Therapy For Unipolar Depression Research Articles

Cost-Utility of Internet-Based Cognitive Behavioral Therapy in Unipolar Depression: A Markov Model Simulation.

Background and ObjectiveUnipolar depression is the most common form of depression and demand for treatment, such as psychotherapy, is high. However, waiting times for psychotherapy often considerably exceed their recommended maximum. As a potentially less costly alternative treatment, internet-based cognitive behavior therapy (ICBT) might help reduce waiting times. We therefore analyzed the cost–utility of ICBT compared to face-to-face CBT (FCBT) as an active control treatment, taking differences in waiting time into account.MethodsWe constructed a Markov model to simulate costs and health outcomes measured in quality-adjusted life years (QALYs) for ICBT and FCBT in Germany. We modeled a time horizon of 3 years using six states (remission, depressed, spontaneous remission, undergoing treatment, treatment finished, death). The societal perspective was adopted. We obtained parameters for transition probabilities, depression-specific QoL, and cost data from the literature. Deterministic and probabilistic sensitivity analyses were conducted. Within a scenario analysis, we simulated different time-to-treatment combinations. Half-cycle correction was applied.ResultsIn our simulation, ICBT generated 0.260 QALYs and saved €2536 per patient compared to FCBT. Our deterministic sensitivity analysis suggests that the base-case results were largely unaffected by parameter uncertainty and are therefore robust. Our probabilistic sensitivity analysis suggests that ICBT is highly likely to be more effective (91.5%), less costly (76.0%), and the dominant strategy (69.7%) compared to FCBT. The scenario analysis revealed that the base-case results are robust to variations in time-to-treatment differences.ConclusionICBT has a strong potential to balance demand and supply of CBT in unipolar depression by reducing therapist time per patient. It is highly likely to generate more QALYs and reduce health care expenditure. In addition, ICBT may have further positive external effects, such as freeing up capacities for the most severely depressed patients.Electronic supplementary materialThe online version of this article (10.1007/s40258-019-00551-x) contains supplementary material, which is available to authorized users.

P.602 Six day combined partial wake and light therapy for unipolar depression

P.602 Six day combined partial wake and light therapy for unipolar depression

Functional Neuroimaging Changes Subsequent to Electroconvulsive Therapy in Unipolar Depression

Electroconvulsive therapy (ECT) is an effective treatment for major depressive episodes; however, the neural mechanisms underlying its therapeutic effects remain largely unknown. This review summarizes the findings of functional neuroimaging studies on the effects of the ECT treatment in patients with unipolar depression. Functional neuroimaging studies show that ECT induces changes in cerebral metabolism, blood flow, neurotransmitter activity, neuronal metabolites, and brain functional connectivity. Nevertheless, most of these studies are cross-sectional, with small sample sizes, and the findings across these studies are inconsistent and often contradictory. The levels of brain functional changes are seldom correlated with alleviation of depressive symptoms. Based on the results of current functional neuroimaging studies, one cannot draw any conclusions about the exact neural mechanisms of the antidepressant effect of ECT. Additional multicenter, large-sample, unified-protocol studies with long-term follow-up and multiple observational markers are needed to clarify and cross-validate the neural mechanisms of the antidepressant effect of ECT and to explore validated neuroimaging markers for predicting and evaluating the clinical efficacy of ECT treatment.

Relapse rates with long‐term antidepressant drug therapy: a meta‐analysis

Several long-term double-blind placebo controlled trials have shown prophylactic antidepressant therapy in unipolar depression. The goal of this work was to conduct a meta-analysis that would incorporate the most recent trials and evaluate their overall level of efficacy and relapse prevention over time. We performed a comprehensive literature search. The extracted data from selected studies were used to construct a regression model and evaluate the effect of treatment, time on medication, severity of illness, age, gender, and number of previous episodes. Across 11 maintenance treatment studies, the relapse rate was significantly different at 1 year for active drug (23%) versus placebo (51%). In addition, time on medication significantly affected the relapse rate. Prophylactic antidepressant drug therapy appears efficacious in preventing future relapses across a range of illness severity as well as age. More studies are needed to explore the effects of various acute antidepressant strategies and the direct influence of treatment resistance on relapse outcomes.

Acute and continuation therapy in unipolar depression: observations from the run-in phase of a maintenance trial

The aim of the study was to analyze treatments and outcome in depressed patients. Patients with recurrent depressive disorder (n = 289), recruited for a prophylaxis study, were followed up in hospital settings for 6 months with diagnostic and depression ratings at baseline and monthly depression ratings. Data on psychotropic drugs were retrieved from hospital case records. Independent associations between baseline, treatment and outcome variables were examined by logistic regression models. Depressive symptoms subsided gradually. After 6 months, 21% had dropped out, 43% were rated as remitted (HAM-D-17 <8) and 8% had not responded (HAM-D-17 >15). Patients once remitted rarely relapsed (<5%). All patients received antidepressant drugs, half of them more than one (2-4) as well as other psychotropic drugs. Patients responding poorly received more frequently multiple antidepressants, tricyclic antidepressants, hypnosedatives, lithium and/or antipsychotics. The 6-month outcome was generally poor. Choice of treatment appeared at least partly to be determined by the therapeutic outcome.

Social problem-solving therapy for unipolar depression: An initial dismantling investigation.

Social problem-solving therapy for unipolar depression: An initial dismantling investigation.

Explanatory style change during cognitive therapy for unipolar depression.

We administered the Attributional Style Questionnaire to 39 unipolar depressed patients at the beginning and end of cognitive therapy and at one-year follow-up, and we administered it to 12 bipolar patients during a depressed episode. A pessimistic explanatory style for bad events correlated with severity of depression for unipolars at cognitive therapy intake (r = .56, p < .0002), termination (r = .57, p < .0008), and one-year follow-up (r = .64, p < .0005) and among the bipolars (r = .63, p < .03). Explanatory style and depressive symptoms significantly improved by the end of cognitive therapy and remained improved at one-year follow-up. For the unipolars in cognitive therapy, explanatory style change from intake to termination correlated with change in depressive symptoms from intake to termination (r = .65, p < .0001). These results suggest that explanatory style may be one of the mechanisms of change for unipolar depressive patients undergoing cognitive therapy.

Tricyclic continuation and maintenance therapy in unipolar depression

The authors review several reported trials of tricyclic administration to ascertain its efficacy as continuation and maintenance therapy in patients with unipolar depression. Insufficient evidence has been accumulated to indicate that maintenance therapy (beyond eight months after recovery from an initial depressive episode) protects against recurrence. But studies do demonstrate that continuation therapy (within eight months of recovery) is useful in the prevention of relapse. It is, nevertheless, important for clinicians to evaluate each patient individually.