I am a clinical psychologist and psychotherapist. I currently work on my PhD.
Discover evidence-based therapies for depression.
What does it mean to “live” with depression? The word “live” is purposefully in quotation marks, because it doesn’t feel much like living. It can feel as if every little part of you aches with pain, and as if everything you do requires an enormity effort. It can feel as if you are constantly pushing an immense boulder up a hill, like Sisyphus in Greek mythology, but you aren’t getting anywhere.
121 million people worldwide suffer with symptoms of clinical depression. Over 80% of them are not receiving any kind of treatment. Depression goes hand in hand with suicidal tendencies, 90% of people who commit suicide being diagnosed with clinical depression or another mental health problem. Such statistics paint an awfully dark picture.
Depression is the epidemic of our modern existence. With Prince Harry as a prime example, more and more people are bravely stepping up to bring light to the mysteries of mental health and fight the taboos of depression. Even if the mysteries surrounding depression slowly coming to the surface, there is still a long way to go to fight the stigma surrounding the treatment of depression. Science is making big advances into finding effective treatments for those living with depression. With evidence-based scientific research on our side, perhaps we can start to better understand how to brighten people’s lives.
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Abstract: Internet addiction (IA) is a risk factor while some psychosocial factors can be protective against depression among adolescents. Mechanisms of IA onto depression in terms of mediations and moderations involving protective factors are unknown and were investigated in this study.A representative cross-sectional study was conducted among Hong Kong Chinese secondary school students (n=9518).Among males and females, prevalence of depression at moderate or severe level (CES-D≥21) was 38.36% and 46.13%, and that of IA (CIAS>63) was 17.64% and 14.01%, respectively. Adjusted for socio-demographics, depression was positively associated with IA [males: adjusted odds ratio (AOR)=4.22, 95% CI=3.61-4.94; females: AOR=4.79, 95% CI=3.91-5.87] and negatively associated with psychosocial factors including self-esteem, positive affect, family support, and self-efficacy (males: AOR=0.76-0.94; females: AOR=0.72-0.92, p<.05). The positive association between IA and depression was partially mediated by the protective psychosocial factors (mainly self-esteem) across sexes. Through significant moderations, IA also reduced magnitude of protective effects of self-efficacy and family support among males and that of positive affect among both sexes against depression.The high IA prevalence contributes to increased risk of prevalent depression through its direct effect, mediation (reduced level of protective factors) and moderation (reduced magnitude of protective effects) effects. Understanding to mechanisms between IA and depression through protective factors is enhanced. Screening and interventions for IA and depression are warranted, and should cultivate protective factors, and unlink negative impact of IA onto levels and effects of protective factors.
Pub.: 15 Sep '16, Pinned: 12 May '17
Abstract: The aims of this study were to explore depression, self-esteem and verbal fluency functions among normal internet users, mildly internet addictions and severely internet additions.
Pub.: 15 Oct '16, Pinned: 12 May '17
Abstract: Depression is an important target of psychological assessment in patients with end-stage renal disease because it predicts their morbidity, mortality, and quality of life. We assessed the effectiveness of cognitive-behavioral therapy in chronic hemodialysis patients diagnosed with major depression by the Mini International Neuropsychiatric Interview (MINI). In a randomized trial conducted in Brazil, an intervention group of 41 patients was given 12 weekly sessions of cognitive-behavioral group therapy led by a trained psychologist over 3 months while a control group of 44 patients received the usual treatment offered in the dialysis unit. In both groups, the Beck Depression Inventory, the MINI, and the Kidney Disease and Quality of Life-Short Form questionnaires were administered at baseline, after 3 months of intervention or usual treatment, and after 9 months of follow-up. The intervention group had significant improvements, compared to the control group, in the average scores of the Beck Depression Inventory overall scale, MINI scores, and in quality-of-life dimensions that included the burden of renal disease, sleep, quality of social interaction, overall health, and the mental component summary. We conclude that cognitive-behavioral group therapy is an effective treatment of depression in chronic hemodialysis patients.
Pub.: 21 May '09, Pinned: 06 May '17
Abstract: Patients with depression often report impairments in social functioning. From a patient perspective, improvements in social functioning might be an important outcome in psychotherapy for depression. Therefore, it is important to examine the effects of psychotherapy on social functioning in patients with depression.We conducted a meta-analysis on studies of psychotherapy for depression that reported results for social functioning at post-treatment. Only studies that compared psychotherapy to a control condition were included (31 studies with 2956 patients).The effect size of psychotherapy on social functioning was small to moderate, before [Hedges' g = 0.46, 95% confidence interval (CI) 0.32-0.60] and after adjusting for publication bias (g = 0.40, 95% CI 0.25-0.55). Univariate moderator analyses revealed that studies using care as usual as a control group versus other control groups yielded lower effect sizes, whereas studies conducted in the USA versus other countries and studies that used clinician-rated instruments versus self-report yielded higher effect sizes. Higher quality studies yielded lower effect sizes whereas the number of treatment sessions and the effect size of depressive symptoms were positively related to the effect size of social functioning. When controlling for these and additional characteristics simultaneously in multivariate meta-regression, the effect size of depressive symptoms, treatment format and number of sessions were significant predictors. The effect size of social functioning remained marginally significant, indicating that improvements in social functioning are not fully explained by improvements in depressive symptoms.Psychotherapy for depression results in small to moderate improvements in social functioning. These improvements are strongly associated with, but not fully explained by, improvements in depressive symptoms.
Pub.: 30 Jan '14, Pinned: 06 May '17
Abstract: Depressive symptoms and pain are common in patients on chronic hemodialysis (HD), yet their associations with quality of life (QOL) are not fully understood. We sought to characterize the longitudinal associations of these symptoms with QOL. As part of a trial comparing two symptom management strategies in patients receiving chronic HD, we assessed depressive symptoms using the Patient Health Questionnaire-9 (PHQ-9), and pain using the Short Form McGill Pain Questionnaire (SF-MPQ) monthly over 24 months. We assessed health-related QOL (HR-QOL) quarterly using the Short Form 12 (SF-12) and global QOL (G-QOL) using a single-item survey. We used random effects linear regression to analyze the independent associations of depressive symptoms and pain, scaled based on 5-point increments in symptom scores, with HR-QOL and G-QOL. Overall, 286 patients completed 1417 PHQ-9 and SF-MPQ symptom assessments, 1361 SF-12 assessments, and 1416 G-QOL assessments. Depressive symptoms were independently and inversely associated with SF-12 physical HR-QOL scores (β = -1.09; 95% confidence interval [CI]: -1.69, -0.50, P < 0.001); SF-12 mental HR-QOL scores (β = -4.52; 95% CI: -5.15, -3.89, P < 0.001); and G-QOL scores (β = -0.64; 95%CI: -0.79, -0.49, P < 0.001). Pain was independently and inversely associated with SF-12 physical HR-QOL scores (β = -0.99; 95% CI: -1.30, -0.68, P < 0.001) and G-QOL scores (β = -0.12; 95%CI: -0.20, -0.05, P = 0.002); but not with SF-12 mental HR-QOL scores (β = -0.16; 95%CI: -0.050, 0.17, P = 0.34). In patients receiving chronic HD, depressive symptoms and to a lesser extent pain, are independently associated with reduced HR-QOL and G-QOL. Interventions to alleviate these symptoms could potentially improve patients' HR-QOL and G-QOL.
Pub.: 19 Nov '14, Pinned: 06 May '17
Abstract: There is growing recognition of the importance of both functioning and quality of life (QoL) outcomes in the treatment of depressive disorders, but the meta-analytic evidence is scarce. The objective of this meta-analysis of randomized controlled trials (RCTs) was to determine the absolute and relative effects of psychotherapy, pharmacotherapy and their combination on functioning and QoL in patients with depression.One hundred and fifty-three outcome trials involving 29 879 participants with depressive disorders were identified through database searches in Pubmed, PsycINFO and the Cochrane Central Register of Controlled Trials.Compared to control conditions, psychotherapy and pharmacotherapy yielded small to moderate effect sizes for functioning and QoL, ranging from g = 0.31 to g = 0.43. When compared directly, initial analysis yielded no evidence that one of them was superior. After adjusting for publication bias, psychotherapy was more efficacious than pharmacotherapy (g = 0.21) for QoL. The combination of psychotherapy and medication performed significantly better for both outcomes compared to each treatment alone yielding small effect sizes (g = 0.32 to g = 0.39). Both interventions improved depression symptom severity more than functioning and QoL.Despite the small number of comparative trials for some of the analyses, this study reveals that combined treatment is superior, but psychotherapy and pharmacotherapy alone are also efficacious for improving functioning and QoL. The overall relatively modest effects suggest that future tailoring of therapies could be warranted to better meet the needs of individuals with functioning and QoL problems.
Pub.: 27 Oct '16, Pinned: 06 May '17
Abstract: There is strong evidence that family factors play a role in the development, maintenance and course of youth depression. However, to date few clinical trials of psychotherapy for youth depression employ family therapy interventions or target the known family risk factors. This is surprising given recent meta-analytic findings showing only modest effect sizes for psychotherapy for youth depression, and that cognitive therapies do not outperform non-cognitive therapies. The aim of this review is to 1) use a developmental systems approach to review empirical evidence on family risk factors for youth depression to identify potential targets for treatment, 2) examine the extent to which these family risk factors have been targeted in clinical trials for youth depression, and 3) provide a road map for the development of empirically validated family-based interventions for youth depression. Strong evidence was found supporting a relationship between family factors at multiple system levels and depressive symptoms or disorders. Support for several different hypothesized causal mechanisms as well as bidirectional effects was found. A comparison of the identified risk factors and psychotherapy trials for youth depression indicated that few RCT's target family factors; among those that do, only a few of the family risk factors are targeted. Recommendations for translation of empirical knowledge of family risk factors and mechanisms to develop empirically valid family-based interventions to enhance existing treatments for youth depression are provided.
Pub.: 10 Apr '09, Pinned: 05 May '17
Abstract: We sought to quantify clinical decision points for identifying depression treatment nonremitters prior to end-of-treatment.Data came from the psychotherapy arms of a randomized clinical trial for chronic depression. Participants (n = 352; 65.6% female; 92.3% White; mean age = 44.3 years) received 12 weeks of cognitive behavioral analysis system of psychotherapy (CBASP) or CBASP plus an antidepressant medication. In half of the sample, receiver operating curve analyses were used to identify efficient percentage of symptom reduction cut points on the Inventory of Depressive Symptoms-Self-Report (IDS-SR) for predicting end-of-treatment nonremission based on the Hamilton Rating Scale for Depression (HRSD). Sensitivity, specificity, predictive values, and Cohen's kappa for identified cut points were calculated using the remaining half of the sample.Percentage of IDS-SR symptom reduction at Weeks 6 and 8 predicted end-of-treatment HRSD remission status in both the combined treatment (Week 6 cut point = 50.0%, Cohen's κ = .42; Week 8 cut point = 54.3%, Cohen's κ = .45) and psychotherapy only (Week 6 cut point = 60.7%, Cohen's κ = .41; Week 8 cut point = 48.7%, Cohen's κ = .49). Status at Week 8 was more reliable for identifying nonremitters in psychotherapy-only treatment.Those with chronic depression who will not remit in structured, time-limited psychotherapy for depression, either with therapy alone or in combination with antidepressant medication, are identifiable prior to end of treatment. Findings provide an operationalized strategy for designing adaptive psychotherapy interventions.
Pub.: 12 Jun '13, Pinned: 05 May '17
Abstract: Several meta-analyses have shown that psychotherapy is effective for reducing depressive symptom severity. However, the impact on quality of life (QoL) is as yet unknown.To investigate the effectiveness of psychotherapy for depression on global QoL and on the mental health and physical health components of QoL.We conducted a meta-analysis of 44 randomised clinical trials comparing psychotherapy for adults experiencing clinical depression or elevated depressive symptoms with a control group. We used subgroup analyses to explore the influence of various study characteristics on the effectiveness of treatment.We detected a small to moderate effect size (Hedges' g = 0.33, 95% CI 0.24-0.42) for global QoL, a moderate effect size for the mental health component (g = 0.42, 95% CI 0.33-0.51) and, after removing an outlier, a small but statistically significant effect size for the physical health component (g = 0.16, 95% CI 0.05-0.27). Multivariate meta-regression analyses showed that the effect size of depressive symptoms was significantly related to the effect size of the mental health component of QoL. The effect size of depressive symptoms was not related to global QoL or the physical health component.Psychotherapy for depression has a positive impact on the QoL of patients with depression. Improvements in QoL are not fully explained by improvements in depressive symptom severity.
Pub.: 20 Aug '16, Pinned: 05 May '17
Abstract: Depression is common among persons with opioid use disorder. We examined the perceived need for depression treatment (PNDT) among opioid-dependent patients and the relationship of PNDT to depression screening result.Between May and December 2015, we surveyed consecutive persons (n = 440) seeking inpatient opioid detoxification. We used the Patient Health Questionnaire-2 (PHQ-2) to screen for depression. To assess perceived need for depression services, participants were asked, “Do you believe you should be treated for depression?” Response options were recorded into four categories: “Not Depressed (ND),” “Perceive Need for Depression Treatment (PNDT),” “Depressed/Don't Want Treatment,” and “Currently Treated.”Participants’ mean age was 32.3 (±8.7) years; 70.7% were male. Nearly two out of three persons screened positive for depression yet only 8.2% were being treated for depression prior to admission. Screening positive for depression was associated with a 2.95 (95%CI 1.82–4.81, p < .005) fold increase in the expected odds of PNDT. But nearly half of those depressed (48%) did not perceive the need for treatment. Approximately 40% of the participants (n = 177) perceived that they were not depressed; of these persons, 52% screened positive for depression.Detoxification program staff should screen patients for depression, and if a clinical diagnosis is confirmed, discuss treatment options, exploring the level of interest in mental health treatment for depression.Screening for and addressing depression, including patients’ interest in treatment, should be central to post-detoxification aftercare planning. (Am J Addict 2017;XX:1–5)
Pub.: 28 Apr '17, Pinned: 02 May '17
Abstract: Although depression and smoking commonly co-occur, the mechanisms underpinning this association are poorly understood. One hypothesis is that depression promotes tobacco dependence, persistence and relapse by increasing sensitivity to acute negative mood and abstinence induced tobacco-seeking behavior.
Pub.: 13 Apr '17, Pinned: 02 May '17
Abstract: Despite the morbidity and negative outcomes associated with early-onset depression, few studies have examined the efficacy of psychosocial treatment for depressive disorders during childhood. Integrating family in treatment could have particularly salutary effects during this developmental period. This trial compared immediate posttreatment effects of family-focused treatment for childhood depression (FFT-CD) with those of individual supportive psychotherapy (IP) for children 7 to 14 years old with depressive disorders.
Pub.: 07 Apr '17, Pinned: 02 May '17
Abstract: This study aims to determine the long-term effect of a stepped care cognitive behavioral therapy prevention program for depression in older people and the factors predicting or moderating outcome.In a randomized controlled trial, 136 participants, aged 55 years or older, who had been treated for depression, received during 12 months a stepped care program (SCP) or care as usual (CAU) and were then followed up for a second year. Outcome was defined as the start of a new mental health treatment for depression in a specialized outpatient setting, as recorded in the patients' electronic medical records.Of the 123 patients, 38 required new mental health treatment. Survival analysis showed that participants in SCP (n = 27) required new treatment significantly more than patients receiving CAU (n = 11). Negative life events in the last year were predictive for new treatment in CAU but not in SCP.An SCP seems to lower the threshold for new specialized mental health treatment for depression, whereas new treatment in CAU patients occurs more often in reaction to recent life events.
Pub.: 25 Jul '13, Pinned: 02 May '17
Abstract: Rejection sensitivity (RS) and deficits in social problem solving are risk factors for depression. Despite their relationship to depression and the potential connection between them, no studies have examined RS and social problem solving together in the context of depression. As such, we examined RS, five facets of social problem solving, and symptoms of depression in a young adult sample.A total of 180 participants completed measures of RS, social problem solving, and depressive symptoms. We used bootstrapping to examine the indirect effect of RS on depressive symptoms through problem solving.RS was positively associated with depressive symptoms. A negative problem orientation, impulsive/careless style, and avoidance style of social problem solving were positively associated with depressive symptoms, and a positive problem orientation was negatively associated with depressive symptoms. RS demonstrated an indirect effect on depressive symptoms through two social problem-solving facets: the tendency to view problems as threats to one's well-being and an avoidance problem-solving style characterized by procrastination, passivity, or overdependence on others.These results are consistent with prior research that found a positive association between RS and depression symptoms, but this is the first study to implicate specific problem-solving deficits in the relationship between RS and depression. Our results suggest that depressive symptoms in high RS individuals may result from viewing problems as threats and taking an avoidant, rather than proactive, approach to dealing with problems. These findings may have implications for problem-solving interventions for rejection sensitive individuals.
Pub.: 15 Apr '17, Pinned: 29 Apr '17
Abstract: To study the disagreement between self-reported suicidal ideation (SR-SI) and clinician-ascertained suicidal ideation (CA-SI) and its correlation with depression and anxiety severity in patients with major depressive disorder (MDD) or bipolar disorder (BPD).Routine clinical outpatients were diagnosed with the MINI-STEP-BD version. SR-SI was extracted from the 16 Item Quick Inventory of Depression Symptomatology Self-Report (QIDS-SR-16) item 12. CA-SI was extracted from a modified Suicide Assessment module of the MINI. Depression and anxiety severity were measured with the QIDS-SR-16 and Zung Self-Rating Anxiety Scale. Chi-square, Fisher exact, and bivariate linear logistic regression were used for analyses.Of 103 patients with MDD, 5.8% endorsed any CA-SI and 22.4% endorsed any SR-SI. Of the 147 patients with BPD, 18.4% endorsed any CA-SI and 35.9% endorsed any SR-SI. The agreement between any SR-SI and any CA-SI was 83.5% for MDD and 83.1% for BPD, with weighted Kappa of 0.30 and 0.43, respectively. QIDS-SR-16 score, female gender, and ≥4 year college education were associated with increased risk for disagreement, 15.44 ± 4.52 versus 18.39 ± 3.49 points (p = 0.0026), 67% versus 46% (p = 0.0783), and 61% versus 29% (p = 0.0096). The disagreement was positively correlated to depression severity in both MDD and BPD with a correlation coefficient R(2) = 0.40 and 0.79, respectively, but was only positively correlated to anxiety severity in BPD with a R(2) = 0.46.Self-reported questionnaire was more likely to reveal higher frequency and severity of SI than clinician-ascertained, suggesting that a combination of self-reported and clinical-ascertained suicidal risk assessment with measuring depression and anxiety severity may be necessary for suicide prevention.
Pub.: 03 Dec '14, Pinned: 22 Apr '17
Abstract: This study investigated factors associated with complete mental health (CMH) among a nationally representative sample of Canadians with a history of depression by conducting secondary analysis of the 2012 Canadian Community Health Survey- Mental Health (n=20,955). CMH was defined as 1) the absence of mental illness, substance abuse, or suicidal ideation in the past year; 2) Happiness or life satisfaction almost every day/past month), and 3) social and psychological well-being. The prevalence of CMH among those with and without a history of depression was determined. In a sample of formerly depressed respondents (n=2,528), a series of logistic regressions were completed controlling for demographics, socioeconomic status, health and lifetime mental health conditions, health behaviours, social support, adverse childhood experiences, and religiosity. Two in five individuals (39%) with a history of depression had achieved CMH in comparison to 78% of those without a history of depression. Formerly depressed adults with CMH were more likely to be female, White, older, affluent, married, with a confidant, free of disabling pain, insomnia, and childhood adversities and no history of substance abuse. They were more likely to exercise regularly and use spirituality to cope.
Pub.: 19 Apr '16, Pinned: 21 Apr '17
Abstract: Research suggests that cognitive and behavioral therapies produce significant benefits over medications alone in the treatment of severe, nonpsychotic major depression or primary psychotic disorders such as schizophrenia. However, previous research has not demonstrated the efficacy of psychotherapy for major depression with psychotic features. In this initial treatment development study, we conducted an open trial of a new behavioral intervention that combines elements of behavioral activation and acceptance and commitment therapy for depression and psychosis. Fourteen patients with major depressive disorder with psychotic features were provided with up to 6 months of Acceptance-Based Depression and Psychosis Therapy (ADAPT) in combination with pharmacotherapy. Patients reported a high degree of treatment credibility and acceptability. Results showed that patients achieved clinically significant and sustained improvements through posttreatment follow-up in depressive and psychotic symptoms, as well as psychosocial functioning. In addition, the processes targeted by the intervention (e.g., acceptance, mindfulness, values) improved significantly over the course of treatment, and changes in processes were correlated with changes in symptoms. Results suggest that ADAPT combined with pharmacotherapy is a promising treatment approach for psychotic depression that should be tested in a future randomized trial.
Pub.: 12 Dec '12, Pinned: 21 Apr '17
Abstract: While the majority of depressed patients are treated in primary care, long-term follow-up data on the naturalistic course of depression and treatment effectiveness in this setting are scarce. This study examined the ten-year course of depression in primary care patients who had participated in a randomized clinical trial aiming at enhancement of depression outcomes.Of the original sample (n=267), 166 patients participated in the ten-year follow-up; missingness was random. Four treatments were compared: (1) Care As Usual (CAU; n=51); (2) a Psychoeducational Prevention program (PEP; n=68); (3) Psychiatric Consultation followed by PEP (PC+PEP; n=21); and (4) brief Cognitive Behavioral Therapy followed by PEP (CBT+PEP; n=26). During the first three years interviews based on the Composite International Diagnostic Interview (CIDI) were three-monthly applied, the seven years thereafter were assessed with a once applied CIDI and a face-to-face life chart-based interview.During the ten-year follow-up 76.5% of the patients developed a new depressive episode, 83.4% used antidepressants (median usage 3.1 years), median depression diagnosis-free time was 9.0 years, and median residual symptom-free time 3.8 years. Treatments did not significantly differ on these outcomes, only trends appeared for lower depression severity for CBT+PEP, and, along with PEP, a higher proportion of symptom-free time.Assessment with the once applied life chart interview (a valid and reliable instrument) is less precise than the three-monthly assessments during the first three years.The long-term course of depression in primary care is unfavorable, whereas treatment effects over time seem absent or small.
Pub.: 16 Apr '17, Pinned: 20 Apr '17
Abstract: Postpartum depression (PPD) is prevalent, occurring in 8 to 13% of new fathers. Identifying effective and acceptable treatments for paternal PPD is important to prevent negative family outcomes. Participation in a patient preferred treatment for depression increases treatment adherence and effectiveness. Thus, developing and delivering interventions that are preferred by the target population is an important aspect of successful treatment. The current study investigated treatment preferences for paternal PPD.Men (N=140) who were within the first year postpartum were recruited from low-risk maternity clinics, baby shows, and partner referrals. Participants completed a 20-minute online survey that included three expert validated treatment descriptions for depression and a series of questionnaires.Participants reported preferring individual and couple psychotherapy to pharmacotherapy for treatment of PPD. Men perceived both individual and couple psychotherapy as being more credible and reported more favourable personal reactions towards them when compared to pharmacotherapy.Participants were not required to meet diagnostic criteria for depression. The majority of participants were asked to respond to a hypothetical scenario of what they would do if faced with PPD.These findings suggest that fathers prefer psychological interventions over pharmacotherapy for treatment of PPD. Future research should investigate efficacious treatment options for paternal PPD based on treatment preferences.
Pub.: 21 Mar '17, Pinned: 20 Apr '17
Abstract: Repetitive transcranial magnetic stimulation (TMS) has been shown to be safe and effective for treatment-resistant depression (TRD) in the general adult population. Efficacy among older (≥60 years) patients, who have a greater burden of cognitive, physical, and functional impairment compared to their younger counterparts, remains unclear. The current study aimed to characterize antidepressant response to an acute course of TMS therapy among patients aged ≥60 years compared to those <60 years in naturalistic clinical practice settings.Data were retrospectively collected and pooled for adults with TRD (N =231; n =75 aged ≥60 years and n = 156 <60 years) who underwent an acute course of outpatient TMS therapy at two outpatient clinics. Self-report depression scales were administered at baseline and end of acute treatment. Change on continuous measures and categorical outcomes were compared across older vs. younger patients.Both age groups showed significant improvements in depression symptoms. Response and remission rates did not differ between groups. Age group was not a significant predictor of change in depression severity, nor of clinical response or remission, in a model controlling for other predictors (all p>.05).Limitations include reliance on self-report clinical measures and variability in comorbidity and concurrent pharmacotherapy due to the naturalistic nature of the study.Results suggest that effectiveness of TMS for TRD is not differentially modified by age. Based on these naturalistic data, age alone should not be considered a contraindication or poor prognostic indicator of the antidepressant efficacy of TMS.
Pub.: 08 Apr '17, Pinned: 20 Apr '17
Abstract: Depression during pregnancy is a common and high impact disease. Generally, 5-10 % of pregnant women suffer from depression. Children who have been exposed to maternal depression during pregnancy have a higher risk of adverse birth outcomes and more often show cognitive, emotional and behavioural problems. Therefore, early detection and treatment of antepartum depression is necessary. Both psychotherapy and antidepressant medication, first choice treatments in a non-pregnant population, have limitations in treating depression during pregnancy. Therefore, it is urgent and relevant to investigate alternative treatments for antepartum depression. Bright light therapy (BLT) is a promising treatment for pregnant women with depressive disorder, for it combines direct availability, sufficient efficacy, low costs and high safety, taking the safety for the unborn child into account as well.In this study, 150 pregnant women (12-18 weeks pregnant) with a DSM-V diagnosis of depressive disorder will be randomly allocated in a 1:1 ratio to one of the two treatment arms: treatment with BLT (9.000 lux) or treatment with dim red light therapy (100 lux). Both groups will be treated for 6 weeks at home on a daily basis for 30 min, within 30 min of habitual wake-up time. Follow-up will take place after 6 weeks of therapy, 3 and 10 weeks after end of therapy, at birth and 2, 6 and 18 months postpartum. Primary outcome will be the average change in depressive symptoms between the two groups, as measured by the Structured Interview Guide for the Hamilton Depression Scale - Seasonal Affective Disorder version and the Edinburg Postnatal Depression Scale. Changes in rating scale scores of these questionnaires over time will be analysed using generalized linear mixed models. Secondary outcomes will be the changes in maternal cortisol and melatonin levels, in maternal sleep quality and gestational age, birth weight, infant behaviour, infant cortisol exposure and infant cortisol stress response.If BLT reduces depressive symptoms in pregnant women, it will provide a safe, cheap, non-pharmacological and efficacious alternative treatment for psychotherapy and antidepressant medication in treating antepartum depression, without any expected adverse reactions for the unborn child.Netherlands Trial Register NTR5476 . Registered 5 November 2015.
Pub.: 09 Nov '16, Pinned: 20 Apr '17
Abstract: Bright light therapy has demonstrated efficacy and is an accepted treatment for seasonal depression. It has been suggested that bright light therapy may have efficacy in nonseasonal depressions. Also, there is evidence that bright light therapy may improve responsiveness to antidepressant pharmacotherapy.We searched PubMed/MEDLINE, PsycINFO, PsycARTICLES, CINAHL, EMBASE, Scopus, and Academic OneFile for English-language literature published between January 1998 and April 2016, using the keywords bright light therapy AND major depression, bright light therapy AND depress*, bright light therapy AND bipolar depression, bright light therapy AND affective disorders, circadian rhythm AND major depression, circadian rhythm AND depress*, and circadian rhythm AND affective disorder.Studies that reported randomized trials comparing antidepressant pharmacotherapy with bright light therapy ≥ 5,000 lux for ≥ 30 minutes to antidepressant pharmacotherapy without bright light therapy for the treatment of nonseasonal depression were included. Studies of seasonal depression were excluded. Following review of the initial 112 returns, 2 of the authors independently judged each trial, applying the inclusionary and exclusionary criteria. Ten studies were selected as meeting these criteria. Subjects in these studies were pooled using standard techniques of meta-analysis.Ten studies involving 458 patients showed improvement using bright light therapy augmentation versus antidepressant pharmacotherapy alone. The effect size was similar to that of other accepted augmentation strategies, roughly 0.5.Analysis of pooled data from randomized trials provides evidence for the efficacy of use of bright light therapy ≥ 5,000 lux for periods ≥ 30 minutes when used as augmentation to standard antidepressant pharmacotherapy in the treatment of major depressive disorder and bipolar depression without a seasonal pattern.
Pub.: 12 Nov '16, Pinned: 20 Apr '17
Abstract: Hemodialysis patients with depression have a higher risk of death and hospitalization. Although there is pharmacological management for the depression of hemodialysis patients, the adverse effect of the drug limits the use. The nonpharmacological way, bicycle riding, may be an effective way for the therapy of the depression in hemodialysis patients. However, the underlying mechanism of this relationship is still not fully explained, while interleukin-6 (IL-6) and interleukin-18 (IL-18) are associated with depression and exercise. Thus, the effects of bicycle riding on the levels of the interleukin were explored.One hundred and eighty-nine patients with chronic hemodialysis were selected and randomly assigned to three groups of medicine (MG, received 20-mg escitalopram daily), medicine and aerobic exercise (MAG, received 20-mg escitalopram daily and bicycle riding six times weekly), and only aerobic exercise (AG, received 20-mg placebo daily and bicycle riding six times weekly). The whole experiment lasted for 18 weeks. The quality of life (36-Item Short Form Health Survey) and depression severity according to criteria in the Diagnostic and Statistical Manual of Mental Disorders, fourth edition [DSM-IV] were measured before and at the end of this study. The serum levels of IL-6 and IL-18 were measured by an enzyme-linked immunosorbent assay kit.The quality of life was improved and depression severity was reduced significantly in the MAG and AG groups when compared with the MG group (P<0.05). Serum levels of IL-6 and IL-18 were the highest in the MG group, moderate in the MAG group and the lowest in AG group. On the other hand, the serum levels of IL-6 and IL-18 were closely associated with depression scores (P<0.05).Aerobic exercise improves the quality of life and ameliorates the depression severity of the patients undergoing hemodialysis by affecting the levels of IL-6 and IL-18. Bicycle riding is a potential way for the depression therapy of the patients with chronic hemodialysis.
Pub.: 18 Jan '17, Pinned: 20 Apr '17
Abstract: Hyperactivity of hypothalamic-pituitary-adrenal (HPA) axis is often observed in the pathophysiology of depression. Antidepressant therapy can restore hippocampal neurogenesis to rescue the HPA axis regulation defects. Xiaochaihutang (XCHT), a famous Chinese herbal formula, has been used clinically in depressive disorders in China. Our previous studies have demonstrated XCHT improved depressive-like behaviors in chronic unpredictable mild stress rat, but the underlying mechanisms of XCHT on hippocampal neurogenesis and the HPA axis were still unclear.
Pub.: 13 Oct '16, Pinned: 20 Apr '17
Abstract: Approximately one in three children and young people with chronic fatigue syndrome (CFS/ME) also have probable depression. Cognitive behaviour therapy (CBT) has a growing evidence base as an effective treatment approach for CFS/ME and for depression in this population.Given the high degree of co-morbidity, this discussion paper aims to compare and contrast CBT for CFS/ME and CBT for depression in children and young people.The existing literature on CBT for depression and CBT for CFS/ME, in relation to children and young people was reviewed.Whilst there are commonalities to both treatments, the cognitive behavioural model of CFS/ME maintenance includes different factors and has a different emphasis to the cognitive behavioural model of depression, resulting in different intervention targets and strategies in a different sequence.A collaborative, formulation-driven approach to intervention should inform the intervention targets and treatment strategies.
Pub.: 10 Mar '17, Pinned: 20 Apr '17
Abstract: Depression is a prevalent devastating mental disorder that affects the normal life of patients and brings a heavy burden to whole society. Although many efforts have been made to attenuate depressive/anxiety symptoms, the current clinic antidepressants have limited effects. Scientists have long been making attempts to find some new strategies that can be applied as the alternative antidepressant therapy. Exercise, a widely recognized healthy lifestyle, has been suggested as a therapy that can relieve psychiatric stress. However, how exercise improves the brain functions and reaches the antidepressant target needs systematic summarization due to the complexity and heterogeneous feature of depression. Brain plasticity, especially adult neurogenesis in the hippocampus, is an important neurophysiology to facilitate animals for neurogenesis can occur in not only humans. Many studies indicated that an appropriate level of exercise can promote neurogenesis in the adult brains. In this article, we provide information about the antidepressant effects of exercise and its implications in adult neurogenesis. From the neurogenesis perspective, we summarize evidence about the effects of exercise in enhancing neurogenesis in the hippocampus through regulating growth factors, neurotrophins, neurotransmitters and metabolism as well as inflammations. Taken together, a large number of published works indicate the multiple benefits of exercise in the brain functions of animals, particularly brain plasticity like neurogenesis and synaptogenesis. Therefore, a new treatment method for depression therapy can be developed by regulating the exercise activity.
Pub.: 20 Apr '17, Pinned: 20 Apr '17
Abstract: Repetitive transcranial magnetic stimulation (rTMS) is an emerging non-pharmacological approach to treating many brain-based disorders. rTMS uses electromagnetic coils to stimulate areas of the brain non-invasively. Deep transcranial magnetic stimulation (dTMS) with the Brainsway H1-coil system specifically is a type of rTMS indicated for treating patients with major depressive disorder (MDD) who are resistant to medication. The unique H1-coil design of this device is able to stimulate neuronal pathways that lie deeper in the targeted brain areas than those reached by conventional rTMS coils. dTMS is considered to be low-risk and well tolerated, making it a viable treatment option for people who have not responded to medication or psychotherapy trials for their depression. Randomized, sham-control studies have demonstrated that dTMS produces significantly greater improvement in depressive symptoms than sham dTMS treatment in patients with major depression that has not responded to antidepressant medication. In this paper, we will review the methodology for treating major depression with dTMS using an H1-coil.
Pub.: 22 Oct '16, Pinned: 20 Apr '17
Abstract: We describe the process evaluation for a randomized controlled trial that compared group support psychotherapy (GSP) with group HIV education for treatment of depression among people with HIV. Process data were obtained using mixed methods. Variables evaluated were indicators of feasibility and acceptability; causal mediating processes and contextual influences. GSP was feasible and acceptable. Potential mediating variables between GSP and reduction of depression were improved emotional and social support, better coping strategies, and pursuit of livelihoods. Culturally sensitive intervention content facilitated intervention delivery. These data complement the trial outcomes, and may provide a contextualized description of how GSP treats depression.
Pub.: 21 Mar '17, Pinned: 20 Apr '17
Abstract: Depression in old age is a disabling disease associated with functional and cognitive decline severely affecting quality of life. Studies specifically investigating antidepressant treatment for this special cohort of patients remain scarce and results are often conflicting. A narrative literature review was undertaken, synthesizing findings from published studies, systematic reviews, and treatment guidelines specifically conducted in elderly depressed patients to summarize implications and current recommendations as well as gaps in evidence for old-age pharmacologic treatment.PubMed and Medline databases were searched for articles from July 2011 to July 2016. Only RCTs, meta-analyses, systematic reviews, and treatment guidelines focussing on the effect of antidepressant pharmacotherapy in old-aged participants were extracted, analysed, and discussed. The search resulted in a total of 26 articles.Selective serotonin reuptake inhibitors (SSRIs) and other second-generation antidepressants are recommended for first-line treatment of old-age depression. The differences in efficacy and tolerability within different substances and substance classes are minimal or non-existent. Tricyclic antidepressants (TCAs) are only considered for second-line treatment, due to their cardiac risk profile and anticholinergic effects. In treatment-resistant depression, augmentation therapy options include lithium and atypical antipsychotics.There is convincing evidence that antidepressants are efficacious in the treatment of old-age depression and that rationales are necessary for treatment planning. However, evidence-based data on recovery and remission rates in old-age depression specific to certain antidepressant drugs are still missing in trials and are of great importance for pharmacological treatment of old-age depression in daily clinical practice.
Pub.: 11 Mar '17, Pinned: 20 Apr '17
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