Abstract:Psychosocial intervention was as effective as antidepressants in reducing depression and in improving quality of life and disability at the end of therapy. However, these findings need further exploration through a larger trial.
“…Two additional studies were found through reference lists and during data extraction, which resulted in 34 randomised controlled trials included in meta-analysis (Fig. 1) (Teasdale et al ., 1984; Ross and Scott, 1985; Scott and Freeman, 1992; Scott et al ., 1997; Ward et al ., 2000; Watson et al ., 2003; Willemse et al ., 2004; Dalgard, 2006; Smit et al ., 2006; González González et al ., 2007; Spek et al ., 2007; Laidlaw et al ., 2008; Lovell et al ., 2008; Wiles et al ., 2008; Kessler et al ., 2009; Serfaty et al ., 2009; Hegerl et al ., 2010; Naylor et al ., 2010; Cramer et al ., 2011; Dwight-Johnson et al ., 2011; Ekers et al ., 2011; Joling et al ., 2011; Levin et al ., 2011; Casañas et al ., 2012; Power and Freeman, 2012; Sørensen Høifødt et al ., 2013; Wiles et al ., 2013; Williams et al ., 2013; Husain et al ., 2014; Kivi et al ., 2014; Gilbody et al ., 2015; Kanter et al ., 2015; Chowdhary et al ., 2016; Gilbody et al ., 2017). Fig.…”
Section: Resultsmentioning
confidence: 99%
“…While random sequence generation and allocation concealment were adequate in the majority of cases, the most common reason for risk of bias was incomplete outcome data. Three studies were given a low risk of bias rating on all applicable criteria (Wiles et al ., 2013; Husain et al ., 2014; Gilbody et al ., 2017). Two additional studies (Smit et al ., 2006; Joling et al ., 2011) fell just short of this mark because no pre-registered study protocol could be found (selective reporting unclear).…”
Depression is common in primary care, and most patients prefer psychological treatment over pharmacotherapy. Cognitive behaviour therapy (CBT) is an effective treatment, but there are gaps in current knowledge about CBT in the primary care context, especially with regard to long-term effects and the efficacy of specific delivery formats. This is an obstacle to the integration of primary care and specialist psychiatry. We conducted a systematic review and meta-analysis of randomised controlled trials of CBT for primary care patients with depression to investigate the effect of CBT for patients with depression in primary care. A total of 34 studies, with 2543 patients in CBT and 2815 patients in control conditions, were included. CBT was more effective than the control conditions [g = 0.22 (95% confidence interval (CI) 0.15–0.30)], and the effect was sustained at follow-up [g = 0.17 (95% CI 0.10–0.24)]. CBT also led to a higher response rate [odds ratio (OR) = 2.47 (95% CI 1.60–3.80)] and remission rate [OR = 1.56 (95% CI 1.15–2.14)] than the control conditions. Heterogeneity was moderate. The controlled effect of CBT was significant regardless of whether patients met diagnostic criteria for depression, scored above a validated cut-off for depression, or merely had depressive symptoms. CBT also had a controlled effect regardless of whether the treatment was delivered as individual therapy, group therapy or therapist-guided self-help. We conclude that CBT appears to be effective for patients with depression in primary care, and recommend that patients with mild to moderate depression be offered CBT in primary care.
“…Two additional studies were found through reference lists and during data extraction, which resulted in 34 randomised controlled trials included in meta-analysis (Fig. 1) (Teasdale et al ., 1984; Ross and Scott, 1985; Scott and Freeman, 1992; Scott et al ., 1997; Ward et al ., 2000; Watson et al ., 2003; Willemse et al ., 2004; Dalgard, 2006; Smit et al ., 2006; González González et al ., 2007; Spek et al ., 2007; Laidlaw et al ., 2008; Lovell et al ., 2008; Wiles et al ., 2008; Kessler et al ., 2009; Serfaty et al ., 2009; Hegerl et al ., 2010; Naylor et al ., 2010; Cramer et al ., 2011; Dwight-Johnson et al ., 2011; Ekers et al ., 2011; Joling et al ., 2011; Levin et al ., 2011; Casañas et al ., 2012; Power and Freeman, 2012; Sørensen Høifødt et al ., 2013; Wiles et al ., 2013; Williams et al ., 2013; Husain et al ., 2014; Kivi et al ., 2014; Gilbody et al ., 2015; Kanter et al ., 2015; Chowdhary et al ., 2016; Gilbody et al ., 2017). Fig.…”
Section: Resultsmentioning
confidence: 99%
“…While random sequence generation and allocation concealment were adequate in the majority of cases, the most common reason for risk of bias was incomplete outcome data. Three studies were given a low risk of bias rating on all applicable criteria (Wiles et al ., 2013; Husain et al ., 2014; Gilbody et al ., 2017). Two additional studies (Smit et al ., 2006; Joling et al ., 2011) fell just short of this mark because no pre-registered study protocol could be found (selective reporting unclear).…”
Depression is common in primary care, and most patients prefer psychological treatment over pharmacotherapy. Cognitive behaviour therapy (CBT) is an effective treatment, but there are gaps in current knowledge about CBT in the primary care context, especially with regard to long-term effects and the efficacy of specific delivery formats. This is an obstacle to the integration of primary care and specialist psychiatry. We conducted a systematic review and meta-analysis of randomised controlled trials of CBT for primary care patients with depression to investigate the effect of CBT for patients with depression in primary care. A total of 34 studies, with 2543 patients in CBT and 2815 patients in control conditions, were included. CBT was more effective than the control conditions [g = 0.22 (95% confidence interval (CI) 0.15–0.30)], and the effect was sustained at follow-up [g = 0.17 (95% CI 0.10–0.24)]. CBT also led to a higher response rate [odds ratio (OR) = 2.47 (95% CI 1.60–3.80)] and remission rate [OR = 1.56 (95% CI 1.15–2.14)] than the control conditions. Heterogeneity was moderate. The controlled effect of CBT was significant regardless of whether patients met diagnostic criteria for depression, scored above a validated cut-off for depression, or merely had depressive symptoms. CBT also had a controlled effect regardless of whether the treatment was delivered as individual therapy, group therapy or therapist-guided self-help. We conclude that CBT appears to be effective for patients with depression in primary care, and recommend that patients with mild to moderate depression be offered CBT in primary care.
“…In Iran, Malakouti et al 39 sought to reduce the number of suicides. In Pakistan, Husain et al 40 compared the effectiveness of psychotherapy to antidepressant medications in reducing depression and improving quality of life. This group compared two integrated interventions without contrasting it to usual care and found no difference between these two arms.…”
Aims and method
This systematic review examines the effectiveness and cost-effectiveness of behavioural health integration into primary healthcare in the management of depression and unhealthy alcohol use in low- and middle-income countries. Following PRISMA guidelines, this review included research that studied patients aged ≥18 years with unhealthy alcohol use and/or depression of any clinical severity. An exploration of the models of integration was used to characterise a typology of behavioural health integration specific for low- and middle-income countries.
Results
Fifty-eight articles met inclusion criteria. Studies evidenced increased effectiveness of integrated care over treatment as usual for both conditions. The economic evaluations found increased direct health costs but cost-effective estimates. The included studies used six distinct behavioural health integration models.
Clinical implications
Behavioural health integration may yield improved health outcomes, although it may require additional resources. The proposed typology can assist decision-makers to advance the implementation of integrated models.
“…All scales have been validated for use in the Urdu language and have been used in previous studies in Pakistan 33. Adverse effects will be monitored using scales that have been specifically designed for minocycline and celecoxib.…”
BackgroundEvidence suggests that the use of anti-inflammatory agents may improve depressive symptoms in patients with bipolar affective disorder. However, there are few well-designed clinical trials demonstrating the efficacy of these newer treatment strategies.Patients and methodsThis is a multicenter, 3-month, randomized, placebo-controlled, double-blind, factorial design trial of minocycline and/or celecoxib added to TAU for the treatment of depressive symptoms in patients experiencing a DSM-5 bipolar I or II disorder and a current major depressive episode. A total of 240 participants will undergo screening and randomization followed by four assessment visits. The primary outcome measure will be mean change from baseline to week 12 on the Hamilton Depression Scale scores. Clinical assessments using the Clinical Global Impression scale, Patient Health Questionnaire-9, and the Generalized Anxiety Disorder 7-item scale will be carried out at every visit as secondary outcomes. Side-effect checklists will be used to monitor the adverse events at each visit. Complete blood count and plasma C-reactive protein will be measured at baseline and at the end of the treatment. Minocycline will be started at 100 mg once daily and increased to 200 mg at 2 weeks. Celecoxib will be started at 200 mg once daily and increased to 400 mg at 2 weeks.DiscussionAnti-inflammatory agents have been shown to be potentially efficacious in the treatment of depressive symptoms. The aim of this study is to determine whether the addition of minocycline and/or celecoxib to TAU improves depressive symptoms in patients with bipolar affective disorder.
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