Psychotherapy, Pharmacotherapy, and Their Combination for Adolescents with Major Depressive Disorder: A Meta-Analysis

2013 ◽  
Vol 31 (1) ◽  
pp. 47-65 ◽  
Author(s):  
Nikita Singh ◽  
John Reece
Keyword(s):  
Major Depressive Disorder ◽  
Treatment Outcome ◽  
Combination Therapy ◽  
Depressive Disorder ◽  
Meta Analysis ◽  
Treatment Strategies ◽  
Inclusion Criteria ◽  
Major Depressive ◽  
Treatment Type ◽  
Significant Difference

This meta-analysis aims to inform clinical practice of treatment strategies for adolescents with major depressive disorder (MDD). The efficacy of three empirically validated treatments was compared to determine the most effective treatment. These were: cognitive-behavioural therapy (CBT), selective serotonin reuptake inhibitor (SSRI) pharmacotherapy, and combination CBT and SSRI therapy. Inclusion criteria required studies to report a reliable and valid pre- and post-treatment measure and adequate data for Hedge's g effect size to be calculated. Forty-nine studies meeting the above inclusion criteria were found and included in the analysis. Although all three treatment strategies were found to be effective, analysis revealed no significant difference in treatment outcome among CBT, SSRI, and combination therapy. An investigation of moderator variables revealed months to follow-up to significantly influence the relationship between treatment type and treatment outcome. Given that CBT has no side effects, is more cost effective, and is equally as effective as SSRI therapy and combination therapy, the current study makes a strong case for CBT as a first-line treatment strategy for adolescents with MDD.

Augmentation strategies in the treatment of major depressive disorder

2016 ◽  
Vol 33 (S1) ◽  
pp. S407-S407
Author(s):  
S. Bise ◽  
B. Kurtovic ◽  
D. Begic ◽  
O. Cemalovic
Keyword(s):  
Major Depressive Disorder ◽  
Combination Therapy ◽  
Depressive Disorder ◽  
Mood Stabilizers ◽  
Augmentation Therapy ◽  
Major Depressive ◽  
Augmentation Strategies ◽  
Significant Difference ◽  
Augmentation Strategy ◽  
Competing Interest

Augmentation strategies for the treatment of Major depressive disorder (MDD) are needed when patients with MDD have a partial, or not responded to antidepressant monotherapy. The focus of augmentation therapy has been combining an antidepressant (AD) medication with another AD. Atypical antipsychotics (AAP) are becoming commonly used to augment antidepressants. Beyond AD and AAP, alternative augmentation strategies include mood stabilizers (MS).AimTo analyze the characteristics of therapy in patients with diagnosis of MDD and to investigate the frequency of augmentation therapy.MethodStudy included 28 patients hospitalized during one year with MDD diagnosis. Statistical analysis was performed with x2 and t-test.ResultAmong patients with MDD there were 18 (64.28%) women with an average age 57.5 and 10 (35.71%) men with an average age 53.5. Of the 28 patients with MDD, 25 (89.28%) were treated with a combination therapy, and monotherapy in the remaining 3 patients (10.71%). Of 25 patients with augmentation strategy treatment, 22 (88%) used two medications and the remaining 3 (12%) tree psychotropic medications (AAP, AD, MS). The most frequent combinations were a combination of AD and AAP (17 patients, 68%). Beyond that frequent combination were AD and MS (6 patients, 24%). Two patients used combination two AAP, and one patient with two AD and one patients used AAP and MS.ConclusionAugmentation strategy is often used in patients with MDD. There is no significant difference in the use combination therapy based on gender and age.Disclosure of interestThe authors have not supplied their declaration of competing interest.

scholarly journals Efficacy of Treatments Targeting Hypothalamic-Pituitary-Adrenal Systems for Major Depressive Disorder: A Meta-Analysis

2021 ◽  
Vol 12 ◽  
Author(s):  
Yudan Ding ◽  
Zirou Wei ◽  
Haohao Yan ◽  
Wenbin Guo
Keyword(s):  
Major Depressive Disorder ◽  
Depressive Disorder ◽  
Receptor Antagonist ◽  
Meta Analysis ◽  
Open Label ◽  
High Quality ◽  
Major Depressive ◽  
Hypothalamic Pituitary Adrenal ◽  
Significant Difference ◽  
Mean Differences

Abnormal hypothalamic-pituitary-adrenal (HPA) axis has been implicated in major depressive disorder (MDD). A number of studies have attempted to use HPA-modulating medications to treat depression. However, their results are inconsistent. The efficacy of these drugs for MDD remains uncertain. The aims of this meta-analysis were to determine the effect and safety profile of HPA-targeting medications for MDD. World of Science and PubMed databases were comprehensively searched up to March 2021. All randomized controlled trials (RCTs) and open-label trials exploring antiglucocorticoid and related medications in patients with depression were included. Standardized mean differences (SMDs) and risk ratios (RRs) with 95% confidence intervals (CIs) were calculated for continuous or dichotomous outcomes, respectively. In the meta-analysis, we identified 16 RCTs and seven open-label studies that included 2972 subjects. Pooling the change data that assessed the efficacy across all included HPA-targeting medications for depression showed a significant difference between interventions and controls with very small heterogeneity after influence analysis (SMD = 0.138, 95%CI = 0.052, 0.224, p = 0.002; I2 = 20.7%, p = 0.212). No obvious publication bias was observed (p = 0.127). Effectiveness remained significant in patients with MDD (SMD = 0.136, 95%CI = 0.049, 0.223, p = 0.002). Subgroup analysis showed a significant difference favoring mifepristone and vasopressin 1B (V1B) receptor antagonist treatment. Adverse events were reported by 14 studies and our analysis of high-quality studies showed a significant difference in favor of controls (RR = 1.283, 95%CI = 1.134, 1.452, p = 0). Our study suggested that patients with MDD may benefit from mifepristone and V1B receptor antagonist treatments that have tolerable side effects. HPA-based medications are promising for depression treatment. However, additional high-quality RCTs, including head-to-head trials, are needed.Systematic Review Registration:https://www.crd.york.ac.uk/PROSPERO/, identifier registration number: CRD42021247279

scholarly journals Restless legs syndrome is a risk factor for major depressive disorder: a systematic review and meta-analysis

2020 ◽  
Author(s):  
Haiwang Zhang ◽  
Changxi Zhou ◽  
Shuai Jin ◽  
Xingde Liu ◽  
Song Li ◽  
...  
Keyword(s):  
Major Depressive Disorder ◽  
Depressive Disorder ◽  
Restless Legs Syndrome ◽  
Meta Analysis ◽  
Case Control Studies ◽  
Major Depressive ◽  
Restless Legs ◽  
Knowledge Infrastructure ◽  
Significant Difference

Abstract A significant association between major depressive disorder (MDD) and restless legs syndrome (RLS), but RLS prevalence is dramatically different among MDD individuals across studies. Our present work aimed to comprehensively evaluate available evidences to determine the role of RLS in MDD. PubMed, Web of Science, Embase, Science Online, Wip Chinese Biomedical Journal, Wanfang and Chinese National Knowledge Infrastructure were searched to identify observational and case-control studies relevant to RLS and MDD. Stata 12.0 software was used for meta-analysis. RLS individuals exhibited a higher risk of MDD than non-RLS controls (OR 2.05, 95%CI 1.80–2.33; p<0.05). No significant differences were found in MDD prevalence between young RLS patients (OR 2.10, 95%CI 1.72–2.56) and older RLS patients (OR 2.02, 95%CI 1.70–2.39). In addition, no significant difference in MDD prevalence was evident between between Asian (OR 1.98, 95%CI 1.66–2.37) and European or American (OR 1.76, 95%CI 1.54–2.01) RLS patients. Our meta-analysis provides evidence that the risk for MDD is higher among RLS patients compared to non-RLS individuals suggesting that RLS may play an important role in MDD patheogenesis.

scholarly journals High Efficacy of OnabotulinumtoxinA Treatment in Patients With Comorbid Migraine and Depression: A Meta-analysis

2020 ◽  
Author(s):  
Oreste Affatato ◽  
Thiago C. Moulin ◽  
Claudia Pisanu ◽  
Victoria S. Babasieva ◽  
Marco Russo ◽  
...  
Keyword(s):  
Major Depressive Disorder ◽  
Depressive Symptoms ◽  
Depressive Disorder ◽  
Chronic Migraine ◽  
Empirical Bayes ◽  
Meta Analysis ◽  
Inclusion Criteria ◽  
Major Depressive ◽  
Bayes Model ◽  
Vas Scores

Abstract Background: Migraine and depression are highly prevalent and partly overlapping disorders that cause strong limitations in daily life. Patients tend to respond poorly to the therapies available for these diseases. OnabotulinumtoxinA has been proven to be an effective treatment for both migraine and depression. While many studies have addressed the effect of onabotulinumtoxinA in migraine or depression separately, a growing body of evidences suggest benecial effects also for patients comorbid with migraine and depression. The current meta-analysis systematically investigates to what extent onabotulinumtoxinA is efficient in migraineurs with depression.Methods: A systematic literature search was performed based on PubMed, Scopus and Web of Science from the earliest date till October 30th, 2020. Mean, standard deviation (SD) and sample size have been used to evaluate improvement in depressive symptoms and migraine using random-effects empirical Bayes model. Results: Our search retrieved 259 studies, eight of which met inclusion criteria. OnabotulinumtoxinA injections administered to patients with both chronic migraine and major depressive disorder led to mean reduction of -8.94 points (CI: [-10.04, -7.84], p < 0:01) in the BDI scale, of -5.90 points (CI: [-9.92, -1.88], p < 0:01) in the BDI-II scale and of -6.19 points (CI: [-9.52, -2.86], p < 0:01) in the PHQ-9 scale, when evaluating depressive symptoms. In the case of the migraine-related symptoms, we found mean reductions of -4.10 (CI: [-7.31, -0.89], p = 0.01) points in the HIT6 scale, -32.05 (CI: [-55.96, -8.14], p = 0.01) in the MIDAS scale, -1.7 (CI: [-3.27, -0.13], p = 0.03) points in the VAS scale and of -6.27 (CI: [-8.48, -4.07], p < 0:01) migraine episodes per month. Comorbid patients showed slightly better improvements in BDI, HIT6 scores and migraine frequency compared to monomorbid patients. The latter group manifested better results in MIDAS and VAS scores. Conclusion: Treatment with onabotulinumtoxinA leads to a signicant reduction of disease severity of both chronic migraine and major depressive disorder in patients comorbid with both diseases. Comparative analyses suggest an equivalent strong effect in monomorbid and comorbid patients, with benecial effects specically seen for certain migraine features.

scholarly journals Antidepressant side effects and their impact on treatment outcome in people with major depressive disorder: an iSPOT-D report

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Taylor A. Braund ◽  
Gabriel Tillman ◽  
Donna M. Palmer ◽  
Evian Gordon ◽  
A. John Rush ◽  
...  
Keyword(s):  
Major Depressive Disorder ◽  
Treatment Outcome ◽  
Side Effects ◽  
Depressive Disorder ◽  
Anxiety Symptoms ◽  
Post Treatment ◽  
Major Depressive ◽  
Treatment Type ◽  
The Impact ◽  
Frequency Intensity

AbstractSide effects to antidepressant medications are common and can impact the prognosis of successful treatment outcome in people with major depressive disorder (MDD). However, few studies have investigated the severity of side effects over the course of treatment and their association with treatment outcome. Here we assessed the severity of side effects and the impact of treatment type and anxiety symptoms over the course of treatment, as well as whether side effects were associated with treatment outcome. Participants were N = 1008 adults with a current diagnosis of single-episode or recurrent, nonpsychotic MDD. Participants were randomised to receive escitalopram, sertraline, or venlafaxine-extended release with equal probability and reassessed at 8 weeks regarding Hamilton Rating Scale Depression (HRSD17) and Quick Inventory of Depressive Symptomatology (QIDS-SR16) remission and response. Severity of side effects were assessed using the Frequency, Intensity, and Burden of Side Effects Rating (FIBSER) scale and assessed at day 4 and weeks 2, 4, 6, and 8. Frequency, intensity, and burden of side effects were greatest at week 2, then only frequency and intensity of side effects gradually decreased up to week 6. Treatment type and anxiety symptoms did not impact the severity of side effects. A greater burden—but not frequency or intensity—of side effects was associated with poorer treatment outcome and as early as 4 days post-treatment. Together, this work provides an informative mapping of the progression of side effects throughout the treatment course and their association with treatment outcome. Importantly, the burden of side effects that are present as early as 4 days post-treatment predicts poorer treatment outcome and should be monitored closely. iSPOT-D: Registry name: ClinicalTrials.gov. Registration number: NCT00693849.

Meta-analysis of volumetric abnormalities in cortico-striatal-pallidal-thalamic circuits in major depressive disorder

2011 ◽  
Vol 42 (4) ◽  
pp. 671-681 ◽  
Author(s):  
E. Bora ◽  
B. J. Harrison ◽  
C. G. Davey ◽  
M. Yücel ◽  
C. Pantelis
Keyword(s):  
Major Depressive Disorder ◽  
Depressive Disorder ◽  
Meta Analysis ◽  
Anterior Cingulate ◽  
Effect Sizes ◽  
Inclusion Criteria ◽  
Late Life Depression ◽  
Subcortical Structures ◽  
Major Depressive ◽  
Antidepressant Use

BackgroundAbnormalities in cortico-striatal-pallidal-thalamic (CSPT) circuits have been implicated in major depressive disorder (MDD). However, the robustness of these findings across studies is unclear, as is the extent to which they are influenced by demographic, clinical and pharmacological factors.MethodWith the aim of clarifying these questions, we conducted a meta-analysis to map the volumetric abnormalities that were most robustly identified in CSPT circuits of individuals with MDD. A systematic search identified 41 studies meeting our inclusion criteria.ResultsThere were significant volume reductions in prefrontal (especially orbitofrontal) and anterior cingulate cortices, and also in subcortical structures such as the caudate nucleus and putamen, with effect sizes ranging from small to moderate. The subgenual anterior cingulate and orbitofrontal cortices were significantly smaller in antidepressant-free samples compared to medicated patients. Late-life depression (LLD) tended to be associated with smaller volumes in circumscribed frontal and subcortical structures, with the most robust differences being found in thalamic volume.ConclusionsIndividuals with major depression demonstrate volumetric abnormalities of CSPT circuits. However, these observations may be restricted to certain subgroups, highlighting the clinical heterogeneity of the disorder. On the basis of this meta-analysis, CSPT abnormalities were more prominent in those with LLD whereas antidepressant use seemed to normalize certain cortical volumetric abnormalities.

scholarly journals Antipsychotic Monotherapy for Major Depressive Disorder: A Systematic Review and Meta-analysis

2021 ◽  
Author(s):  
Akira Nishi ◽  
Kyosuke Sawada ◽  
Hiroyuki Uchida ◽  
Masaru Mimura ◽  
Hiroyoshi Takeuchi
Keyword(s):  
Major Depressive Disorder ◽  
Placebo Group ◽  
Adverse Events ◽  
Depressive Disorder ◽  
Rating Scale ◽  
Meta Analysis ◽  
Depression Severity ◽  
Major Depressive ◽  
Increased Risk ◽  
Significant Difference

Abstract No clinical guidelines currently recommend antipsychotic monotherapy (APM) for major depressive disorder (MDD). Although several randomized controlled trials (RCTs) have compared the effectiveness, efficacy, and safety of APM versus placebo in patients with MDD, no meta-analysis has examined this topic. We conducted a systematic literature search using MEDLINE and Embase to identify relevant RCTs and performed a meta-analysis to compare the following outcomes between APM and placebo: study discontinuation due to all causes, lack of efficacy, and adverse events, changes in total scores on depression severity scales (e.g., Hamilton Depression Rating Scale and Montgomery Åsberg Depression Rating Scale) and in the Clinical Global Impression - Severity scale (CGI-S) score, and individual adverse event rates. A total of 13 identified studies with 14 comparisons involving 3,197 participants that met the eligibility criteria were included in the meta-analysis. No significant difference was found in study discontinuation due to all causes between the APM and placebo groups. However, there were significant differences in study discontinuation due to lack of efficacy in favor of the APM group and study discontinuation due to adverse events in favor of the placebo group. Compared with the placebo group, the APM group was significantly superior in relation to score reduction on the depression severity scales and CGI-S and inferior in relation to 8 of 23 individual adverse events. APM could be a useful treatment option for the acute phase of MDD, although clinicians should be aware of an increased risk of some adverse events.

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