Use In Treatment Of Depression Research Articles

Association of Cannabis with Apneic Episodes in a Breastfed Infant: A Case Study.

Background: The use of cannabis and its perceived safety among pregnant and breastfeeding women has increased in the context of expanding legalization. Current guidelines recommend abstaining from the use of cannabis while pregnant or breastfeeding due to the potential for harm, although there is still much that is unknown in this field. Case Presentation: A 5-week-old infant presented with recurrent apneic episodes and a positive urine delta-9-tetrahydrocannabinol (THC) screening test. The infant's mother reported regular cannabis use for treatment of depression and anxiety while pregnant and breastfeeding. The infant was subsequently transitioned to formula feedings, and the infant's condition improved. Conclusion: Cannabis and its active metabolites can be transferred into breast milk and may have deleterious neurologic effects on infants. However, a causal relationship between cannabis exposure and short- or long-term neurologic sequelae has not yet been definitively established. Further studies are warranted to assess the safety of maternal cannabis use for breastfed infants.

Predictors of short-term response and the role of heavy alcohol use in treatment of depression

BackgroundDepression and alcohol use disorders frequently co-occur. However, research on psychosocial interventions for treating this dual pathology is limited. The Ostrobothnian Depression Study (ODS) aimed to increase the systematic use of evidence-based methods, particularly among patients with comorbid depression and substance use in a naturalistic setting. This is a secondary analysis of the ODS study. The aim of the present study was to explore the predictors of a response to treatment during the first six months of the ODS intervention with a specific focus on the role of comorbid heavy alcohol use.MethodsThe study sample (n = 242) comprised psychiatric specialist care patients with depression (Beck Depression Inventory score ≥ 17) at baseline. Patients with a baseline Alcohol Use Disorders Identification Test (AUDIT) score > 10 (n = 99) were assigned to the AUD (Alcohol Use Disorder) group in this study. The ODS intervention comprised behavioral activation (BA) for all and additional motivational interviewing (MI) for those in AUD group. The predictors of response to treatment (minimum of 50% reduction in depressive symptoms) during the first six months were analyzed with logistic regression models.ResultsIn the total sample at six months (n = 150), predictors of response to treatment were more severe depression (OR 1.10, CI 1.02–1.18), larger amounts of alcohol consumed (OR = 1.16, CI 1.03–1.31) and antipsychotic medication “not in use” (OR = 0.17, CI 0.07–0.44). In the non-AUD group (n = 100), more severe depression (OR 1.12, CI 1.01–1.25) and antipsychotics “not in use” (OR 0.20, CI 0.06–0.67) also predicted a positive response. Among AUD group patients (n = 50), larger amounts of alcohol consumed (OR 1.54, CI 1.04–2.27) and antipsychotic medication “not in use” (OR 0.12, CI 0.02–0.60) predicted a response to the treatment intervention.ConclusionsThe severity of symptoms and comorbid disorders were found to predict better treatment response, suggesting that the intervention was more effective in patients with severe symptoms. Patients with depression should be treated effectively regardless of having concomitant AUD. The results of this study suggest that BA combined with MI should be one of the treatment options for this dual pathology.Trial registrationClinicalTrials.gov Identifier NCT02520271 (11/08/2015).

Patterns in Medication Use for Treatment of Depression in Autistic Spectrum Disorder.

Depression impacts many individuals with autism spectrum disorder (ASD), carrying increased risk of functional impairment, hospitalization, and suicide. Prescribing medication to target depression in patients with ASD occurs despite limited available systematic data describing medication management of depression in this population. The purpose of this study is to discover prescribing patterns for individuals with MDD and ASD during this time period (2004-2012) to inform current and future prescribing practices with historical data. Drawing from a large clinical database describing the prescribing practices in patients with ASD, we identified 166 individuals with ASD (mean age 14.5 ± 8.3 years old) who received medication targeting symptoms of depression. We report prescribing rates for specific drugs, drug treatment duration, and reasons for drug discontinuation when applicable. Sertraline, mirtazapine, and fluoxetine were the three most commonly prescribed medications to treat comorbid depression for this patient population. Among 241 drug starts, 123 (49%) drug treatments were continued at the final reviewed follow-up visit (average treatment duration of ± 0.72 years). The most common reason for discontinuation across all medications prescribed was loss of or lack of effectiveness. This study raises concern that standard of care pharmacological treatments for depression in individuals with ASD may be less effective than in neurotypical populations. There remains a need to develop effective interventions for depression specifically tailored to the needs of individuals with ASD.

Magic Mushrooms – an exploratory look at how mental health professionals feel and think about Psilocybin

Psilocybin recently received breakthrough status by the FDA for its use in treatment of depression. We therefore investigated mental health professionals’ (MHPs) opinions on Psilocybin (n = 155). Overall, attitudes were neutral but self-rated knowledge of Psilocybin was low. The term used in the survey, ‘Psilocybin’ or ‘Magic Mushrooms’, did not significantly affect their responses. Some variables (i.e., gender, attitudes towards medical cannabis, and personal history of psychedelic usage) were associated with ratings of Psilocybin. These results provide a baseline of MHPs' thoughts on Psilocybin and what should be considered in the future if it is FDA-approved.

The Effect of Bariatric Surgery on Long-term Depression Treatment in Patients With Obesity.

In a large multisite cohort of Veterans who underwent Roux-en-Y gastric bypass (RYGB) or laparoscopic sleeve gastrectomy (LSG), initiation of (ie, incident) and persistence of (ie, continuation of preoperative) depression treatment are compared with matched nonsurgical controls. Bariatric surgery has been associated with short-term improvements in depression but less is known about longer term outcomes. In a retrospective cohort study, we matched 1713 Veterans with depression treatment who underwent bariatric surgery in Veterans Administration bariatric centers from fiscal year 2001 to 2016 to 15,056 nonsurgical controls using sequential stratification and examined the persistence of depression treatment via generalized estimating equations. Incidence of depression treatment was compared using Cox regression models between 2227 surgical patients and 20,939 matched nonsurgical controls without depression treatment at baseline. In surgical patients with depression treatment at baseline, the use of postsurgical depression treatment declined over time for both surgical procedures, but postsurgical patients had greater use of depression treatment at 5 years [RYGB: odds ratio=1.24, 95% confidence interval (CI): 1.04-1.49; LSG: odds ratio=1.27, 95% CI: 1.04-1.56] compared with controls. Among those without depression treatment at baseline, bariatric surgery was associated with a higher incidence of depression treatment compared with matched controls (RYGB: hazard ratio=1.34, 95% CI: 1.17-1.53; LSG: hazard ratio at 1-5 years=1.27, 95% CI: 1.10-1.47). Bariatric surgery was associated with a greater risk of postoperative incident depression treatment and greater persistence of postoperative depression treatment. Depression may worsen for some patients after bariatric surgery, so clinicians should carefully monitor their patients for depression postoperatively.

An MDS Evidence-Based Review on Treatments for Huntington's Disease.

Huntington's disease (HD) is a rare neurodegenerative disorder with protean clinical manifestations. Its management is challenging, consisting mainly of off-label treatments. The International Parkinson and Movement Disorder Society commissioned a task force to review and evaluate the evidence of available therapies for HD gene expansion carriers. We followed the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. Eligible randomized controlled trials were identified via an electronic search of the CENTRAL, MEDLINE, and EMBASE databases. All eligible trials that evaluated one or more of 33 predetermined clinical questions were included. Risk of bias was evaluated using the Cochrane Risk of Bias tool. A framework was adapted to allow for efficacy and safety conclusions to be drawn from the balance between the GRADE level of evidence and the importance of the benefit/harm of the intervention. Twenty-two eligible studies involving 17 interventions were included, providing data to address 8 clinical questions. These data supported a likely effect of deutetrabenazine on motor impairment, chorea, and dystonia and of tetrabenazine on chorea. The data did not support a disease-modifying effect for premanifest and manifest HD. There was no eligible evidence to support the use of specific treatments for depression, psychosis, irritability, apathy, or suicidality. Similarly, no evidence was eligible to support the use of physiotherapy, occupational therapy, exercise, dietary, or surgical treatments. Data for therapeutic interventions in HD are limited and support only the use of VMAT2 inhibitors for specific motor symptoms. © 2021 International Parkinson and Movement Disorder Society.

Termiticidal Activity of Ethanolic and n- Hexane Leaf Extraction of Calotropis procera, Cannabis indica and Mentha longifolia Against a Higher Termite Microtomes obesi

Depression is considered as affective disorder characterized by change in mood, lack of interest in the surrounding. It is one of the mental health problems of people all over the world. Depression is a multifaceted condition characterised by episodes of mood disturbances alongside other symptoms such as anhedonia, psychomotor complaints, feelings of guilt and suicidal tendencies, all of which can range in severity. Anxiety and fear can be defined as response of subject to real or potential threats that may impair his/her homeostasis that can significantly mark function and quality of life. Some of depressive disorder overlap those of anxiety disorders, including severe phobias, generalized anxiety disorder, social anxiety disorder, posttraumatic stress disorder, and obsessive-compulsive disorder. Anxietyrelated disorders such as patient’s nervousness, obsessive compulsive disorder and post-traumatic stress are foremost causes of infirmity in the world. Antidepressant and anxiolytic drug are the drug use for treatment of depression and anxiety but there are several side effect of these drug were observed like dry mouth, mental confusion, weakness and sedation. So, we evaluate the anti-depressant and anti-anxiety effect of N. Jatamansi root extract in rats by dose dependent manner. The behavior assessment observed by force swim test, locomotor activity, tail suspension test and elevated plus maze for depression and anxiety experimentation. The drug given 150 mg/kg and 300 mg/kg by oral route. The study observed that the ethanolic root extract reduced depression and anxiety generated by force swim test, tail suspension method, actophotometer and elevated plus maze.

Therapeutic Mechanisms of Ketamine.

Major depressive disorder is the greatest burden of developed countries in the context of morbidity caused by mental disorders. Until recent, ketamine has been mostly used for anesthesia, analgesia, sedation and treatment of chronic pain syndromes. However, unique pharmacodynamic properties of ketamine have increased interests in it's use for treatment of depression. It is assumed that ketamine reverses synaptic chronic stress pathology within one day of administration by postsynaptic glutamate activation, providing synaptic connectivity restoration that last for days or weeks. Potential glutamatergic agents, in context of treatment of major depressive disorder are not entirely novel phenomenon. Considering the aforementioned, current neurobiological view of depression as a solely monoaminergic phenomenon should be reassessed in order to prompt discovery of putative antidepressant drugs of novel generation. Acute side effects, such as increased salivation, increase in heart rate, systemic arterial pressure and intracranial pressure necessitate careful monitoring during intravenous administration of ketamine, even in subanesthetic doses. However, major burden of ketamine administration lies in it's ability to produce psychotomimetic side effects and emergence delirium. Esketamine nasal spray has now been widely approved and is considered safe in terms of acute side effects, tolerability and consistent therapeutic benefit.

Effect of Venlafaxine, Pramipexole, and Valsartan on Spermatogenesis in Male Rats

The study’s aim was to explore the effect of venlafaxine, valsartan, and pramipexole on spermatogenesis. It was hypothesized that these drugs may affect the male fertility because of their long-term use in treatment of depression, hypertension, and Parkinson’s diseases. Male rats were given venlafaxine, valsartan, and pramipexole at low- and high-dose levels orally once daily for 10 weeks. Testosterone (25 mg/kg) was given as a standard via an intramuscular route once weekly. Rats were sacrificed after blood collection by cardiac puncture, and testes were removed. Sperm parameters were examined from spermatozoa of the cauda epididymis, and testes were treated for histopathological analysis. Results showed nonsignificant effect of venlafaxine on the sperm count, whereas a decreased sperm count was noted in all the treatment groups as compared to that of the control except valsartan at a low dose, which significantly (p < 0.001) raised the sperm count (96.26 ± 2.4) in reference with the control value (49.13 ± 2.3). Treatments had variable effects on total sperm motility and morphological parameters, but valsartan at a low dose showed maximum sperm motility (71.55 ± 0.7) among all. DNA integrity of spermatozoa remained intact in all groups. Luteinizing hormone and follicle-stimulating hormone levels decreased, and testosterone levels increased in all treatment groups as compared to control values, which indicate fertility. Histopathology revealed normal texture of testes with venlafaxine and valsartan, but testicular damage occurred with high-dose pramipexole. It is concluded that the use of venlafaxine, valsartan, and pramipexole at a low dose is devoid of any harmful effect on spermatogenesis, whereas pramipexole at a high dose adversely affect it.

Depression treatment use among stroke individuals with depression: A cross-sectional analysis of the Medical Expenditure Panel Survey.

Depression is the most prevalent psychiatric comorbidity among stroke individuals. Despite the effectiveness of antidepressants and psychotherapy, data on the use of these treatments among stroke survivors is limited. The main objective of this study was to document prevalence of antidepressant use, types of antidepressants utilized, and adherence to antidepressants among stroke individuals. Retrospective, cross-sectional data obtained from the Medical Expenditure Panel Surveys (MEPS), for the years 2011, 2013 and 2015, was utilized for this study. Treatment for depression was categorized into three mutually exclusive categories: 1) antidepressants only, 2) antidepressants and psychotherapy (combination), and 3) No treatment. Adherence to antidepressants was measured using the Proportion of Days Covered (PDC) ratio. Adherence between antidepressant only and combination therapy group was compared using Student's t-test. A multinomial logistic regression analysis was used to further examine the association between patient characteristics and likelihood of receiving depression treatment. A total of 759 stroke individuals with comorbid depression were identified. Of these, 51.2% utilized only antidepressants, 12.6% utilized a combination treatment of antidepressants and psychotherapy and 31.7% did not receive treatment for depression. Selective Serotonin Reuptake Inhibitors (SSRI's) was the most commonly used antidepressants in the stroke population. Males (P = 0.04), age group of 40-64 years (P < 0.001), and African Americans (P = 0.02) constituted for the highest proportions of untreated stroke survivors. Among treated stroke individuals, adherence was higher for combination therapy users compared to those using antidepressants only (mean PDC = 65.8 ± 6.89 and 57.6 ± 3.74, respectively). Almost 70% of stroke individuals received some form of treatment for depression and several patient-related factors (gender, age, race, marital status, and comorbidity burden) were associated with the utilization of depression treatment. Future researchers need to investigate the factors responsible for lack of depression treatment in stroke individuals and policy makers should aim for a more patient centered care.

Prevalence, patterns and predictors of depression treatment among community-dwelling older adults with stroke in the United States: a cross sectional study

BackgroundDepression is one of the most common psychiatric conditions among stroke survivors and is associated with several negative health outcomes. However, little is known about the depression treatment patterns among stroke survivors. The objective of this study was to examine national-level prevalence, patterns and predictors of depression treatment among community-dwelling stroke survivors.MethodsThis study adopted a retrospective, cross-sectional study design using multiple years of Medical Expenditure Panel Survey (MEPS) (2002–2012) data. The study population consisted of older adults (age ≥ 50 years) who (i) were stroke survivors (ICD-9-CM codes of 430–438), (ii) did not die during the calendar year, and (iii) had co-occurring depression (ICD-9-CM code of 296.xx, or 311.xx). Depression treatment, identified by antidepressant medication and/or psychotherapy use, was the dependent variable of this study. Multinomial logistic regression analysis was conducted to examine the association of individual level factors with depression treatment among stroke survivors with co-occurring depression.ResultsThe final study sample consisted 370 (unweighted) community-dwelling older adults with self-reported stroke and depression. The prevalence of co-occurring depression among stroke survivors was 22.03% [95% Confidence Interval (CI) 19.7–24.4%]. An overwhelming majority (87.6%) of stroke survivors with co-occurring depression reported some form of depression treatment. Antidepressants only and combination therapy was reported by 74.8% (95% CI, 71.6–78.0%] and 12.8% (95% CI, 10.5–15.1%) by stroke survivors with co-occurring depression respectively. Approximately, 61% of stroke survivors with co-occurring depression reported using SSRIs, followed by SNRIs (15.2%), miscellaneous antidepressants (12.1%), TCAs (9.8%), phenylpiperazine antidepressants (5.2%), and tetracyclic antidepressants (4%). Sertraline (15.8, 95% CI, 12.7–19.0%) had the highest reported use among individual antidepressants.ConclusionsVast majority (nearly 90%) of the study sample received some form of depression treatment and several individual level factors (such as age, education) were associated with the report of depression treatment use. Future longitudinal studies are warranted to assess the comparative treatment benefits of antidepressants, psychotherapy and their combination. Healthcare providers should carefully assess the risks and benefits of antidepressant (such as SSRIs or TCAs) use in this vulnerable population prior to their use.

Prevalence, Patterns, and Predictors of Depression Treatment among Community-Dwelling Elderly Individuals with Dementia in the United States

Co-occurring dementia and depression exerts a substantial burden on the elderly. This study utilizes data from a nationally representative cohort of community-dwelling individuals 65 years and older to examine the prevalence, patterns, and predictors of depression treatment among elderly individuals with co-occurring dementia and depression. Retrospective, cross-sectional study. Multiple years of Medical Expenditure Panel Survey (2002, 2004, 2006, 2008, 2010, and 2012) data. The study sample consisted of elderly (age ≥65 years) individuals who 1) had dementia, 2) were alive during the calendar year, and 3) had co-occurring depression. The dependent variable of this study was depression treatment, identified by antidepressant medication with or without psychotherapy use. Individual level factors associated with depression treatment among elderly individuals with dementia and co-occurring depression were evaluated by conducting multinomial logistic regression. Co-occurring depression prevalence among community-dwelling elderly individuals with dementia was approximately 22%. An overwhelming majority (nearly 88%) of the study sample reported receipt of depression treatment. Antidepressants only and combination therapy (antidepressant with psychotherapy) was reported by 75% and 13%, respectively, of the study sample. Age, race/ethnicity, marital status, limitations of instrumental activities of daily living, perceived mental health status, and pain were significantly associated with the reporting of receipt of depression treatment. An overwhelming majority of the study sample received depression treatment and several subgroup differences (such as in terms of age) existed in terms of reporting the use of depression treatment was observed.

Relationship between personality and psychopathology in a longitudinal community study: a test of the predisposition model

Mounting evidence supports the notion that personality is crucial in the aetiopathology of common mental disorders, but studies that allow for aetiological conclusions are lacking. The aim of the present study was thus to provide a test of the predisposition model. We analysed data from the Zurich Cohort Study, a 30-year longitudinal epidemiological community study of an adult cohort (n = 591) from 1979 to 2008. Personality was assessed in 1988 with an established personality questionnaire, and psychopathology through seven semi-structured interviews between 1979 and 2008. On the basis of personality assessment from 1988, used as predictor of subsequent psychopathology (1993-2008), while adjusting for sex and prior mental disorders (1979-1988), neuroticism related significantly with future major depression episodes [odds ratio (OR) = 1.41], anxiety disorders (OR = 1.32) and depression treatment use (OR = 1.41). When participants with a past 10-year history (i.e. 1979-1988) of either major depression, anxiety disorder or depression treatment use were excluded, neuroticism in 1988 still significantly predicted first incidence (i.e. 1993-2008) of major depression episodes (OR = 1.53) and depression treatment use (OR = 1.84). The present study provides compelling evidence that the personality trait of neuroticism constitutes an independent risk factor for subsequent major depression episodes and use of respective professional treatments, which serves as a proxy for particularly severe and impairing depression episodes. We therefore advocate that personality traits could provide clinically useful prognostic information when considered carefully.

Depressed older adults may be less cared for than depressed younger ones

The aim of the study was to investigate depression treatment use, either psychotherapy (PT) or antidepressant drugs (ADT) in the older and younger depressed population. Cohorts of 6316 elderly (≥65 year-old) and 25,264 matched non-elderly (25–64 year-old) depressed patients were created from a large national claims database of managed care plans from 2003 to 2006. Factors associated with ADT or PT were assessed using multivariate logistic models. During the 120 days following the depression diagnosis, the elderly persons were less often treated than the younger adults either by ADT (25.6% vs. 33.8%) or by PT (13.0% vs. 34.4%). ADT dispensing occurred later in the elderly group (51 vs. 14 days). ADT was associated with comorbid chronic conditions or polypharmacy in the elderly and younger adults. The selection of treatment (ADT or PT) was associated with the history of treated depression using the same type of treatment, in both groups. Thus, depression goes commonly untreated. Comorbidity was associated with higher ADT dispensing rates. However, although depressed elderly commonly presented with comorbidity, this age group was at higher risk of untreated illness or later treatment.

Complementary, Holistic, and Integrative Medicine

1. Anju Sawni, MD* 2. Cora Collette Breuner, MD, MPH† 1. *Assistant Professor of Pediatrics, Division of Adolescent Medicine, Wayne State University School of Medicine/Children's Hospital of Michigan, Detroit, MI. 2. †Associate Professor of Pediatrics, Adolescent Medicine Division, Adjunct Associate Professor, Orthopedics and Sports Medicine, Seattle Children's Hospital University of Washington, Seattle, WA. * Abbreviations: CAM: : complementary and alternative medicine EFAs: : essential fatty acids SJW: : St John's Wort The use of complementary and alternative medicine (CAM) has increased dramatically in the pediatric population in the United States. (1) Concerns regarding adverse effects, cultural and personal reluctance, and unknown consequences of long-term use of pharmacologic treatments for depression, sleep disorders, and substance abuse, make many parents and adolescents uncomfortable; thus, they seek treatments that are “more natural” and “safer.” Medication as the first line of treatment generally is not recommended to treat mild depression. Sleep disorders in children often are related to the child’s environment (chaotic home life, anxiety, poor sleep hygiene, etc). Promoting a healthy mind, body, and spirit in children is important in developing emotional stability. Achieving this goal involves good nutrition, exercise, a healthy environment, proper sleep hygiene, and supportive family, friends, and community. Integration of CAM therapies such as mind-body therapies (meditation, yoga, self-hypnosis, relaxation), herbs and supplements, and massage may be helpful as well. Depression affects a large number of children and adolescents. Prevalence rates for depression range from 1% to 2% of prepubertal children to 3% to 8% of adolescents. (2) Despite scientific evidence supporting the effectiveness of psychopharmacologic intervention, the use of antidepressants has received negative publicity and is not easily accepted by many parents. Medication as the first line of treatment generally is not used to treat mild depression; thus, some CAM therapies may provide effective alternatives for treatment of mild depression. Children, adolescents, and young adults are using CAM to treat depression. (1)(3)(4) ### Lifestyle Therapies A child’s diet is the foundation for the structure and function of the developing brain. (5) Adequate nutrients are essential for optimal production of neurotransmitters that affect mood, …

How Might Yoga Help Depression? A Neurobiological Perspective

Depression is a prevalent mental health condition worldwide and is the leading cause of disability in adults under the age of 45. Most individuals with major depressive disorder (MDD) report only a 50% decrease in symptoms with the use of the standard allopathic treatments for depression. The mechanisms underlying depression remain poorly understood even though stress and its correlates contribute to multiple aspects of the phenomenology of depression. Thus, stress and depression are clearly linked, as stress may precipitate or exacerbate depressive symptoms and depression may be a cause and/or outcome of acute or chronic stress. Therefore, use of additional therapeutic approaches to address stress and depression, such as complementary therapies including yoga, may contribute importantly to symptom reduction. Based on an emerging picture of how stress and mood are regulated within the nervous system, and considering the Executive Homeostatic Network concept that we have recently advanced, we provide an integrative overview of biological mechanisms and substrates that may mediate depression, which should be targets for research to evaluate how the practice of yoga can mitigate depressive symptomatology.

Innovative ICT solutions to improve treatment outcomes for depression: the ICT4Depression project.

Depression is expected to be the disorder with the highest disease burden in high-income countries by the year 2030. ICT4Depression (ICT4D) is a European FP7 project, which aims to contribute to the alleviation of this burden by making use of depression treatment and ICT innovations. In this project we developed an ICT-based system for use in primary care that aims to improve access as well as actual care delivery for depressed adults. Innovative technologies within the ICT4D system include 1) flexible self-help treatments for depression, 2) automatic assessment of the patient using mobile phone and web-based communication 3) wearable biomedical sensor devices for monitoring activities and electrophysiological indicators, 4) computational methods for reasoning about the state of a patient and the risk of relapse (reasoning engine) and 5) a flexible system architecture for monitoring and supporting people using continuous observations and feedback via mobile phone and the web. The general objective of the ICT4D project is to test the feasibility and acceptability of the ICT4D system within a pilot study in the Netherlands and in Sweden during 2012 and 2013.

The Cochrane library and the treatment of major depression in children and youth: an overview of reviews

AbstractBackgroundMajor depression (MDD) in children and adolescents is a mood disorder that has up to 25% lifetime prevalence by the end of adolescence. Pharmacological and nonpharmacological treatments are recommended to reduce symptoms, increase psychosocial functioning, and prevent relapse. Traditionally, decisions for these treatments were made based on reported effects for adults, but a body of pediatric‐based evidence is now emerging to inform treatment decisions.ObjectivesTo synthesize the evidence currently in the Cochrane Library Database of Systematic Reviews (CDSR) related to the question: ‘In children and youth with diagnosed major depression, do pharmacologic or nonpharmacologic treatments improve symptom response, response rates, functional capacity, adherence and persistence, and decrease cost and adverse events?’.MethodsCDSR was searched using the term ‘depression’ in the title for all systematic reviews examining pharmacologic and nonpharmacologic interventions for the treatment of depression in children ⩽18 years. Data were extracted and entered into tables; data were synthesized using qualitative and quantitative methods.Main ResultsOf the studies included in the CDSR, there was no significant improvement in treatment outcomes in depressed children and adolescents treated with pharmacological (tricyclic antidepressant [TCA] or selective serotonin reuptake inhibitor [SSRI]) or nonpharmacological (exercise) interventions.Author's ConclusionsAlthough this overview indicates no clear evidence for pharmacological and nonpharmacological interventions for treatment of depression in this age group, the CDSR does not include several recent research publications in this area that demonstrate beneficial effects of treatment. In context of existing research there may be a moderate effect of SSRI in moderate to severe depression in children and youth. Best practice recommendations are consideration of treatment with SSRI (fluoxetine first line) in moderate to severe depression with close monitoring and weighing risk/benefit profile based on individual assessment. Psychotherapeutic interventions not in this overview, including Cognitive Behavioral Therapy (CBT) and Interpersonal Therapy (IPT), have some evidence of effectiveness in mild to moderate depression. Although exercise remains an important part of healthy living, there is no evidence to support its use in treatment of depression in children and adolescents. This overview in the context of recent research indicates the need for ongoing study in this important area of child and youth mental health. Copyright © 2009 The Cochrane Collaboration. Published by John Wiley &amp; Sons, Ltd. The Cochrane Collaboration

Patient perspectives on improving the depression referral processes in obstetrics settings: a qualitative study

Objectives Although depression screening in obstetrics settings has been recommended, little research exists to guide strategies for screening follow up and depression referral. The purpose of this qualitative study was to inform recommendations for depression screening follow up and referral in obstetrics settings based on responses from a key sample of women about influences on depression treatment use and engagement. Methods A stratified purposeful sampling based on pregnancy, socioeconomic status and depression severity was used to identify 23 women who completed semistructured interviews that centered on their beliefs about what would prevent or facilitate entry into depression treatment in the context of obstetrical care. We conducted a thematic analysis through an iterative process of expert transcript review, creation of and refining codes and identifying themes. Results Two broad themes influencing depression treatment usage emerged including practical and psychological factors. Among practical factors, women reported a strong preference for treatment provided in the obstetric clinic or in the home with a desire for a proactive referral process and flexible options for receiving treatment. Psychological factors included differing conceptualizations of depression, knowledge about severity and treatment and issues of stigma. Conclusions This study suggests that the current standard practice of depression screening and referral to specialty treatment does not match with perceived influences on treatment use among our sample of perinatal women. Recommendations derived from the results for improving follow up with screening and depression referral in obstetrics settings are provided as a platform for further research.

Illness perceptions associated with perinatal depression treatment use

The relationship between psychological beliefs about depression and depression treatment use was examined in depressed pregnant and postpartum women using the Common Sense Model as a framework (CSM; Leventhal H, Nerenz DR, Steele DF (1984) A handbook of psychology and health illness representations and coping with health threats. Hillsdale, NJ: Erlbaum.). Pregnant women who screened >/ 10 on the Edinburgh Postnatal Depression Scale (EPDS; Cox et al. Br J Psychiatry 150:782-786, 1987) completed measures of depression symptoms, perceptions and treatment at three time points through 6 weeks postpartum. Understanding modifiable beliefs may be useful in improving low rates of perinatal depression treatment use.