Randomised controlled trial comparing problem solving treatment with amitriptyline and placebo for major depression in primary care

Mynors-Wallis, Laurence; Gath, Dennis; Lloyd-Thomas, A R; Tomlinson, Deborah

doi:10.1136/bmj.310.6977.441

Cited by 434 publications

(270 citation statements)

References 20 publications

(17 reference statements)

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“…Both major and minor depressions are associated with increased medical morbidity and mortality, even after adjustment for health status and health behaviors (12)(13)(14). Similarly, there is evidence that therapy to treat these depressive conditions is effective and associated with improvements in mood, functioning, and quality of life (15)(16)(17).…”

Section: Methodsmentioning

confidence: 99%

The Prevalence of Comorbid Depression in Adults With Diabetes

Anderson¹,

Freedland²,

et al. 2001

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OBJECTIVE -To estimate the odds and prevalence of clinically relevant depression in adults with type 1 or type 2 diabetes. Depression is associated with hyperglycemia and an increased risk for diabetic complications; relief of depression is associated with improved glycemic control. A more accurate estimate of depression prevalence than what is currently available is needed to gauge the potential impact of depression management in diabetes. RESEARCH DESIGN AND METHODS -MEDLINE and PsycINFO databases andpublished references were used to identify studies that reported the prevalence of depression in diabetes. Prevalence was calculated as an aggregate mean weighted by the combined number of subjects in the included studies. We used 2 statistics and odds ratios (ORs) to assess the rate and likelihood of depression as a function of type of diabetes, sex, subject source, depression assessment method, and study design.RESULTS -A total of 42 eligible studies were identified; 20 (48%) included a nondiabetic comparison group. In the controlled studies, the odds of depression in the diabetic group were twice that of the nondiabetic comparison group (OR ϭ 2.0, 95% CI 1.8 -2.2) and did not differ by sex, type of diabetes, subject source, or assessment method. The prevalence of comorbid depression was significantly higher in diabetic women (28%) than in diabetic men (18%), in uncontrolled (30%) than in controlled studies (21%), in clinical (32%) than in community (20%) samples, and when assessed by self-report questionnaires (31%) than by standardized diagnostic interviews (11%).CONCLUSIONS -The presence of diabetes doubles the odds of comorbid depression. Prevalence estimates are affected by several clinical and methodological variables that do not affect the stability of the ORs.

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Section: Methodsmentioning

confidence: 99%

The Prevalence of Comorbid Depression in Adults With Diabetes

Anderson¹,

Freedland²,

et al. 2001

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“…1. Thirty-five studies met inclusion criteria [2][3][4]5,6,8,[15][16][17][18]20,21,24,27,31,33,34,[40][41][42][43]45,46,[50][51][52][53][56][57][58][60][61][62]65,66]. Fig.…”

Section: Selection and Inclusion Of Studiesmentioning

confidence: 99%

The Effects of Blinding on the Outcomes of Psychotherapy and Pharmacotherapy for Adult Depression: a Meta-Analysis

et al. 2015

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BackgroundRandomized trials with antidepressants are often run under double blind placebo-controlled conditions, whereas those with psychotherapies are mostly unblinded. This can introduce bias in favor of psychotherapy when the treatments are directly compared. In this meta-analysis, we examine this potential source of bias.MethodsWe searched Pubmed, PsycInfo, Embase and the Cochrane database (1966 to January 2014) by combining terms indicative of psychological treatment and depression, and limited to randomized trials. We included 35 trials (with 3721 patients) in which psychotherapy and pharmacotherapy for adult depression were directly compared with each other. We calculated effect sizes for each study indicating the difference between psychotherapy and pharmacotherapy at post-test. Then, we examined the difference between studies with a placebo condition and those without in moderator analyses.ResultsWe did not find a significant difference between the studies with and those without a placebo condition. The studies in which a placebo condition was included indicated no significant difference between psychotherapy and pharmacotherapy (g = −0.07; NNT = 25). Studies in which no placebo condition was included (and patients and clinicians in both conditions were not blinded), resulted in a small, but significant difference between psychotherapy and pharmacotherapy in favor of pharmacotherapy (g = −0.13; NNT = 14).ConclusionsStudies comparing psychotherapy and pharmacotherapy in which both groups of patients (and therapists) are not blinded (no placebo condition is included) result in a very small, but significantly higher effect for pharmacotherapy.

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“…Training in problem-solving skills has been shown to be effective in reducing caregiver stress, as well as negative affect and depressive symptomatology in a wide range of clinical populations (Drotar, 1997;D'Zurilla, 1986;Mynors-Wallis, Gath, Lloyd-Thomas, & Tomlinson, 1995;Nezu, 1986;Nezu & Perri, 1989;Robin & Foster, 1989).…”

Section: Behavioral Cognitive Behavioral and Interpersonal Therapiesmentioning

confidence: 99%

Psychosocial Treatment of Children in Foster Care: A Review

Racusin

Maerlender

Sengupta

et al. 2005

Community Ment Health J

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A substantial number of children in foster care exhibit psychiatric difficulties. Recent epidemiological and historical trends in foster care, clinical findings about the adjustment of children in foster care, and adult outcomes are reviewed, followed by a description of current approaches to treatment and extant empirical support. Available interventions for these children can be categorized as either symptom-focused or systemic, with empirical support for specific methods ranging from scant to substantial. Even with treatment, behavioral and emotional problems often persist into adulthood, resulting in poor functional outcomes. We suggest that self-regulation may be an important mediating factor in the appearance of emotional and behavioral disturbance in these children.

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Randomised controlled trial comparing problem solving treatment with amitriptyline and placebo for major depression in primary care

Cited by 434 publications

References 20 publications

The Prevalence of Comorbid Depression in Adults With Diabetes

The Prevalence of Comorbid Depression in Adults With Diabetes

The Effects of Blinding on the Outcomes of Psychotherapy and Pharmacotherapy for Adult Depression: a Meta-Analysis

Psychosocial Treatment of Children in Foster Care: A Review

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