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.

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.

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.

scholarly journals Efficacy, safety, and tolerability of vortioxetine for the treatment of major depressive disorder in patients aged 55 years or older

CNS Spectrums ◽  
2016 ◽  
Vol 22 (4) ◽  
pp. 348-362 ◽  
Author(s):  
George G. Nomikos ◽  
Dapo Tomori ◽  
Wei Zhong ◽  
John Affinito ◽  
William Palo
Keyword(s):  
Body Weight ◽  
Major Depressive Disorder ◽  
Depressive Disorder ◽  
Rating Scale ◽  
Liver Enzymes ◽  
Meta Analysis ◽  
Vital Signs ◽  
Fixed Dose ◽  
Major Depressive ◽  
Mean Differences

ObjectiveThese post hoc analyses evaluate the efficacy, safety, and tolerability of vortioxetine versus placebo in patients aged ≥55 years with major depressive disorder (MDD).MethodsStudy-level efficacy data from 12 short-term, fixed-dose, randomized, placebo-controlled trials of vortioxetine 5–20 mg/day were assessed using a random-effects meta-analysis. Adverse events (AEs), vital signs, ECG values, liver enzymes, and body weight were pooled from the same studies. Patients had baseline Montgomery–Åsberg Depression Rating Scale (MADRS) total scores ranging from 22–30.Results1508 patients (mean age=62.4 years; range, 55–88 years) were included. Mean differences from placebo in change from baseline to study end (6/8 weeks) in MADRS were –2.56 (5 mg, n=324, P=0.035), –2.87 (10 mg, n=222, P=0.007), –1.32 (15 mg, n=90, P=NS), and –4.65 (20 mg, n=165, P=0.012). Odds ratios for response versus placebo were 1.6 (5 mg, P=NS), 1.8 (10 mg, P=0.002), 1.2 (15 mg, P=NS), and 2.5 (20 mg, P<0.001), and for remission versus placebo were 1.5 (5 mg, P=NS), 1.5 (10 mg, P=NS), 1.4 (15 mg, P=NS), and 2.7 (20 mg, P=0.001). The proportion of patients with AEs for placebo and vortioxetine 5–20 mg was 61.5% and 62.3%, respectively, with no increase at increased doses. Vortioxetine demonstrated a placebo-level incidence of serious AEs (1.2%). AEs occurring in ≥5% of any treatment group were nausea, headache, diarrhea, dizziness, dry mouth, constipation, fatigue, vomiting, and anxiety. No clinically significant mean changes in vital signs, ECG values, liver enzymes, or body weight emerged during treatment.ConclusionVortioxetine 5–20 mg/day is efficacious and well tolerated in MDD patients aged ≥55 years, a group that is often comorbid with other conditions and treated with other medications.

scholarly journals The effect of exercise interventions on inflammatory markers in major depressive disorder: protocol for a systematic review and meta-analysis

2021 ◽  
Vol 4 ◽  
pp. 42
Author(s):  
Diana Grunberg ◽  
Jason A. Martin ◽  
John F. Cryan ◽  
Ken D. O’Halloran ◽  
Eric Kelleher ◽  
...  
Keyword(s):  
Systematic Review ◽  
Major Depressive Disorder ◽  
Depressive Disorder ◽  
Meta Analysis ◽  
Control Group ◽  
Search Term ◽  
Major Depressive ◽  
Exercise Interventions ◽  
Mean Differences ◽  
Inflammatory Molecules

Background: Depression currently affects 4.4% of the global population, and 93.7% of this population suffer from major depressive disorder (MDD) according to 2017 statistics. MDD patients are more likely to suffer from co-morbidities such as cardiovascular disease and high body mass index (BMI), thus contributing to its large cost to society. Throughout the literature, there are known links between inflammation and MDD. Interestingly, while exercise is considered a promising intervention for MDD, the mechanism(s) of action remain unclear, thereby preventing the creation of optimal, cost-saving, exercise “prescriptions” for those with MDD. Thus, the aim of this review and meta-analysis is to summarize and analyse the current literature exploring how quantified exercise interventions modulate inflammatory molecules in MDD patients. Methods: Electronic databases (APA PsycINFO, and PubMed/MEDLINE (EBSCO interface), EMBASE) will be searched using a detailed search strategy comprised of three search term themes: exercise, depression/MDD, and inflammation/inflammatory molecules. Only quantified exercise interventions performed in adult humans with MDD validated via a recognized diagnostic criterion will be included. Studies should also include a MDD control group and explore changes in inflammatory molecules. Examples of these molecules include: C-reactive protein (CRP), interleukin-6 (IL-6), interleukin-1 beta (IL-1b), tumour necrosis factor-alpha (TNF-a), homocysteine, d-dimer and myeloperoxidase (MPO). After eligible studies are identified, standardized data extraction will be employed and the risk of bias in each study will be appraised using the Cochrane handbook checklists. In the event of two or more homogenous studies exploring exercise effects over a similar period of time, raw mean differences or standardized mean differences will be pooled using random effects analysis. This systematic review and meta-analysis will be reported according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. Dissemination: This systematic review and meta-analysis will be disseminated in peer-reviewed journals. PROSPERO registration: CRD42020186006 (31/08/2020)

scholarly journals Mindfulness-Based Cognitive Therapy in Major depressive disorder - systematic review and metanalysis

2017 ◽  
Vol 30 (suppl 1) ◽  
pp. 335-349
Author(s):  
Rafaela Liberali
Keyword(s):  
Systematic Review ◽  
Major Depressive Disorder ◽  
Depressive Disorder ◽  
Meta Analysis ◽  
Depression Symptoms ◽  
Major Depressive ◽  
Promising Alternative ◽  
Randomized Studies ◽  
Resistant Depression ◽  
Mean Differences

Abstract Introduction: MBCT practices increases the ability of concentration and attention, as well is particularly effective for people with current and treatment-resistant depression. Objective: To analyze the effects of the application of MBCT in symptoms of MDD. Methods: systematic review and meta-analysis. To find suitable studies, we searched PubMed/MEDLINE's database using the keywords mindfulness and major depressive disorder. Studies in English published between 2003 and 2015 were selected. The studies were evaluated according to their methodological quality by PEDro scale (score greater than 3), studies that showed empirical evidence, had an experimental study design (randomized and non-randomized), and whose full text was available. For the meta-analysis, we used a random-effects model with standardized mean differences and 95% confidence intervals. Results: Fourteen es were included, of which three were non-randomized, with only one group with intervention of MBCT, and 11 were randomized studies, divided into two-group samples and three-group samples. The non-randomized studies showed a PEDro score of 5, while the two-group and three-group randomized studies showed PEDro scores of 5-10 and 6-9, respectively. In the meta-analysis, the four randomized studies selected revealed a moderate effect of MBCT on the outcome of depression symptoms, with a mean difference of -0.52 (95% CI: -1.050 to -0.002; p = 0.04). Conclusion: The MBCT presented as a promising alternative for the treatment of this disorder.

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