in brain regions involved in mood regulation and emotional behavior. Several randomized clinical trials have shown its effectiveness in reducing the symptoms of depression in some people, despite its short-term side effects that include mainly disorientation, dizziness, nausea, and increased blood pressure. In 2019, the United States Food and Drug Administration (FDA) as well as the European Medicines Agency approved the use of esketamine nasal spray in combination with an oral antidepressant for treatment-resistant depression in adults. Our study aimed to evaluate the effectiveness of this new therapeutic proposal in a case series of five Greek patients with treatment- resistant depression. Intranasal esketamine was administered under medical supervision in combination with an oral antidepressant. Depressive symptoms were evaluated at three time points (baseline, end of treatment, and one-year post-treatment) using the Montgomery-Åsberg Depression Rating Scale (MADRS), the Patient Health Questionnaire (PHQ-9), the CGI Clinical Global Impression Scale, and the Perceived Deficits Questionnaire for Depression (PDQ-D). Possible side effects were assessed using the Richmond Suppression Agitation Scale (RASS), the Sheehan Disability Scale (SDS), the CADSS Disruptive States Scale, and a predefined list of adverse events (AEs) and serious adverse events (SAEs). Patients followed an individualized treatment plan for seven to twelve months depending on the achievement of an adequate response. Statistical analysis of the results revealed a significant improvement (p<0.05) on all scales used. All participants maintained their level of improvement at follow-up after twelve months. Adverse effects were found to be mild and tolerable. It is worth noting that significant side effects were reported only by the two patients with comorbid personality disorder. The results, despite limited to a small sample, indicate the positive effect of esketamine on the stable reduction of depressive symptoms among patients with resistant depression, even after the completion of treatment.

Effects of a single‐session, online, experiential happiness workshop on graduate student mental health and wellness

AbstractGraduate students regularly experience anxiety, sleep disturbances, and depression, but little research exists on how to support their mental health. We evaluated the effects of a single‐session, online, synchronous, happiness workshop on graduate student well‐being, mental health, and physical health. Forty‐five students participated in a quasi‐experimental study. Students attended a synchronous 2.5‐h online happiness workshop, or a no‐workshop control condition. After workshop completion and as compared with no‐treatment controls, participants reported significant reductions in depression symptoms but no significant changes on seven other measures. At 6 months, participants reported further reductions in depression symptoms. Moreover, across four open‐ended questions, 37.0%–48.1% of workshop participants (a) recalled workshop tools, (b) found them useful, (c) had been practicing them regularly, and (d) used them in sessions with clients. Despite study limitations, single‐session, synchronous, online, happiness workshops may have salutatory effects on graduate student mental health. Additional research is needed.

Age-Specific Changes in the Effects of Social Connectedness and Loneliness on Depressive Symptoms: Evidence From the Korean Longitudinal Study of Ageing Before and During the COVID-19 Pandemic.

This study investigates the longitudinal effects of changes in the associations between two distinct aspects of social connections-i.e., social connectedness and loneliness-on depressive symptoms among community-dwelling Korean adults. This study also examines whether these associations vary across three age groups (45-64, 65-74, and 75 or above). Using data from the Korean Longitudinal Study of Ageing collected between 2014 and 2020 (n=3,642 individuals), fixed effects models were used to examine the age-specific associations between the two distinct aspects of social connections and depressive symptoms (Center for Epidemiologic Studies-Depression Scale) while, accounting for time-invariant individual heterogeneity. Social connectedness is measured by asking the frequency of interactions with friends, relatives, or neighbors. The findings indicate that the impact of loneliness on depressive symptoms outweighs that of social disconnectedness. Notably, this study unveils age-specific patterns concerning the impact of the coronavirus disease-2019 pandemic on depressive symptoms and changes in the association between loneliness and depressive symptoms. Specifically, middle-aged individuals reported higher levels of depressive symptoms and loneliness along with a heightened impact of loneliness on depressive symptoms, despite maintaining stable social connections. Conversely, the oldest adults experienced reductions in both depressive symptoms and loneliness, despite a significant decrease in socializing. These findings shed light on the differential effects of loneliness on depressive symptoms within distinct age groups before and during the pandemic. The implications of these findings are discussed with a focus on informing the development of targeted policy interventions tailored to the specific needs of different age groups.

Long-term follow-up of clinical trial participants: Predictors of post-trial response in older subjects

Background and objectiveThe post-trial follow-up (PTFU) phase of a clinical trial can provide important information on maintenance of intervention effects. However, approaches for the PTFU are rarely described. This short communication describes our process for PTFU that involved recontacting older subjects who participated in a clinical trial between 2015 and 2019. We also describe correlates of response to our PTFU survey. MethodsThe parent clinical trial aimed to reduce depression symptoms among older spousally-bereaved adults. We attempted to recontact our sample during the early stages of the COVID-19 pandemic. Using logistic regression, we examined physical health, depression symptoms, cognitive status, and disability as correlates of participant response to the PTFU phase. ResultsForty-two percent of participants responded to the PTFU survey. Disability – or the inability to participate in major life tasks and social roles - was significantly associated with response. Participants with greater disability were less likely to respond to the PTFU survey. ConclusionsOlder adults with disabilities may need alternative and supportive strategies for engaging in the PTFU phase.Clinical Trials Registration: NCT02631291

Herbs Used to Treat Depression: An Updated Review

Depression is a prevalent mental illness. In addition to being a substantial contribution to the overall global disease burden, depression is one of the main causes of disability worldwide. Complementary therapies are necessary because of the drawbacks of standard antidepressant therapy, including side effects, even though the former can help reduce depression symptoms and avoid relapse of the illness. Because they have fewer side effects and are less expensive than other therapies for depression, herbal medications have drawn a lot of interest recently. Compared to synthetic medications, herbal plants have fewer adverse effects and exhibit antidepressant properties. As such, they may be able to help people who are depressed. Because herbs have fewer adverse effects than conventional drugs, many people prefer them for symptom treatment. If traditional medications aren't working for you because of side effects, poor efficacy, or accessibility issues, using phytomedicine can be a good alternative. This review will concentrate on herbs that are used to cure depression. Keywords: Herbal medicines, Depression, Herb, Treatment, St. John’s Wort

Effectiveness of a Behavioral Activation Intervention for Peripartum Women with Opioid Use Disorder.

Pregnant women with opioid use disorder show elevated rates of comorbid mental health problems, both of which are associated with negative health outcomes for mothers and children. There is substantial evidence supporting the benefits of treatment of perinatal opioid use disorder, as well as perinatal depression and anxiety, but there are gaps in knowledge about the effectiveness of perinatal behavioral health interventions in the context of co-occurring substance use disorder. The current study seeks to address this gap by examining outcomes of a behavioral activation treatment in a group of peripartum women with opioid use disorder (N = 68). Behavioral activation has shown promise in treating co-occurring depression and substance use problems. The intervention was delivered as part of an integrated care treatment model, in which patients received co-located obstetric, substance use, and mental health care in a hospital-based clinic. Hierarchical linear modeling was used to assess change in symptoms over time. Results suggest that the group behavioral activation intervention was associated with reduced depression and anxiety symptoms, demonstrated by significant reductions in PHQ-9 and GAD-7 scores over the course of treatment. Moreover, there were indications that increased attendance was associated with further reductions in depressive symptoms. Results contribute to understanding the effectiveness of behavioral activation in the context of peripartum opioid use disorder. Findings also add to the evidence supporting integrated care models and offer a potential blueprint for improving outcomes and reducing barriers to care in this population.

Prevention of sickness absence through early identification and rehabilitation of at-risk patients with musculoskeletal disorders (PREVSAM): short term effects of a randomised controlled trial in primary care

Purpose To evaluate short-term effects of the PREVention of Sickness Absence for Musculoskeletal disorders (PREVSAM) model on sickness absence and patient-reported health outcomes. Methods Patients with musculoskeletal disorders were randomised to rehabilitation according to PREVSAM or treatment as usual (TAU) in primary care. Sickness absence and patient-reported health outcomes were evaluated after three months in 254 participants. Results The proportion of participants remaining in full- or part-time work were 86% in PREVSAM vs 78% in TAU (p = 0.097). The PREVSAM group had approximately four fewer sickness benefit days during three months from baseline (p range 0.078–0.126). No statistically significant difference was found in self-reported sickness absence days (PREVSAM 12.4 vs TAU 14.5; p = 0.634), nor were statistically significant differences between groups found in patient-reported health outcomes. Both groups showed significant improvements from baseline to three months, except for self-efficacy, and only the PREVSAM group showed significantly reduced depression symptoms. Conclusions The findings suggest that for sickness absence, the PREVSAM model may have an advantage over TAU, although the difference did not reach statistical significance at the p < 0.05 level, and similar positive effects on patient-reported health outcomes were found in both groups. Long-term effects must be evaluated before firm conclusions can be drawn.

Algorithm-based modular psychotherapy vs. cognitive-behavioral therapy for patients with depression, psychiatric comorbidities and early trauma: a proof-of-concept randomized controlled trial.

Effect sizes of psychotherapies currently stagnate at a low-to-moderate level. Personalizing psychotherapy by algorithm-based modular procedures promisesimproved outcomes, greater flexibility, and a better fit between research and practice. However, evidence for the feasibility and efficacy of modular-based psychotherapy, using a personalized treatment algorithm, is lacking. This proof-of-concept randomized controlled trial was conducted in 70 adult outpatients with a primary DSM-5 diagnosis of major depressive disorder, a score higher than 18 on the 24-item Hamilton Rating Scale for Depression (HRSD-24), at least one comorbid psychiatric diagnosis according to the Structured Clinical Interview for DSM-5 (SCID-5), a history of at least "moderate to severe" childhood maltreatment on at least one domain of the Childhood Trauma Questionnaire (CTQ), and exceeding the cut-off value on at least one of three measures of early trauma-related transdiagnostic mechanisms: the Rejection Sensitivity Questionnaire (RSQ), the Interpersonal Reactivity Index (IRI), and the Difficulties in Emotion Regulation Scale-16 (DERS-16). Patients were randomized to 20 sessions of either standard cognitive-behavioral therapy alone (CBT) or CBT plus transdiagnostic modules according to a mechanism-based treatment algorithm (MoBa), over 16 weeks. We aimed to assess the feasibility of MoBa, and to compare MoBa vs. CBT with respect to participants' and therapists' overall satisfaction and ratings of therapeutic alliance (using the Working Alliance Inventory - Short Revised, WAI-SR), efficacy, impact on early trauma-related transdiagnostic mechanisms, and safety. The primary outcome for efficacy was the HRSD-24 score at post-treatment. Secondary outcomes included, among others, the rate of response (defined as a reduction of the HRSD-24 score by at least 50% from baseline and a score <16 at post-treatment), the rate of remission (defined as a HRSD-24 score ≤8 at post-treatment), and improvements in early trauma-related mechanisms of social threat response, hyperarousal, and social processes/empathy. We found no difficulties in the selection of the transdiagnostic modules in the individual patients, applying the above-mentioned cut-offs, and in the implementation of MoBa. Both participants and therapists reported higher overall satisfaction and had higher WAI-SR ratings with MoBa than CBT. Both approaches led to major reductions of depressive symptoms at post-treatment, with a non-significant superiority of MoBa over CBT. Patients randomized to MoBa were nearly three times as likely to experience remission at the end of therapy (29.4% vs. 11.4%; odds ratio, OR = 3.2, 95% CI: 0.9-11.6). Among mechanism-based outcomes, MoBa patients showed a significantly higher post-treatment effect on social processes/empathy (p<0.05) compared to CBT patients, who presented an exacerbation on this domain at post-treatment. Substantially less adverse events were reported for MoBa compared to CBT. These results suggest the feasibility and acceptability of an algorithm-based modular psychotherapy complementing CBT in depressed patients with psychiatric comorbidities and early trauma. While initial evidence of efficacy was observed, potential clinical advantages and interindividual heterogeneity in treatment outcomes will have to be investigated in fully powered confirmation trials.

Effectiveness of a mindfulness and acceptance-based intervention for improving the mental health of adolescents with HIV in Uganda: An open-label trial.

Adolescents with HIV (AWH) face the double burden of dealing with challenges presented by their developmental phase while coping with stigma related to HIV, affecting their mental health. Poor mental health complicates adherence to daily treatment regimens, requiring innovative psychosocial support strategies for use with adolescents. We assessed the effectiveness of a mindfulness and acceptance-based intervention on the mental health of AWH in Uganda. One hundred and twenty-two AWH, mean age 17 ±1.59 (range 15 to 19 years), 57% female, receiving care at a public health facility in Kampala were enrolled in an open-label randomized trial (ClinicalTrials.gov: NCT05010317) with assessments at pre-and post-intervention. The mindfulness and acceptance-based intervention involved weekly 90-minute group sessions for four consecutive weeks facilitated by two experienced trainers. Sessions involved clarifying values, skillfully relating to thoughts, allowing and becoming aware of experiences non-judgmentally, and exploring life through trial and error. The control group received the current standard of care. Three mental health domains (depression, anxiety, and internalized stigma) were compared between the intervention and control groups. A linear mixed effects regression was used to analyze the effect of the intervention across the two time points. Results showed that the intervention was associated with a statistically significant reduction in symptoms of depression (β = -10.72, 95%CI: 6.25, -15.20; p < .0001), anxiety (β = -7.55, 95%CI: 2.66, -12.43; p = .0003) and stigma (β = -1.40, 95%CI: 0.66 to -2.15; p = .0004) over time. Results suggest that mindfulness and acceptance-based interventions have the potential to improve the mental health of AWH.