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1.
BMC Psychiatry ; 21(1): 233, 2021 05 04.
Artículo en Inglés | MEDLINE | ID: mdl-33947374

RESUMEN

BACKGROUND: Several evidence-based psychotherapeutic treatment options are available for depression, but the treatment results could be improved. The D*Phase study directly compares short-term psychodynamic supportive psychotherapy (SPSP) and cognitive behavioural therapy (CBT) for Major Depressive Disorder (MDD). The objectives are 1. to investigate if, from a group level perspective, SPSP is not inferior to CBT in the treatment of major depressive disorder, 2. to build a model that may help predict the optimal type of treatment for a specific individual; and 3. to determine whether a change of therapist or a change of therapist and treatment method are effective strategies to deal with non-response. Furthermore (4.), the effect of the therapeutic alliance, treatment integrity and therapist allegiance on treatment outcome will be investigated. METHOD: In this pragmatic randomised controlled trial, 308 patients with a primary diagnosis of MDD are being recruited from a specialised mental health care institution in the Netherlands. In the first phase, patients are randomised 1:1 to either SPSP or CBT. In case of treatment non-response, a second phase follows in which non-responders from treatment phase one are randomised 1:1:1 to one of three groups: continuing the initial treatment with the same therapist, continuing the initial treatment with another therapist or continuing the other type of treatment with another therapist. In both treatment phases, patients are offered sixteen twice-weekly psychotherapy sessions. The primary outcome is an improvement in depressive symptoms. Process variables, working alliance and depressive symptoms, are frequently measured. Comprehensive assessments take place before the start of the first phase (at baseline), in week one, two and four during the treatment, and directly after the treatment (week eight). DISCUSSION: While the naturalistic setting of the study involves several challenges, we expect, by focusing on a large and diverse number of research variables, to generate important knowledge that may help enhance the effect of psychotherapeutic treatment for MDD. TRIAL REGISTRATION: The study was registered on 26 August 2016 with the Netherlands Trial Register, part of the Dutch Cochrane Centre (NL5753), https://www.trialregister.nl/trial/5753.


Asunto(s)
Terapia Cognitivo-Conductual , Trastorno Depresivo Mayor , Depresión , Trastorno Depresivo Mayor/terapia , Humanos , Países Bajos , Psicoterapia , Ensayos Clínicos Controlados Aleatorios como Asunto
2.
Adv Exp Med Biol ; 1305: 311-332, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33834407

RESUMEN

Major depressive disorder (MDD) represents a key contributor to the global burden of mental illness given its relatively high lifetime prevalence, frequent comorbidity, and disability rates. Evidence-based treatment options for depression include pharmacotherapy and psychotherapy, such as cognitive behavioral therapy (CBT). Beyond traditional CBT, over 15 years ago, Hayes proclaimed a new generation of contextualistic and process-orientated so-called third wave of CBT interventions, including acceptance and commitment therapy (ACT). Using mindfulness and acceptance as well as commitment and behavior change processes, the transdiagnostic ACT approach aims to increase psychological flexibility as universal mechanism of behavior change and to build a value-driven orientation in life. ACT for MDD can be provided as either stand-alone individual, group, or self-help formats (e.g., apps) or combined with other approaches like behavioral activation. To date, a steadily growing empirical support from outcome and process research suggests the efficacy of ACT, which appears to work specifically through the six proposed core processes involved in psychological flexibility, such as defusion. In view of an ongoing interest of clinicians in "third-wave" CBTs and the important role of clients' preferences in providing therapy choices that work, the purpose of this chapter is to give a brief overview on the application of ACT in the treatment of MDD in adults.


Asunto(s)
Terapia de Aceptación y Compromiso , Terapia Cognitivo-Conductual , Trastorno Depresivo Mayor , Atención Plena , Adulto , Trastorno Depresivo Mayor/terapia , Humanos , Solución de Problemas , Resultado del Tratamiento
3.
Adv Exp Med Biol ; 1305: 375-427, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33834410

RESUMEN

Complementary and alternative medicine (CAM) encompasses a wide range of different non-mainstream therapies that have been increasingly used for treatment or adjunctive treatment of various ailments with mood disorders and "depressive difficulties" being two of the commonly CAM (self-)medicated conditions. We focus specifically on clinically diagnosed (in line with the standard criteria) depressive disorders, primarily major depressive disorder (MDD), and overview evidence of efficacy/safety of a range of CAM modalities addressing exclusively randomized controlled trials (RCTs) and systematic reviews/meta-analyses of RCTs. The list of addressed CAM interventions is not exhaustive: due to space limitation, addressed are interventions with at least a few conducted RCTs in the specific clinical conditions. We try to provide numerical and meaningful data as much as it is possible and to (a) indicate situations in which the reported data/estimates might have been "too enthusiastic" and (b) warn about heterogeneity of results that, together with other possible limitations (various biases and imprecision), results in uncertainty about the effects.


Asunto(s)
Terapia por Acupuntura , Terapias Complementarias , Trastorno Depresivo Mayor , Trastorno Depresivo Mayor/terapia , Humanos
4.
Adv Exp Med Biol ; 1305: 493-501, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33834414

RESUMEN

Major depressive disorder (MDD) is a heterogeneous condition with complex pathophysiology resulting from the interaction between genetic and environmental factors. Despite a reasonable array of therapeutic options, the management of MDD has been marked by an increasing number of treatment resistant cases. Identifying the multiple pathways involved in the pathogenesis of MDD is fundamental to move the field forward and to define novel and more effective therapeutic targets. The current disease models are not able to recapitulate the complexity of this condition. In the last years, induced pluripotent stem cells (iPSCs) have emerged as a unique tool to help the elucidation of the pathophysiology of psychiatric disorders through disease modeling. In addition, the iPSCs may play an important role in the validation of new therapeutic targets.


Asunto(s)
Trastorno Depresivo Mayor , Células Madre Pluripotentes Inducidas , Depresión , Trastorno Depresivo Mayor/genética , Trastorno Depresivo Mayor/terapia , Humanos
6.
Medicine (Baltimore) ; 100(14): e25273, 2021 Apr 09.
Artículo en Inglés | MEDLINE | ID: mdl-33832092

RESUMEN

BACKGROUND: The optimal dose (number of pulses per session) of repetitive transcranial magnetic stimulation (rTMS), using the H-coil, in major depressive disorder (MDD) has not previously been reported. OBJECTIVE: To explore the relationship between rTMS dose and antidepressant effect, and collect data for the design of a definitive trial. METHODS: This was a double-blind, three-arm parallel-group, randomized [1:1:1], pilot trial conducted in Stockholm, Sweden (September 2014 to September 2016). The primary outcome was change in depression severity measured with the Montgomery Åsberg Depression Rating Scale (MADRS) after 4 weeks. Participants (n = 29) with MDD were randomized to 1000, 2000, or 4000 pulses of rTMS for 20 sessions during 4 weeks. RESULTS: At 4 weeks, the 3 treatment groups reduced the mean MADRS (95% CI) by 11.6 (4.0-19.2), 9.1 (5.0-13.3), and 11.3 (4.1-18.5) points respectively. Eleven participants met criteria for response and 10 for remission. No serious adverse events occurred. Ratings of subjective memory improved in all groups. Exploring the effect of dose and time, 4000 pulses had the largest reduction in MADRS during the first 2 weeks. A comparison of change in MADRS between 2000 and 4000 pulses after 2 weeks will require a sample size of 66 patients at power .80 and alpha .05. CONCLUSIONS: It is feasible to conduct a definitive trial investigating whether a higher number of magnetic pulses per treatment session gives a more rapid antidepressive response.


Asunto(s)
Trastorno Depresivo Mayor/terapia , Estimulación Magnética Transcraneal/métodos , Adulto , Método Doble Ciego , Femenino , Humanos , Masculino , Persona de Mediana Edad , Proyectos Piloto , Escalas de Valoración Psiquiátrica
7.
Artículo en Inglés | MEDLINE | ID: mdl-33671189

RESUMEN

Background: Individuals suffering from major depressive disorder (MDD) often describe workplace-related stress as one of the main causes of their disorder. Here, we present the story of a 33 year old "Bob" (a pseudonym) who suffered from a moderate (Hamilton-21 = 18) major depressive episode. Workplace-related stress seemed to be the main stressor for Bob at the time. We were interested in long-lasting effects of a newly established group called "work-related interpersonal Psychotherapy, W-IPT". W-IPT consists of eight weekly 90 min sessions. The follow-ups were 12 weeks after the group-treatment and 18 months later. Bob was chosen because he agreed in advance to participate in a follow-up. We were interested if the group-treatment of W-IPT also has a persistent positive effect. Case presentation: We present the case of a 33-year-old man "Bob". He was included in our previous published pilot-study 2020 with diagnosed moderate MDD, and he attended the group treatment. This case report focuses on a follow-up period of 18 months. A structured clinical interview for DSM-IV was carried out in order to be included in the study, and no comorbid diagnoses were detected. Conclusions: However, the psychotherapeutic effects in this case seem enduring and prolonged. Of course, additional research to study the long-term effects of W-IPT is needed, and more patients need to be included.


Asunto(s)
Trastorno Depresivo Mayor , Psicoterapia de Grupo , Adulto , Trastorno Depresivo Mayor/terapia , Manual Diagnóstico y Estadístico de los Trastornos Mentales , Humanos , Masculino , Proyectos Piloto , Psicoterapia , Resultado del Tratamiento
8.
J Affect Disord ; 286: 40-48, 2021 05 01.
Artículo en Inglés | MEDLINE | ID: mdl-33676262

RESUMEN

BACKGROUND: Magnetic Seizure therapy (MST) is an effective treatment for major depressive disorder (MDD) but its mechanism of action is not fully understood. The present study sought to characterize neuroimaging correlates of response and side effects of MST in a MDD cohort. METHODS: Fifteen severe MDD patients underwent a six-day course of MST treatment to the vertex. Before and after treatment, participants received rs-fMRI and structural MRI scans as well as assessments of depressive symptoms and neuropsychological functioning. 10 healthy volunteers received functional and structural MRI scans at similar time intervals. RESULTS: MST treatment was associated with increased functional connectivity between the subgenual anterior cingulate cortex (sgACC) and the parietal cortex, which positively correlated with clinical improvement. In contrast, greater decrease in functional connectivity between the right anterior hippocampus and the prefrontal cortex was correlated with lesser clinical and cognitive improvements. Changes in gray matter volume were evident in the bilateral parietal cortex, but were not associated with treatment outcomes. LIMITATIONS: The sample size was small and results warrant replication. CONCLUSIONS: This is the first quantitative fMRI study to investigate the neural correlates of MST treatment for MDD patients. While preliminary, these findings suggest that the modulation of sgACC activity is integral to the antidepressant mechanisms of MST. In contrast, changes in the hippocampus were not associated with symptom improvement, and appeared to contribute instead to side effects. Future studies in larger samples are warranted and explore the effect of e-electric field and correlates of response.


Asunto(s)
Trastorno Depresivo Mayor , Encéfalo/diagnóstico por imagen , Trastorno Depresivo Mayor/diagnóstico por imagen , Trastorno Depresivo Mayor/terapia , Giro del Cíngulo , Humanos , Imagen por Resonancia Magnética , Convulsiones/diagnóstico por imagen , Convulsiones/terapia
9.
BMC Psychiatry ; 21(1): 143, 2021 03 10.
Artículo en Inglés | MEDLINE | ID: mdl-33691647

RESUMEN

BACKGROUND: Major depressive disorder (MDD) is a highly prevalent mental disorder with large disease burden, high levels of relapse or persistence, and overall suboptimal outcomes of protocolized pharmacological and psychotherapeutic treatments. There is an urgent need to improve treatment effectiveness, possibly through systematic treatment personalization. In psychotherapeutic treatments this can be achieved by case conceptualization. To support this process, we developed the Therap-i module, which consists of personalized Experienced Sampling Methodology (ESM) and feedback. The Therap-i module is integrated into outpatient psychotherapeutic treatment as usual (TAU) for depression. The study aim is to investigate the efficacy of the Therap-i module in decreasing symptomatology in unresponsive or relapsing patients diagnosed with MDD. We hypothesize that the Therap-i module will contribute to TAU by i) decreasing depressive symptoms, and ii) improving general functioning, therapeutic working alliance, and illness perception. This paper provides details of the study rationale, aims, procedures, and a discussion on potential pitfalls and promises of the module. METHODS: Patients diagnosed with MDD (n = 100) will enrol in a pragmatic two-armed randomized controlled trial. Randomization is stratified according to the patient's treatment resistance level assessed with the Dutch Method for quantification of Treatment Resistance in Depression (DM-TRD). All fill-out the Inventory of Depressive Symptomatology Self Report (IDS-SR), Outcome Questionnaire (OQ-45), Illness Perception Questionnaire Mental Health (IPQ-MH), and Work Alliance Inventory Self Report (WAI-SR). In the intervention arm, through close collaboration between patient, clinician, and researcher, a personalized ESM diary is developed based on the patient's case conceptualization. During the ESM monitoring period (8 weeks, 5 assessments/day), patients receive feedback three times, which is discussed among the abovementioned three parties. Both patients and clinicians will evaluate the Therap-i module. RESULTS: Data collection is ongoing. DISCUSSION: This is the first study in which personalized ESM and feedback is integrated in outpatient psychotherapeutic TAU for depression. The labour intensive procedure and methodological pitfalls are anticipated challenges and were taken into account when designing the study. When hypotheses are confirmed, the Therap-i module may advance treatment for depression by providing insights into personalized patterns driving or perpetuating depressive complaints. TRIAL REGISTRATION: Trial NL7190 (NTR7381) , registered prospectively 03-08-2018.


Asunto(s)
Depresión , Trastorno Depresivo Mayor , Trastorno Depresivo Mayor/terapia , Evaluación Ecológica Momentánea , Retroalimentación , Humanos , Resultado del Tratamiento
10.
J Affect Disord ; 286: 166-173, 2021 05 01.
Artículo en Inglés | MEDLINE | ID: mdl-33725616

RESUMEN

BACKGROUND: Methodologically well-designed RCTs concerning the efficacy of Hypnotherapy in the treatment of Major Depression are lacking. The aim of this study was to determine whether Hypnotherapy (HT) is not inferior to Cognitive Behavioral Therapy (CBT), the gold-standard psychotherapy, in the percentage reduction of depressive symptoms, assessed in mild to moderate Major Depression (MD). METHODS: This study reports the main results of a monocentric two-armed randomized-controlled rater-blind clinical trial. A total of 152 patients with MD were randomized to either CBT or HT receiving outpatient individual psychotherapy with 16 to 20 sessions for the duration of six months. The primary outcome was the mean percentage improvement in depressive symptoms assessed with the Montgomery-Asberg Depression Rating Scale (MADRS) before and after treatment. RESULTS: The difference in the mean percentage symptom reduction between HT and CBT was 2.8 (95% CI=-9.85 to 15.44) in the Intention-to-treat sample and 4.0 (95% CI=-9.27 to 17.27) in the Per Protocol sample (N=134). Concerning the pre-specified non-inferiority margin of -16.4, both results confirm the non-inferiority of HT to CBT. The results for the follow-ups six and twelve months after the end of the treatment support the primary results. LIMITATIONS: For ethical reasons the trial did not include a control group without treatment; therefore we can only indirectly conclude that both treatment conditions are effective. CONCLUSION: This is the first study to demonstrate that HT was not inferior to CBT in MD, while employing rigorous methodological standards.


Asunto(s)
Terapia Cognitivo-Conductual , Trastorno Depresivo Mayor , Hipnosis , Depresión , Trastorno Depresivo Mayor/terapia , Humanos , Resultado del Tratamiento
11.
Artículo en Inglés | MEDLINE | ID: mdl-33652563

RESUMEN

BACKGROUND: There is a substantial lack of qualitative research concerning individual cognitive behavioral therapy (CBT) for patients with major depressive disorder (MDD). In the present study, we wanted to explore how patients suffering from MDD experience improvement in CBT. METHOD: Patients with MDD (N = 10) were interviewed at therapy termination with semi-structured qualitative interviews. The transcripts were analyzed using a thematic analysis approach. RESULTS: We identified three elements that were relevant to the process of improvement for all patients: the therapeutic relationship, the therapeutic interventions and increased insight. There is a dynamic interrelationship and synergy between these elements that may explain why patients considered the same elements as helpful, but often in different ways and at different stages of therapy. CONCLUSIONS: Highlighting the synergies and interrelationship between the elements that patients experience as helpful, may help therapists to learn from and utilize these experiences. This is a reminder of the importance of always being attentive to the individual processes of patients.


Asunto(s)
Terapia Cognitivo-Conductual , Trastorno Depresivo Mayor , Depresión , Trastorno Depresivo Mayor/terapia , Humanos , Investigación Cualitativa
12.
Medicine (Baltimore) ; 100(12): e25241, 2021 Mar 26.
Artículo en Inglés | MEDLINE | ID: mdl-33761717

RESUMEN

BACKGROUND: There are no clinical trials evaluating the efficacy of combined music and Tai Chi therapy for patients with major depression. Therefore, the primary objective of the present study was to evaluate the efficacy of Tai Chi and music therapy on psychological status and quality of life among patients with major depressive disorder in China. METHODS: This work is a part of a comprehensive research project to assess and provide intervention that potentially improves psychological status and quality of life among patients with major depressive disorder. This research project has been received ethical approval from the Medical Research and Ethics Committee in Taizhou Second People's Hospital (no. tzey2020023). After the introductory briefing, the acceptance to take the presession questionnaire implied the participant's consent to participate in the study. Eligible participants are divided into 3 groups according to completely randomized design: combined group (music therapy + Tai Chi), music therapy alone group, and Tai Chi alone group. The analyses will be performed using SPSS 22.0.0 (SPSS Inc, Chicago, IL). RESULTS: This protocol will provide a reliable theoretical basis for the following research. CONCLUSION: The sample came from a single health center. Therefore, the results cannot be generalized for the entire population. TRIAL REGISTRATION: This study protocol was registered in Research Registry (researchregistry6597).


Asunto(s)
Trastorno Depresivo Mayor , Musicoterapia/métodos , Calidad de Vida , Tai Ji , Adulto , Trastorno Depresivo Mayor/diagnóstico , Trastorno Depresivo Mayor/psicología , Trastorno Depresivo Mayor/terapia , Femenino , Humanos , Masculino , Música/psicología , Ensayos Clínicos Controlados Aleatorios como Asunto , Tai Ji/métodos , Tai Ji/psicología , Resultado del Tratamiento
13.
Nutrients ; 13(3)2021 Feb 26.
Artículo en Inglés | MEDLINE | ID: mdl-33652997

RESUMEN

This narrative review was conducted using searches of the PubMed/Medline and Google Scholar databases from inception to November 2019. Clinical trials and relevant articles were identified by cross-referencing major depressive disorder (and/or variants) with the following terms: folate, homocysteine, S-adenosylmethionine (SAMe), L-acetylcarnitine, alpha-lipoic acid, N-acetylcysteine, L-tryptophan, zinc, magnesium, vitamin D, omega-3 fatty acids, coenzyme Q10, and inositol. Manual reviews of references were also performed using article reference lists. Abnormal levels of folate, homocysteine, and SAMe have been shown to be associated with a higher risk of depression. Numerous studies have demonstrated antidepressant activity with L-methylfolate and SAMe supplementation in individuals with depression. Additionally, the amino acids L-acetylcarnitine, alpha-lipoic acid, N-acetylcysteine, and L-tryptophan have been implicated in the development of depression and shown to exert antidepressant effects. Other agents with evidence for improving depressive symptoms include zinc, magnesium, omega-3 fatty acids, and coenzyme Q10. Potential biases and differences in study designs within and amongst the studies and reviews selected may confound results. Augmentation of antidepressant medications with various supplements targeting nutritional and physiological factors can potentiate antidepressant effects. Medical foods, particularly L-methylfolate, and other supplements may play a role in managing depression in patients with inadequate response to antidepressant therapies.


Asunto(s)
Suplementos Dietéticos , Trastornos del Humor/terapia , Terapia Nutricional/métodos , Oligoelementos/uso terapéutico , Vitaminas/uso terapéutico , Adulto , Antidepresivos/uso terapéutico , Terapia Combinada , Trastorno Depresivo Mayor/terapia , Femenino , Humanos , Masculino , Ensayos Clínicos Controlados Aleatorios como Asunto
14.
J Affect Disord ; 284: 203-216, 2021 04 01.
Artículo en Inglés | MEDLINE | ID: mdl-33609955

RESUMEN

BACKGROUND: The treatment effect of multi-component LM interventions on depressive symptoms has not yet been examined. METHODS: We systematically searched six databases from inception to February 2020 to identify randomized controlled trials (RCTs) involving any multi-component LM interventions (physical activity, nutritional advice, sleep management, and/or stress management) on depressive symptoms relative to care as usual (CAU), waitlist (WL), no intervention (NI), or attention control (AC) comparisons. RESULTS: Fifty studies with 8,479 participants were included. Multi-component LM interventions reduced depressive symptoms significantly relative to the CAU (p >.001; d = 0.20) and WL/NI (p > .01; d = 0.22) comparisons at immediate posttreatment. However, no significant difference was found when compared with AC. The intervention effects were maintained in the short-term (1- to 3-month follow-up) relative to the CAU comparison (p > .05; d = 0.25), but not in the medium- and long-term. The moderator analyses examining the effect of multi-component LM interventions compared with CAU suggested that the number of lifestyle factors adopted was a significant moderator. Although disease type was not a significant moderator, there was a tendency that the clinical effect of multi-component LM interventions was stronger (d = 0.45) in those diagnosed with major depression. No publication bias was detected. LIMITATIONS: Low number of RCTs available in some subgroup analyses prevented from finding meaningful effects. Results may not be extended to major depression, because data on secondary depression were captured. CONCLUSION: Multi-component LM interventions appeared to be effective in mitigating depressive symptoms; however, the magnitude of the clinical effect was small. Future research is needed to assess more comprehensive and individualized LM interventions which have a greater emphasis on motivational and compliance aspects and focus solely on individuals with depression.


Asunto(s)
Depresión , Trastorno Depresivo Mayor , Depresión/terapia , Trastorno Depresivo Mayor/terapia , Humanos , Estilo de Vida , Psicoterapia , Ensayos Clínicos Controlados Aleatorios como Asunto
15.
Depress Anxiety ; 38(4): 456-467, 2021 04.
Artículo en Inglés | MEDLINE | ID: mdl-33528865

RESUMEN

BACKGROUND: Treatment-resistant depression (TRD) is a debilitating chronic mental illness that confers increased morbidity and mortality, decreases the quality of life, impairs occupational, social, and offspring development, and translates into increased costs on the healthcare system. The goal of this study is to reach an agreement on the concept, definition, staging model, and assessment of TRD. METHODS: This study involved a review of the literature and a modified Delphi process for consensus agreement. The Appraisal of Guidelines for Research & Evaluation II guidelines were followed for the literature appraisal. Literature was assessed for quality and strength of evidence using the grading, assessment, development, and evaluations system. Canadian national experts in depression were invited for the modified Delphi process based on their prior clinical and research expertize. Survey items were considered to have reached a consensus if 80% or more of the experts supported the statement. RESULTS: Fourteen Canadian experts were recruited for three rounds of surveys to reach a consensus on a total of 27 items. Experts agreed that a dimensional definition for treatment resistance was a useful concept to describe the heterogeneity of this illness. The use of staging models and clinical scales was recommended in evaluating depression. Risk factors and comorbidities were identified as potential predictors for treatment resistance. CONCLUSIONS: TRD is a meaningful concept both for clinical practice and research. An operational definition for TRD will allow for opportunities to improve the validity of predictors and therapeutic options for these patients.


Asunto(s)
Trastorno Depresivo Mayor , Trastorno Depresivo Resistente al Tratamiento , Canadá , Consenso , Trastorno Depresivo Mayor/diagnóstico , Trastorno Depresivo Mayor/epidemiología , Trastorno Depresivo Mayor/terapia , Trastorno Depresivo Resistente al Tratamiento/terapia , Humanos , Calidad de Vida
16.
Artículo en Inglés | MEDLINE | ID: mdl-33562699

RESUMEN

Exercise programs are considered an effective (add-on) treatment option for depressive disorders. However, little is known about the acute effects of exercise on affective responses in in-patient settings. Therefore, the aim of the present study was to compare the effects of a single 30-min bout of walking on affective responses to a passive control condition in patients with major depressive disorder during treatment in a mental health center. In total, 23 in-patients were exposed to two conditions (duration: 30 min) using a within-subject design: an exercise (light-moderate walking outdoors) and a passive control condition (sitting and reading). Affective responses were assessed based on the Circumplex Model in four phases: pre, during, post, and two hours following the conditions. The main results include a significantly larger pre-post increase in energetic arousal in the exercise condition compared to the control condition, p = 0.012, ηp² = 0.25, but no significantly different pre-follow-up change between conditions, p = 0.093, ηp² = 0.12. Negatively valenced affective responses showed significantly stronger pre-post decreases after the exercise condition compared to the passive control condition, p < 0.036, ηp² > 0.18. Positively valenced affective response activity showed a pre-post increase in the exercise condition and a pre-post decrease in the passive control condition, p = 0.017, ηp² = 0.23. The higher-activated, positively valenced immediate response of light- to moderate-intensity walking may serve as an acute emotion regulation in patients with major depressive disorder and provide a favorable state for adherence to exercise programs.


Asunto(s)
Trastorno Depresivo Mayor , Nivel de Alerta , Trastorno Depresivo Mayor/terapia , Ejercicio Físico , Humanos , Caminata
17.
J Affect Disord ; 283: 384-394, 2021 03 15.
Artículo en Inglés | MEDLINE | ID: mdl-33581464

RESUMEN

BACKGROUND: Given that major depression is a global public health problem, and that sub-threshold depression (SD) has been shown to be a significant risk indicator of major depression disorder, the awareness of SD interventions has increased. The current study explored the effect of increasing cognitive load on the forgetting of unwanted and negative memories of sub-threshold depression individuals (SDs) (Study 1) and proposed a cognitive load intervention (CLI) (study 2). METHODS: 53 SDs and 52 normal participants were recruited to explore the effect of cognitive load on the directed forgetting of negative items (Study 1). The treatment effect of CLI on 62 SDs was investigated. SDs completed up to 8 CLI/control sessions over an 8-week period while regularly recording their depression symptoms (Study 2). RESULTS: The results showed that it is more difficult for SDs to forget negative 'to-be-forgotten' items than normal controls (F (1, 99) = 27.98, p < 0.001, η2 = 0.22). In study 1, increasing cognitive load promoted directed forgetting for negative items in SDs. Study 2 showed that there were significant reductions in depression symptoms of SDs over the 8-week CLI (e.g. BDI-Ⅱ scores: F (1, 60) = 99.93, p < 0.001, η2 = 0.63). LIMITATIONS: Small sample size and lack of verification by neuroimaging may limit the generalizability of these results. CONCLUSIONS: The study revealed that increasing cognitive load can promote SDs to forget negative information, while the CLI project effectively reduced the depression level of SDs, thus providing encouraging initial support for its use in the treatment of SD.


Asunto(s)
Depresión , Trastorno Depresivo Mayor , Cognición , Depresión/terapia , Trastorno Depresivo Mayor/terapia , Humanos
18.
J Affect Disord ; 284: 238-246, 2021 04 01.
Artículo en Inglés | MEDLINE | ID: mdl-33631438

RESUMEN

BACKGROUND: Individuals with major depressive disorder often experience cognitive deficits. Cognitive remediation (CR) is an intervention aimed at improving cognition in psychiatric disorders. However, its efficacy on global and specific domains of cognition in adults with depression requires systematic investigation. Further, given individual differences in treatment outcome, moderators of CR effects in depression need to be identified. METHODS: We performed a systematic review and meta-analysis of published controlled trials of CR in adults with depression. We analyzed results from eight studies to estimate the efficacy of CR on global cognition and on six cognitive domains. We also examined three potential moderators, namely session format (individual vs. group), treatment duration, and participants' age. RESULTS: CR was found to improve global cognition (g = 0.44), verbal memory (g = 0.60), attention/processing speed (g = 0.41), working memory (g = 0.35), and executive functioning (g = 0.30). No significant improvements emerged for visuospatial memory and verbal fluency. Furthermore, no significant moderating effect of participant's age, session duration or session format were observed. LIMITATIONS: Conclusions are limited by the small number of studies, the heterogeneity in cognitive measures, and the lack of indicators of everyday functioning. CONCLUSION: Our meta-analysis supports the use of CR in improving global cognition in adults with major depressive disorder with a moderate effect size and this efficacy varies between cognitive domains.


Asunto(s)
Trastornos del Conocimiento , Remediación Cognitiva , Trastorno Depresivo Mayor , Adulto , Cognición , Depresión , Trastorno Depresivo Mayor/terapia , Humanos
19.
Behav Ther ; 52(2): 465-477, 2021 03.
Artículo en Inglés | MEDLINE | ID: mdl-33622514

RESUMEN

We examined the outcomes of individual cognitive behavioral therapy (CBT) for social anxiety disorder (SAD) in a sample of 93 adults seeking treatment in a university outpatient clinic specializing in CBT for SAD. Treatment followed the structure of a manual, but number of sessions varied according to client needs. After approximately 20 weeks of therapy, patients' social anxiety had decreased and their quality of life had increased. Patients with more severe SAD or comorbid major depressive disorder (MDD) at pretreatment demonstrated higher levels of social anxiety averaged across pre- and posttreatment. However, clinician-rated severity of SAD, comorbid MDD, or comorbid generalized anxiety disorder did not predict treatment outcome. Higher pretreatment scores on measures of safety behaviors and cognitive distortions were associated with higher social anxiety averaged across pre- and posttreatment and predicted greater decreases from pre- to posttreatment on multiple social anxiety outcome measures. We found no predictors of change in quality of life. Those with high levels of safety behaviors and distorted cognitions may benefit more from CBT, perhaps due to its emphasis on targeting avoidance through exposure and changing distorted thinking patterns through cognitive restructuring methods. Our study lends support to the body of research suggesting that manualized CBT interventions can be applied flexibly in clinical settings with promising outcomes for patients over a relatively short course of therapy.


Asunto(s)
Terapia Cognitivo-Conductual , Trastorno Depresivo Mayor , Fobia Social , Adulto , Trastorno Depresivo Mayor/terapia , Humanos , Fobia Social/terapia , Calidad de Vida , Resultado del Tratamiento
20.
Epidemiol Psychiatr Sci ; 30: e10, 2021 Feb 02.
Artículo en Inglés | MEDLINE | ID: mdl-33526166

RESUMEN

AIMS: Late-life depression has substantial impacts on individuals, families and society. Knowledge gaps remain in estimating the economic impacts associated with late-life depression by symptom severity, which has implications for resource prioritisation and research design (such as in modelling). This study examined the incremental health and social care expenditure of depressive symptoms by severity. METHODS: We analysed data collected from 2707 older adults aged 60 years and over in Hong Kong. The Patient Health Questionnaire-9 (PHQ-9) and the Client Service Receipt Inventory were used, respectively, to measure depressive symptoms and service utilisation as a basis for calculating care expenditure. Two-part models were used to estimate the incremental expenditure associated with symptom severity over 1 year. RESULTS: The average PHQ-9 score was 6.3 (standard deviation, s.d. = 4.0). The percentages of respondents with mild, moderate and moderately severe symptoms and non-depressed were 51.8%, 13.5%, 3.7% and 31.0%, respectively. Overall, the moderately severe group generated the largest average incremental expenditure (US$5886; 95% CI 1126-10 647 or a 272% increase), followed by the mild group (US$3849; 95% CI 2520-5177 or a 176% increase) and the moderate group (US$1843; 95% CI 854-2831, or 85% increase). Non-psychiatric healthcare was the main cost component in a mild symptom group, after controlling for other chronic conditions and covariates. The average incremental association between PHQ-9 score and overall care expenditure peaked at PHQ-9 score of 4 (US$691; 95% CI 444-939), then gradually fell to negative between scores of 12 (US$ - 35; 95% CI - 530 to 460) and 19 (US$ -171; 95% CI - 417 to 76) and soared to positive and rebounded at the score of 23 (US$601; 95% CI -1652 to 2854). CONCLUSIONS: The association between depressive symptoms and care expenditure is stronger among older adults with mild and moderately severe symptoms. Older adults with the same symptom severity have different care utilisation and expenditure patterns. Non-psychiatric healthcare is the major cost element. These findings inform ways to optimise policy efforts to improve the financial sustainability of health and long-term care systems, including the involvement of primary care physicians and other geriatric healthcare providers in preventing and treating depression among older adults and related budgeting and accounting issues across services.


Asunto(s)
Servicios de Salud Comunitaria/estadística & datos numéricos , Depresión/terapia , Gastos en Salud/estadística & datos numéricos , Calidad de Vida/psicología , Anciano , Anciano de 80 o más Años , Servicios de Salud Comunitaria/economía , Análisis Costo-Beneficio , Estudios Transversales , Trastorno Depresivo Mayor/terapia , Femenino , Geriatría , Investigación sobre Servicios de Salud , Hong Kong , Humanos , Vida Independiente , Masculino , Persona de Mediana Edad , Cuestionario de Salud del Paciente , Apoyo Social
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