Treatment Of Moderate Depression Research Articles

The Effect of Synbiotic as an Adjuvant Therapy to Fluoxetine in Moderate Depression: A Randomized Multicenter Trial

Background: Depression is a serious and burdensome disorder in modern societies, with lifetime prevalence of about 16%. Disturbed immune responses in the gut and immune-privileged sites including the central nervous system might occur subsequent to dysbiosis of gut microbiome. In this study we aimed at assessing the efficacy of 6 weeks synbiotic supplementation in the treatment of moderate depression in a double-blind, placebo-controlled, multi-center, and randomized trial. Methods: A total of 40 adult outpatients, who met the diagnostic and statistical manual of mental disorders fifth edition for moderate depression, were recruited based on the structured interview for DSMV. Recruited patients had a Hamilton rating scale for depression (HAM-D) score of 17 to 23 at baseline. All patients received fluoxetine (20 mg/d) for 4 weeks. Then, either a synbiotic capsule (plus fluoxetine) or placebo (plus fluoxetine) was added to the therapy for 6 weeks. Results: The mean age of the participants in the synbiotic treated group was 34.45 years and it was 35.50 years in the placebo group. Following the adjustment of ANCOVA models for gender, age, and BMI at baseline, there was a greater reduction in HAM-D score in synbiotic treated patients (Mean ± SD = -19.25 ± 1.71) compared to placebo taking group (Mean ± SD = -17.75 ± 2.05; P = 0.024). At the end of the 10th week of the intervention and after applying ANCOVA adjusted for the mentioned variables as well as baseline HAM-D score, it was found that the synbiotic group had a significantly decreased HAM-D score compared to the placebo (3.65 vs. 4.80, P = 0.013). Conclusions: The results of the current study revealed the efficacy of synbiotic as an adjuvant therapy in moderate depression.

Predictors of response in the treatment of moderate depression

Objective:To identify neurocognitive and sociodemographic variables that could be associated with clinical response to three modalities of treatment for depression, as well as variables that predicted superior response to one treatment over the others.Method:The present study derives from a research project in which depressed patients (n=272) received one of three treatments – long-term psychodynamic psychotherapy (n=90), fluoxetine therapy (n=91), or a combination thereof (n=91) – over a 24-month period.Results:Sociodemographic variables were not found to be predictive. Six predictive neurocognitive variables were identified: three prognostic variables related to working memory and abstract reasoning; one prescriptive variable related to working memory; and two variables found to be moderators.Conclusions:The results of this study indicate subgroups of patients who might benefit from specific therapeutic strategies and subgroups that seem to respond well to long-term psychodynamic psychotherapy and combined therapy. The moderators found suggest that abstract reasoning and processing speed may influence the magnitude and/or direction of clinical improvement.

Study on alleviating side effect of paroxetine and improving quality of life using acupuncture in treatment of mild or moderate depression

Objective To study the effect of acupuncture on alleviating side effect of paroxetine and improving quality of life in treating mild or moderate depression. Methods A randomized controlled clinical trial was performed. Inpatients and outpatients with depression (n=72) were randomly divided into electro-acupuncture(EA) and paroxetine group (group A, n=23), manual acupuncture and paroxetine group (group B, n=32) and paroxetine alone group (group C, n=17). Outcome was assessed with Hamilton depression scale(HAMD) at baseline and weeks 1, 2, 4, and 6. Side effects were assessed with rating scale for side effects(SERS) at baseline and weeks 2, 4, and 6.The world health organization quality of life(WHOQOL-BREF) scale on quality of life was given at baseline and week 6. Results There were no differences among the three groups at baseline (P>0.05). According to the HAMD scores, significant difference was seen between group A and C (Z=3.2242, P 0.05). SERS scores in the acupuncture groups were significantly lower than those for paroxetine alone at weeks 2(F=5.48, P<0.05), week 4(F=7.70, P<0.05), and week 6 (F=7.73, P<0.05). WHOQOL-BREF scores were significantly higher in the two acupuncture groups than those in the paroxetine only group in five periods, which were total subjective feelings regarding quality of life(F=4.19, P<0.05), health sensation(F=4.49, P<0.05), physical condition(F=12.46, P<0.05), psychology condition(F=10.52, P<0.05) and circumstances(F=5.36, P<0.05). Conclusion Acupuncture can alleviate side effect of paroxetine and improve quality of life in treating mild or moderate depression. Key words: Depression; Acupuncture treatment; Side effect; Quality of life

Neurocognitive changes in depressed patients in psychodynamic psychotherapy, therapy with fluoxetine and combination therapy

BackgroundRandomized controlled trials (RCTs) examining the efficacy of different forms of therapy for depression are relatively common. However, there are not many RCTs comparing neurocognitive effects of these treatments. Neurocognitive changes across three types of treatment for depression were compared. Long-term psychodynamic psychotherapy (LTPP) was compared with fluoxetine treatment, and their combination, in the treatment of moderate depression. MethodsA 272 adult patients with beck depression inventory (BDI) scores 20–35 were randomized to receive LTPP, fluoxetine monotherapy or their combination for a 24 months period. The Wechsler adult intelligence scale version III (WAIS-III) was the primary neuropsychological measure. ResultMultilevel mixed model analyses indicated that there were neurocognitive changes within and between treatments, with statistically significant differences over time (p>.01). LTPP and combined treatment seemed to be more efficacious in modifying specific areas of cognition than fluoxetine alone. LimitationsSample very homogenous, threatening external validity. ConclusionsLTPP and its combination with fluoxetine demonstrated to be effective for specific neurocognitive increasing in patients with moderate depression. This study suggests marked differences over time in the neurocognitive effects between the three treatment forms compared. Results found here may be of clinical relevance for building bridges between pharmacotherapy and psychodynamic psychotherapy.

Comparative Efficacy and Safety of a Once-Daily Dosage of Hypericum Extract STW3-VI and Citalopram in Patients with Moderate Depression: A Double-Blind, Randomised, Multicentre, Placebo-Controlled Study

The objective of this double-blind, randomised, placebo-controlled, multicentre clinical study was to demonstrate the non-inferiority and safety of the hypericum extract STW3-VI in a once-daily dosage regime in the treatment of moderate depression. During the 6-week treatment phase, the course of depression was documented by use of HAMD (items 1-17), the von Zerssen's Adjective Mood Scale (BfS) and the CGI scales. The primary objective of this 3-arm design study was to demonstrate the non-inferiority of hypericum extract STW3-VI (900 mg) to the SSRI citalopram (20 mg) and superiority of hypericum over placebo. Outpatients (N = 388) suffering from moderate depression were enrolled. The safety and tolerability of hypericum extract in comparison to citalopram and placebo was investigated on the basis of CGI, the occurrence of adverse events and the investigation of laboratory parameters and vital signs. From almost identical baseline values of 21.9 +/- 1.2 points (hypericum extract), 21.8 +/- 1.2 points (citalopram) and 22.0 +/- 1.2 points (placebo), the HAMD score was reduced to 10.3 +/- 6.4 (hypericum extract), 10.3 +/- 6.4 (citalopram) and 13.0 +/- 6.9 (placebo), respectively. Based on this data, the statistical significant therapeutic equivalence of hypericum extract STW3-VI to citalopram (p < 0.0001) and the superiority of this hypericum extract over placebo (p < 0.0001) was demonstrated. At the end of treatment 54.2 % (hypericum extract), 55.9 % (citalopram) and 39.2 % (placebo) of the patients were assessed as therapy responders. The secondary efficacy parameters, change in BfS, CGI and amount of therapy responders showed that the hypericum group was not statistically different from the citalopram group, and significantly superior to the placebo group. Significantly more adverse events with "certain", "probable" or "possible" relation to study medication were documented in the citalopram group (hypericum: 17.2 %, citalopram: 53.2 %, placebo: 30 %). In most cases, the investigators assessed the tolerability of hypericum extract, citalopram and placebo as "good" or "very good". The non-inferiority of hypericum extract as compared to citalopram and the superiority of both active compounds to placebo were demonstrated, as well as a better safety and tolerability of hypericum extract in comparison to citalopram. These results revealed that hypericum extract STW3-VI is a good alternative to chemically defined antidepressants in the treatment of outpatients with moderate depression.

Change in instrumental activities of daily living disability in female senior patients with musculosceletal pain: A prospective, randomized, controlled trial

Previous studies found that depressive symptoms and low functional self-efficacy are associated with the occurrence of disabling musculoskeletal pain, and diminished quality of life in elderly people. The target of this study was to consider the change in instrumental activities of daily living (IADL) disability and health related quality of life after integrative psychotherapeutic treatment program of depressive symptoms in senior female patients with musculoskeletal pain. In an 8-week outpatient-based, random, prospective, controlled trial, 36 female patients between 70 and 79 with a history of clinically evident musculoskeletal pain and afflicted with depressive symptoms, but who were able to bathe, walk, dress, and transferring inside the house were evaluated. The study was performed using the Center for Epidemiological Studies Depression Scale (CES-D), IADL, and the Health Survey (SF-36). In comparison with the untreated group, according to the intent-to-treat principle, significant changes on the CES-D ( P < 0.01), IADL ( P < 0.01), and all scales of SF-36 were observed after eight weeks in the treated subjects. The treatment of moderate depression with integrative psychotherapy may be efficacious in improving of IADL disability and health related quality of life in affected senior female patients with musculoskeletal pain.

The CAM network – Challenges and opportunities

Over the past two decades, there has been an increase in both interest in and use of complementary and alternative medicine (CAM) among patients in the developed world. This has been best documented among adult patients, but it is increasingly clear that CAM is more widely used by families for the treatment of children, especially children with chronic diseases. The frequency of CAM use among children with some chronic disorders approaches 70%. The increase in interest in CAM is related to a number of factors: cultural belief in the use of traditional medicines, the assumption that natural therapies are more likely to be safe, and the unfortunate fact that our ability to control many chronic diseases and the adverse effects of conventional therapy is less than optimal. This presents a problem for the child health care practitioner. First, many parents are reluctant to disclose to the practitioner that they are using CAM for fear of damaging the doctor-patient relationship or of being labelled a CAM user. Second, even when families do disclose the use of CAM, the child health care worker is often faced with a paucity of reliable information on the efficacy and safety of these preparations, notably when used in combination with conventional medications. This is unfortunate for all concerned because there is increasing evidence that CAM may be more efficacious, but also less safe, than was previously believed. As an example, we now know that St John’s wort is a moderately effective agent in the treatment of moderate depression. It is also known that St John’s wort is a modestly effective inhibitor of CYP3A4, the isozyme of the cytochrome responsible for 50% of human drug metabolism via cytochrome P450, including the metabolism of cyclosporine, nifedipine and nelfinavir. An additional example is the fact that many therapeutic products (ranging from antibiotics to immunosuppressives) originated from natural products. Teaching about CAM in the undergraduate and postgraduate medical curriculum of most conventional practitioners ranges from scant to none. Thus, the child health care practitioner is faced with a major knowledge gap in terms of providing optimal therapy for children and their families. In this context, the development of PedCAM, a childfocused CAM Network, is a welcome development. What is the promise of such a network? First, it provides an opportunity for clinicians and researchers with an interest in CAM to interact on a regular basis with people with similar interests. This includes the opportunity to collaborate with international partners. The development of National Institutes of Health-supported research units in the United States and international groups such as the Consortium for the Globalization of Chinese Medicine suggests that there is rich potential in such collaborations. This leads to the second opportunity, which is the development of research projects to assess the safety, efficacy and optimal use of CAM to help guide practitioners to use the right therapy for the right patient. The third opportunity is the dissemination of validated evidence-based information about the appropriate use

Hypericum extract versus imipramine or placebo in patients with moderate depression: randomised multicentre study of treatment for eight weeks.

Objectives: To assess the efficacy and safety of hypericum extract (STEI 300, Steiner Arzneimittel, Berlin) compared with imipramine and placebo in patients in primary care with a current episode of...

An Evaluation of Major Components in a Self-Control Therapy Program for Depression

Five conditions were compared in a study attempting to disassemble a behavioral self-control program previously shown to be effective in the treatment of moderate depression. Conditions were: (1) Self-Monitoring only; (2) Self-Monitoring plus Self-Evaluation; (3) Self-Monitoring plus Self-Reinforcement; (4) the full Self-Control package including Self-Monitoring, Self-Evaluation, and Self-Reinforcement; and (5) a Waiting List Control. Fifty-six volunteer female subjects from the community were screened on MMPI and Research Diagnostic Criteria for moderate, nonpsychotic, nonbipolar depression. Therapy was conducted in seven highly structured weekly 11/2 hour group sessions. Results indicated that all treatment conditions did better than the Waiting List controls on self-report and interviewer rating measures of depression. Only minor differences were found on behavioral observation measures taken in interview and group settings. No consistent effects were found for separate components, with the possible exception of a negative effect for the Self-Evaluation component on some measures. Results are discussed in terms of research strategies for assessing therapy programs.