Randomised controlled trial of problem solving treatment, antidepressant medication, and combined treatment for major depression in primary care

Mynors-Wallis, Laurence; Gath, Dennis; Day, A. C.; Baker, F. M.

doi:10.1136/bmj.320.7226.26

Cited by 375 publications

(287 citation statements)

References 13 publications

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“…31 Several international studies have also shown positive evidence for the treatment of common mental disorders in primary care through drugs or psychosocial treatments. In many of these trials, usually conducted in developed countries, interventions were applied by counselors in primary care in an individual basis, 32 and involved cognitive-behavior and interpersonal or problem solving therapies. Nonetheless, Patel et al stressed, in a recent narrative review, that there is strong evidence from low and middle income (LAMI) countries of effective options for treating depression with both drugs and psychological treatments.…”

Section: The Existing Solutionsmentioning

confidence: 99%

Common mental disorders in Petrópolis-RJ: a challenge to integrate mental health into primary care strategies

Fortes

Lopes

Villano

et al. 2011

Rev. Bras. Psiquiatr.

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OBJECTIVE: Common mental disorders are present in more than 50% of patients attending primary care clinics. The main objectives of this study were to detect whether there is any special group of patients within the Family Health Strategy that should be considered to be in greater risk for common mental disorders and to recommend alternative interventions to aid these patients. METHOD: In 2002, a cross-sectional study on common mental disorders seen at Family Health Strategy centers was conducted in Petrópolis, State of Rio de Janeiro. RESULTS: Common mental disorders were associated with women (OR = 2.90; 95% CI 1.82-4.32), younger than 45 years of age (OR = 1.43; 95% CI 1.02-2.01), with a monthly per capita family income of less than US$40.00 (OR = 1.68; 95% CI 1.20-2.39), and without a partner (OR = 1.71; 95% CI 1.22-2.39). Illiteracy was associated with common mental disorders among patients who were not extremely poor. Social support networks such as going often to church (OR = 0.62; 95% CI 0.43-0.89); participating in artistic and sporting activities (OR = 0.42; 95% CI 0.26-0.70) and having at least four trusted relatives or friends (OR = 0.53; 95% CI 0.31-0.91) was inversely associated with common mental disorders. DISCUSSION: Poor women with little social support represent a special group at risk for common mental disorders in the primary care setting. Some countries have developed special interventions to treat patients with common mental disorders in primary care. CONCLUSION: Mental health care programs could include evidence-based psychosocial interventions to assist women in overcoming the vicious circle of poverty and dealing with their mental disorders.

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Section: The Existing Solutionsmentioning

confidence: 99%

Common mental disorders in Petrópolis-RJ: a challenge to integrate mental health into primary care strategies

Fortes

Lopes

Villano

et al. 2011

Rev. Bras. Psiquiatr.

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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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“…O tratamento de resolução de problemas (TRP) demonstrou, em um ensaio controlado randomizado, ser eficaz para transtornos depressivos no atendimento primário (Mynors-Wallis et al, 2000). O TRP pode ser oferecido por não-especialistas depois de treinamento e, portanto, é uma alternativa com boa relação custoeficácia às psicoterapias formais, que não costumam ser rápidas nem estar disponíveis em locais de atendimento primário de muitos países.…”

Section: Psicoterapiaunclassified

Diretrizes da World Federation of Societies of Biological Psychiatry (WFSBP) para tratamento biológico de transtornos depressivos unipolares, 1ª parte: tratamento agudo e de continuação do transtorno depressivo maior

Bauer¹,

Whybrow²,

Angst³

et al. 2009

Rev. psiquiatr. clín.

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Randomised controlled trial of problem solving treatment, antidepressant medication, and combined treatment for major depression in primary care

Cited by 375 publications

References 13 publications

Common mental disorders in Petrópolis-RJ: a challenge to integrate mental health into primary care strategies

Common mental disorders in Petrópolis-RJ: a challenge to integrate mental health into primary care strategies

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

Diretrizes da World Federation of Societies of Biological Psychiatry (WFSBP) para tratamento biológico de transtornos depressivos unipolares, 1ª parte: tratamento agudo e de continuação do transtorno depressivo maior

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