Depression Treatment: Guided Self-Help Cognitive Behavioural Therapy for Depression in Primary Care: A Randomised Controlled Trial.

Guided self-help cognitive behavioural therapy for depression in primary care: a randomised controlled trial.

Filed under: Depression Treatment

PLoS One. 2013; 8(1): e52735
Williams C, Wilson P, Morrison J, McMahon A, Andrew W, Allan L, McConnachie A, McNeill Y, Tansey L

Access to Cognitive behavioural therapy (CBT) for depression is limited. One solution is CBT self-help books. Trial Objectives: To assess the impact of a guided self-help CBT book (GSH-CBT) on mood, compared to treatment as usual (TAU). Hypotheses:GSH-CBT will have improved mood and knowledge of the causes and treatment of depression compared to the control receiving TAUGuided self-help will be acceptable to patients and staff.Participants: Adults attending seven general practices in Glasgow, UK with a BDI-II score of ?14. 141 randomised to GSH-CBT and 140 to TAU. Interventions: RCT comparing ‘Overcoming Depression: A Five Areas Approach’ book plus 3-4 short face to face support appointments totalling up to 2 hours of guided support, compared with general practitioner TAU. Primary outcome: The BDI (II) score at 4 months. Numbers analysed: 281 at baseline, 203 at 4 months (primary outcome), 117 at 12 months. Outcome: Mean BDI-II scores were lower in the GSH-CBT group at 4 months by 5.3 points (2.6 to 7.9, p<0.001). At 4 and 12 months there were also significantly higher proportions of participants achieving a 50% reduction in BDI-II in the GSH-CBT arm. The mean support was 2 sessions with 42.7 minutes for session 1, 41.4 minutes for session 2 and 40.2 minutes of support for session 3. Adverse effects/Harms: Significantly less deterioration in mood in GSH-CBT (2.0% compared to 9.8% in the TAU group for BDI-II category change).Weaknesses: Our follow-up rate of 72.2% at 4 months is better than predicted but is poorer at 12 months (41.6%). In the GSH-CBT arm, around 50% of people attended 2 or fewer sessions. 22% failed to take up treatment.GSH-CBT is substantially more effective than TAU.Controlled-Trials.com ISRCTN13475030. HubMed – depression

The risk of developing depression when suffering from neurological diseases.

Filed under: Depression Treatment

Ger Med Sci. 2013; 11: Doc02
Thielscher C, Thielscher S, Kostev K

Aim of the study: To investigate the comorbidity of Alzheimer’s/dementia, epilepsy, multiple sclerosis and Parkinson’s with depression.Methods: 42,914 patients who were newly diagnosed with the four comorbid diseases were included in the study. We analyzed how many of these patients developed depression within five years.Results: Between 21% (males with epilepsy) and 39% (women with Parkinson’s)/44% (Alzheimer’s patients under 60 years) developed depression within five years. Conclusion: We recommend routine checks for depression in patients diagnosed with one of these diseases, especially in the most comorbid ones.
HubMed – depression

Age-related symptom and life quality changes in women with irritable bowel syndrome.

Filed under: Depression Treatment

World J Gastroenterol. 2012 Dec 28; 18(48): 7175-83
Tang YR, Yang WW, Liang ML, Xu XY, Wang MF, Lin L

To explore age-related changes in symptoms and quality of life (QoL) of women with irritable bowel syndrome (IBS).Two-hundred and fifty-four female adult outpatients with IBS attending the Department of Gastroenterology at the First Affiliated Hospital of Nanjing Medical University between January, 2008 and October, 2008 were approached. Patients with a history of abdominal surgery, mental illness or those who had recently taken psychotropic drugs were excluded. A physician obtained demographic and abdominal symptom data. All patients were asked to complete the Zung Self-Rated Anxiety and Depression Scale (SDS/SAS) and the IBS-specific QoL questionnaire. The patients were divided into six groups according to age, in 10-year increments: 18-27 years, 28-37 years, 38-47 years, 48-57 years, 58-67 years and 68-75 years (maximum 75 years). Age-related differences of abdominal pain or discomfort were analyzed using rank-sum tests. Differences in SDS/SAS and IBS-QoL scores between age groups were analyzed using one-way analysis of variance. Pearson’s correlations evaluated potential associations between IBS symptoms, psychological factors and QoL in each age group.There were no differences in the distribution of IBS subtypes between age groups (?(2) = 20.516, P = 0.153). Differences in the severity of abdominal pain/discomfort with age were statistically significant (?(2) = 25.638, P < 0.001); patients aged 48-57 years, 58-67 years or 68-75 years had milder abdominal pain/discomfort than those in the younger age groups. The severity of anxiety or depressive symptoms did not differ between age groups (SDS, ?(2) = 390.845, P = 0.110; SAS, ?(2) = 360.071, P = 0.220). Differences of IBS-QoL scores were statistically significant between age groups (?(2) = 1098.458, P = 0.011). The scores of patients in the 48-57-year group were lower than those in the 18-27-year and 28-37-year groups (48-57-year group vs 18-27-year group, 74.88 ± 8.76 vs 79.76 ± 8.63, P = 0.021; 48-57-year group vs 28-37-year group, 74.88 ± 8.76 vs 79.04 ± 8.32, P = 0.014). The scores in the 68-75-year group were lower than those in the 18-27-year, 28-37-year and 38-47-year groups (68-75-year group vs 18-27-year group, 71.98 ± 9.83 vs 79.76 ± 8.63, P = 0.003; 68-75-year group vs 28-37-year group, 71.98 ± 9.83 vs 79.04 ± 8.32, P = 0.002; 68-75-year group vs 38-47-year group,71.98 ± 9.83 vs 76.44 ± 8.15, P = 0.039). Anxiety and depression were negatively correlated with QoL in all age groups (SDS and QoL: 18-27-year group, r = -0.562, P = 0.005; 28-37-year group, r = -0.540, P < 0.001; 38-47-year group, r = -0.775, P < 0.001; 48-57-year group, r = -0.445, P = 0.001; 58-67-year group, r = -0.692, P < 0.001; 68-75-year group, r = -0.732, P < 0.001. SAS and QoL: 18-27-year group, r = -0.600, P = 0.002; 28-37-year group, r = -0.511, P < 0.001; 38-47-year group, r = -0.675, P < 0.001; 48-57-year group, r = -0.558, 58-67-year group, P = 0.001; r = -0.588, P < 0.001; 68-75-year group, r = -0.811, P < 0.001). A negative correlation between abdominal pain severity and QoL was found in patients aged more than 58 years (58-67-year group, r = -0.366, P = 0.017; 68-75-year group, r = -0.448, P = 0.048 ), but not in younger patients (18-27-year group, r = 0.080, P = 0.716; 28-37-year group, r = -0.063, P = 0.679; 38-47-year group, r = -0.029, P = 0.812; 48-57-year group, r = -0.022, P = 0.876).Factors affecting QoL should always be treated in IBS, especially emotional problems in young adults. Even mild abdominal pain should be controlled in elderly patients. HubMed – depression

UNDERSTANDING DEPRESSION: TREATMENT BY KLEIN & WENDER, SIGNED BY AUTHOR

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