Treatment Of Depression In Adults Research Articles

Juvenile rat and pediatric trazodone studies: how to gain extra sensitivity to overcome bioanalytical challenges.

Trazodone (TZD)is used for the treatment of depression in adults and, off-label, as a sleep medication in adult and pediatric populations. The off-label use is well documented, however further clinical studies are needed to confirm its efficacy and safety for the treatment of sleep disorders. In this scenario, we developed a bioanalytical method to quantify low TZD concentrations in samples collected by capillary microsampling (CMS) to support dose finding, Good Laboratory Practice juvenile rat toxicokinetic and upcoming pediatric studies. A method using only 8μl of plasma was developed and successfully used for analyzing CMS samples from juvenile rats throughout toxicokinetic study. By harmoniously maximizing each analytical step, we achieved a sensitive method to quantify TZD in CMS samples.

Patterns and predictors of depression treatment among adults with chronic kidney disease and depression in ambulatory care settings in the United States.

One in five adults with chronic kidney disease (CKD) in the United States (US) suffers from depression. Comorbid depression in adults with CKD is associated with higher morbidity and mortality. This study used US national survey data to examine patterns and predictors of depression treatment among adults with non-dialysis-dependent CKD in the US. A retrospective, cross-sectional study was conducted using 2014-2015 National Ambulatory Medical Care Survey (NAMCS) data. The final study sample consisted of visits by 9.02million adults (unweighted n = 262; age ≥ 18years) with CKD and depression in the US. Depression treatment was defined as antidepressant use with or without psychotherapy. To identify predictors of depression treatment, multivariable logistic regression analysis was conducted adjusting for predisposing, enabling, and need factors. Approximately half of adults with CKD and depression received depression treatment. Primary care was the main setting of treatment, and the most commonly prescribed antidepressant class was selective serotonin reuptake inhibitors. Adults being seen for treatment of a chronic problem were 3.2 times more likely to receive depression treatment (OR 3.20; 95% CI 1.38-7.21). In addition, there was a 9% higher likelihood of receiving depression treatment for each unit increase in total number of medications (OR 1.09; 95% CI 1.01-1.19). Finally, adults receiving care in the South were 63% less likely to receive depression treatment (OR 0.37; 95% CI 0.15-0.89). Depression treatment was recorded in approximately half of US ambulatory care visits involving adults with CKD and depression from 2014 to 2015. Further research is warranted to determine how to appropriately manage treatment of depression in adults with CKD.

Brief Behavioural Activation (Brief BA) in secondary schools: A feasibility study examining acceptability and practical considerations

AimsThis paper reports on a feasibility study of delivering Brief Behavioural Activation in schools, focusing on acceptability, demand, implementation, practicality, adaptation and integration.RationaleDepression in adolescence is a common and serious mental health problem, with long-term negative impacts on social and academic functioning. In the UK, access to evidence-based psychological treatments is limited and training and employing therapists to deliver these is expensive. Treatments are typically offered in specialist Child and Adolescent Mental Health services (CAMHs) following a General Practitioner (GP) referral, yet few depressed young people seek help from their GP or other health professionals. In the UK there are current proposals to significantly increase the role of schools in providing access to mental health treatment for children and young people but currently there is little evidence that this is acceptable, feasible or effective.Behavioural Activation (BA) is an evidence-based treatment for depression in adults. BA has recently been adapted for young people (Brief Behavioural Activation; Brief BA, Pass & Reynolds, 2014). The adaptation is developmentally sensitive, acceptable to parents and young people, links behaviours to values and is highly collaborative.MethodBrief BA was introduced into five schools where feasibility data were collected. Brief BA was delivered by four therapists from differing professional backgrounds and experience.FindingsInitial data suggest that Brief BA is feasible to deliver in schools. Brief BA was integrated successfully with some adaptation, demand was high, and the service was highly acceptable to students, parents and school staff.ConclusionsThis study provides early evidence to support the use of Brief BA to treat adolescent depression in schools, with clear learning points for future feasibility evaluation.

Protocol for a feasibility study and randomised pilot trial of a low-intensity psychological intervention for depression in adults with autism: the Autism Depression Trial (ADEPT)

IntroductionHigh rates of co-occurring depression are reported in autism spectrum disorder (ASD), a neurodevelopmental condition characterised by social communication impairments and repetitive behaviours. Cognitive-behavioural interventions adapted for ASD have been...

FDA approves Abilify pill with sensor that tracks compliance

The U.S. Food and Drug Administration last month approved the first drug in the United States with a digital ingestion tracking system. Abilify MyCite (aripiprazole tablets with sensor) has an ingestible sensor embedded in the pill that records that the medication was taken. The product is approved for the treatment of schizophrenia, for acute treatment of manic and mixed episodes associated with bipolar I disorder, and for use as an add‐on treatment for depression in adults.

Comparison of behavioural activation with guided self-help for treatment of depression in adults with intellectual disabilities: a randomised controlled trial

SummaryBackgroundPsychological therapies are first-line interventions for depression, but existing provision is not accessible for many adults with intellectual disabilities. We investigated the clinical and cost-effectiveness of a behavioural activation intervention (BeatIt) for people with intellectual disabilities and depression. BeatIt was compared with a guided self-help intervention (StepUp).MethodsWe did a multicentre, single-blind, randomised, controlled trial with follow-up at 4 months and 12 months after randomisation. Participants aged 18 years or older, with mild to moderate intellectual disabilities and clinically significant depression were recruited from health and social care services in the UK. The primary outcome was the Glasgow Depression Scale for people with a Learning Disability (GDS-LD) score at 12 months. Analyses were done on an intention-to-treat basis. This trial is registered with ISCRTN, number ISRCTN09753005.FindingsBetween Aug 8, 2013, and Sept 1, 2015, 161 participants were randomly assigned (84 to BeatIt; 77 to StepUp); 141 (88%) participants completed the trial. No group differences were found in the effects of BeatIt and StepUp based on GDS-LD scores at 12 months (12·03 [SD 7·99] GDS-LD points for BeatIt vs 12·43 [SD 7·64] GDS-LD points for StepUp; mean difference 0·26 GDS-LD points [95% CI −2·18 to 2·70]; p=0·833). Within-group improvements in GDS-LD scores occurred in both groups at 12 months (BeatIt, mean change −4·2 GDS-LD points [95% CI −6·0 to −2·4], p<0·0001; StepUp, mean change −4·5 GDS-LD points [–6·2 to −2·7], p<0·0001), with large effect sizes (BeatIt, 0·590 [95% CI 0·337–0·844]; StepUp, 0·627 [0·380–0·873]). BeatIt was not cost-effective when compared with StepUp, although the economic analyses indicated substantial uncertainty. Treatment costs were only approximately 3·6–6·8% of participants' total support costs. No treatment-related or trial-related adverse events were reported.InterpretationThis study is, to our knowledge, the first large randomised controlled trial assessing individual psychological interventions for people with intellectual disabilities and mental health problems. These findings show that there is no evidence that BeatIt is more effective than StepUp; both are active and potentially effective interventions.FundingNational Institute for Health Research.

Psychological treatments for depression in adults with mild to moderate intellectual disabilities: are we there yet?

Psychological treatments for depression in adults with mild to moderate intellectual disabilities: are we there yet?

The Effect of Cognitive Therapy on Depression among the Adults with Stuttering

Introduction: The aim of this study was to determine the effectiveness of cognitive therapy on depression among the adults with stuttering. Materials and Methods: This was a quasi-experimental study with pretest-posttest design and control group. The statistical population included all adults referred to speech therapy clinics in Karaj City, Iran, in 2016; among them, 40 respondents diagnosed with depression were selected via available sampling and randomly assigned in experimental and control groups. The depression level was assessed among all the patients using the Beck Depression Inventory (pretest). Interventions were administered based on cognitive therapy in 10 sessions for the experimental group. At the end of intervention, all the participants were assessed again for depression level (posttest). The data were analyzed via SPSS software using ANCOVA test. Results: Comparing the mean pretest and posttest scores in both the experimental and control groups, the mean posttest depression score decreased significantly in experimental group (P < 0.010). Conclusion: Our results provide the evidence to suggest that cognitive therapy is an excellent method for treatment of depression in adults with stuttering. In addition, regarding the effectiveness of intervention, it can be widely used for treatment of mental disorders in clinics.

Within-Group Effect Size Benchmarks for Cognitive–Behavioral Therapy in the Treatment of Adult Depression

Within-Group Effect Size Benchmarks for Cognitive–Behavioral Therapy in the Treatment of Adult Depression

Psychological treatments are as effective as pharmacotherapies in the treatment of adult depression: a summary from Randomized Clinical Trials and neuroscience evidence.

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Treatment for Depression and Health-Related Quality of Life among Adults with Arthritis.

Depression treatment has been proven to relieve depressive symptoms and pain and may therefore improve the health-related quality of life (HRQoL) among adults with arthritis. The objective of the current study was to examine the HRQoL associated with depression treatment among adults with arthritis and depression. A retrospective longitudinal cohort study design using data from the Medical Expenditure Panel Survey(2009-2012) was adopted. The study sample consisted of adults (≥ 21years) with co-existing arthritis and depression (N=1692). Depression treatment was categorized into: antidepressants only, psychotherapy with or without antidepressants, and neither antidepressants nor psychotherapy. Multivariable Ordinary Least Square (OLS) regressions, which controlled for observed selection bias with inverse probability treatment weights (IPTW) were built to examine the association between depression treatment categories and the HRQoL scores. The OLS regression controlled for factors in the biological, psychological and social domains that may affect HRQoL. A majority of individuals reported taking antidepressants only (52%), 24.4% reported receiving psychotherapy with or without antidepressants and 23% did not receive either antidepressants or psychotherapy. In multivariable OLS regression with IPTWs, adults using only antidepressants had marginally higher physical component summary scores (beta=0.96, p value=0.096) compared to no depression treatment. There were no significant associations between depression categories and mental component summary scores. HRQoL was not affected by depression treatment in adults with coexisting arthritis and depression. Improvement in HRQoL may require a collaborative care approach and such intense care may not be replicated in real-world practice settings.

Brief Behavioral Activation Treatment for Depressed Adolescents Delivered by Nonspecialist Clinicians: A Case Illustration

Behavioral activation (BA) can be as effective as cognitive-behavioral therapy for the treatment of depression in adults, but to date there is little research with adolescents. This is problematic given the recognized need to increase access to evidence-based interventions for depression in young people. We have developed a new adaptation of brief Behavioral Activation (Lejuez, Hopko, Acierno, Daughters, & Pagoto, 2011) specifically for young people: Brief BA for depressed adolescents. In this paper, we use a case example with session-by-session measurement to show how a nonspecialist clinician can deliver this intervention successfully. We discuss the key themes arising from this training case, challenges the clinician faced, and how these were managed through training and supervision.

Psychotherapies vs. pharmacotherapies vs. combination therapies in depressive and anxiety disorders

Both psychological and pharmacological therapies have been found to be effective in the treatment of adult depression and anxiety disorders. Psychological treatments include cognitive behavior therapy, interpersonal therapy, behavioral activation, exposure therapies, and several other types of therapy. Pharmacological treatments include SSRIs, SNRIs TCAs, MAIOs and several other types. In this presentation the results of meta-analyses of trials directly comparing the effects of psychological and pharmalogical treatments will be presented, as well as meta-analyses of combined treatments versus either psychotherapy alone or pharmacotherapy alone. Results show that psychological and pharmacological treatments are probably about equally effective at the short term, and combined treatment is more effective than either psychotherapy or pharmacotherapy alone. In the presentation several other issues related to this group of trials will be discussed, like the influence of conflicts of interest and the (lack of) blinding in psychotherapy trials.Disclosure of interestThe author has not supplied his declaration of competing interest.

Is behavioural activation effective in the treatment of depression in young people? A systematic review and meta-analysis.

PurposeDepression is currently the leading cause of illness and disability in young people. Evidence suggests that behavioural activation (BA) is an effective treatment for depression in adults but less research focuses on its application with young people. This review therefore examined whether BA is effective in the treatment of depression in young people.MethodsA systematic review (International Prospective Register of Systematic Reviews reference: CRD42015020453), following Preferred Reporting Items for Systematic Reviews and Meta‐Analyses guidelines, was conducted to examine studies that had explored behavioural interventions for young people with depression. The electronic databases searched included the Cochrane Library, EMBASE, MEDLINE, CINAHL Plus, PsychINFO, and Scopus. A meta‐analysis employing a generic inverse variance, random‐effects model was conducted on the included randomized controlled trials (RCTs) to examine whether there were overall effects of BA on the Children's Depression Rating Scale – Revised.ResultsTen studies met inclusion criteria: three RCTs and seven within‐participant designs (total n = 170). The review showed that BA may be effective in the treatment of depression in young people. The Cochrane risk of bias tool and the Moncrieff scale used to assess the quality of the included studies revealed a variety of limitations within each.ConclusionsDespite demonstrating that BA may be effective in the treatment of depression in young people, the review indicated a number of methodological problems in the included studies meaning that the results and conclusions should be treated with caution. Furthermore, the paucity of studies in this area highlights the need for further research.Practitioner points Currently BA is included within National Institute for Health and Clinical Excellence (NICE, 2009) guidelines as an evidence‐based treatment for depression in adults with extensive research supporting its effectiveness. It is important to investigate whether it may also be effective in treating young people.Included studies reported reductions in depression scores across a range of measures following BA.BA may be an effective treatment of depression in young people.

The applicability of bright light therapy in adults with moderate, severe or profound intellectual disabilities: a brief report

Bright light therapy (BLT) is effective in the treatment of depression in the general population. It may be a good treatment option for adults with intellectual disabilities (ID) too. However, its applicability and effectiveness are not studied in groups of adults with ID, yet. Our aim was to study the applicability of BLT in adults with ID. Bright light therapy was offered for 2weeks, using a 10000 lux light box, to 14 adults with moderate, severe or profound ID. Applicability of BLT and change in depressive symptoms were studied with questionnaires. Bright light therapy was successfully applied for ≥10days in 10 participants. It was also applicable in participants with rather severe challenging behaviour. Before BLT, nine participants scored above the cut-off score of the ADAMS' depressive mood subscale. After BLT, six of them scored below cut-off. Bright light therapy is applicable in adults with moderate, severe of profound ID. Its effectiveness as a treatment for depression in adults with ID should be further studied.

Treatment of Depression in Adults with Fabry Disease.

Fabry disease (FD) is a genetic X-linked, multisystemic, progressive lysosomal storage disorder (LSD). Depression has emerged as a disease complication, with prevalence estimates ranging from 15 to 62%. This is a pilot study examining the effects of psychological counseling for depression in FD on depression, adaptive functioning (AF), quality of life (QOL), and subjective pain experience. Telecounseling was also piloted, as it has beneficial effects in other chronic diseases which make in-person counseling problematic. Subjects completed 6months of in-person or telecounseling with the same health psychologist, followed by 6months without counseling. Self-report measures of depression, AF, QOL, and subjective pain were completed every 3months. All subjects experienced improvements in depression, which were sustained during the follow-up period. Improvements in depression were correlated with improvements in mental health QOL and subjective pain severity, while improvements in mental health QOL were correlated with improvements in AF. While statistical comparison between counseling modes was not possible with the given sample size, relevant observations were noted. Recommendations for future research include replication of results with a larger sample size and a longer counseling period. The use of video counseling may be beneficial. In conclusion, the present pilot study supports the efficacy of psychological treatment for depression in people with FD, highlighting the importance of having health psychologists housed in LSD treatment centers, rather than specialty psychology/psychiatry settings, to increase participation and decrease potential obstacles to access due to perceived stigma.

Does Group CBT for Depression Do What It Says on the Tin? A Systemic Review and Meta-analysis of Group CBT for Depressed Adults (2000–2016)

The present study aimed to update previous meta-analyses of gCBT, and focus specifically on recent studies in which the Beck Depression Inventory (BDI) was used to assess outcome. PsycINFO, PubMed, EMBASE, and Cochrane were searched for eligible studies. Both randomized controlled trials (RTC, k = 9) and non-RTCs (k = 1) published since 2000 were included. On the BDI large significant effect sizes were found for gCBT compared with treatment as usual (TAU, d = 4.64), wailing list controls (WLC, d = 1.20), and both of these comparison conditions combined with studies of well-defined alternative treatments (ALT, d = 1.61). On the BDI a moderate effect size (d = 0.53) was found for comparisons of gCBT and ALT groups. gCBT also had large and significant effects on depressive cognition assessed with the Automatic Thoughts Questionnaire and the Dysfunctional Attitudes Scale compared with WLC and ALT comparison groups (d = 2.66). This meta-analysis shows that gCBT is a robust intervention for depression in adults.

S-adenosyl methionine (SAMe) for depression in adults.

Depression is a recurrent illness with high rates of chronicity, treatment-resistance and significant economic impact. There is evidence in the literature that S-adenosyl methionine (SAMe), a naturally occurring compound in the human body, has antidepressant efficacy. This product may be an important addition to the armamentarium of antidepressant agents. To assess the effects of SAMe in comparison with placebo or antidepressants for the treatment of depression in adults. We searched the Cochrane Common Mental Disorders Group's Specialised Register (CCMDCTR Studies and Reference Register), MEDLINE, EMBASE, PsycINFO, international trial registers ClinicalTrials.gov and the World Health Organization trials portal (ICTRP). We checked reference lists, performed handsearching and contacted experts in the field. The CCMDCTR literature search was last updated on 5 February 2016. Randomised controlled trials comparing SAMe with placebo or antidepressants in adults with a diagnosis of major depression. Two authors independently performed extraction of data and assessment of risk of bias. We contacted trialists of included studies for additional information. This systematic review included eight trials comparing SAMe with either placebo, imipramine, desipramine or escitalopram. We accepted trials that used SAMe as monotherapy or as add-on therapy to selective serotonin reuptake inhibitors (SSRIs), and we accepted both oral and parenteral administration. The review involved 934 adults, of both sexes, from inpatient and outpatient settings.The trials were at low risk of reporting bias. We judged the risk of selection, performance, detection and attrition bias as unclear or low, and one study was at high risk of attrition bias.There was no strong evidence of a difference in terms of change in depressive symptoms from baseline to end of treatment between SAMe and placebo as monotherapy (standardised mean difference (SMD) -0.54, 95% confidence interval (CI) -1.54 to 0.46; P = 0.29; 142 participants; 2 studies; very low quality evidence). There was also no strong evidence of a difference in terms of drop-out rates due to any reason between SAMe and placebo, when used as monotherapy (risk ratio (RR) 0.88, 95% CI 0.61 to 1.29; P = 0.52; 142 participants; 2 studies; low quality evidence).Low quality evidence showed that the change in depressive symptoms from baseline to end of treatment was similar between SAMe and imipramine, both as monotherapy (SMD -0.04, 95% CI -0.34 to 0.27; P = 0.82; 619 participants; 4 studies). There was also no strong evidence of a difference between SAMe and a tricyclic antidepressant in terms of drop-outs due to any reason (RR 0.61, 95% CI 0.28 to 1.31; P = 0.2; 78 participants; 3 studies; very low quality evidence).There was little evidence of a difference in terms of change in depressive symptoms from baseline to end of treatment between SAMe and escitalopram, both as monotherapy (MD 0.12, 95% CI -2.75 to 2.99; P = 0.93; 129 participants; 1 study; low quality evidence). There was no strong evidence of a difference between SAMe and escitalopram in terms of drop-outs due to any reason (RR 0.81, 95% CI 0.57 to 1.16; P = 0.26; 129 participants; 1 study; low quality evidence).There was low quality evidence that SAMe is superior to placebo as add-on to SSRIs in terms of change in depressive symptoms from baseline to end of treatment (MD -3.90, 95% CI -6.93 to -0.87; P = 0.01; 73 participants; 1 study). There was no strong evidence of a difference between SAMe and placebo as adjunctive therapy to an SSRI in terms of drop-outs due to any reason (RR 0.70, 95% CI 0.31 to 1.56; P = 0.38; 73 participants; 1 study; very low quality evidence).For all comparisons, secondary outcome measures of response and remission rates were consistent with these primary outcome measures.With regard to all extractable measures of the acceptability of SAMe, the quality of the evidence was low to very low. SAMe was not different from placebo and established antidepressants. The exception was that compared to imipramine, fewer participants experienced troublesome adverse effects when treated with parenteral SAMe.The specific adverse effects were not detailed in most of the included studies. There were two reports of mania/hypomania recorded for 441 participants in the SAMe arm. Given the absence of high quality evidence and the inability to draw firm conclusions based on that evidence, the use of SAMe for the treatment of depression in adults should be investigated further. Future trials should be in the form of large randomised controlled clinical trials of high methodological quality, with particular attention given to randomisation, allocation concealment, blinding and the handling of missing data. Comparator antidepressants from all classes should be used. Adverse events should be detailed for each participant, bearing in mind that induction of mania is of particular interest.

New screening and treatment guidelines for adult and adolescent depression

Almost 7% of U.S. adults have major depressive disorder. The leading cause of disability in high-income countries, depression is linked to higher mortality rates due to suicide and an inability to manage other health conditions. About 8% of adolescents have major depressive disorder, a precursor to recurrent bouts with the condition in adulthood. Depression at this age can affect schoolwork and relationships with family and peers and point to a greater risk for other mental health conditions and suicide later in life. The impact of depression on public health and individual quality of life prompted USPSTF earlier this year to release new recommendations on the screening of adults and adolescents for depression. In close succession to the new recommendations were new clinical guidelines on treatment of depression in adults and a warning about potential risks of antidepressants in adolescents. “The update to screening recommendations is a perfect opportunity for pharmacists to step up and identify people for further evaluation and treatment,” said Stephen Saklad, PharmD, BCPP, director of the psychiatric pharmacy program at University of Texas Health Science Center at San Antonio.

Are antidepressants effective? A debate on their efficacy for the treatment of major depression in adults

ABSTRACTRecently, the efficacy of antidepressants, a treatment used by 11% of US American adults, has been debated. Thousands of randomized controlled trials (RCTs) have been used to study antidepressants, with the majority demonstrating at least moderate superiority over placebo. In contrast, studies have found antidepressant effects to be unspecific and mainly resulting from placebo. The effects of antidepressants may also be overestimated due to selective publishing and selection of patients who have a high chance of response in RCTs. Studies have also shown the drugs do not reduce suicidal events when compared to placebo, and efficacy differences to placebo are often too small to prove clinical relevance. Here, we review the claims for and against antidepressant efficacy.