IMPORTANCE Current guidelines recommend treating severe depression with pharmacotherapy. Randomized clinical trials as well as traditional meta-analyses have considerable limitations in testing for moderators of treatment outcomes. OBJECTIVES To conduct a systematic literature search, collect primary data from trials, and analyze baseline depression severity as a moderator of treatment outcomes between cognitive behavioral therapy (CBT) and antidepressant medication (ADM).

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The lack of predictive relations in a this good sized sample suggests that gender does not moderate differential response to CBT versus medication treatment and that it neither predicts nonspecific response across the treatments nor the specificity of response for either treatment with respect to pill placebo.

This is the first comprehensive cohort study of the health of older people ever conducted in Iran. The aim of this project is to investigate the health status of older people in Amirkola in the northern part of Iran, near the Caspian Sea. The Amirkola Health and Ageing Project (AHAP) is mainly concerned with geriatric medical problems, such as falling, bone fragility and fractures, cognitive impairment and dementia, poor mobility and functional dependence. It is planned that all participants will be re-examined after 2 years. Data are collected via questionnaire, examinations and venepuncture. AHAP started in April 2011 and 1616 participants had been seen by 18 July 2012, the end of the baseline stage of this study. The participation rate was 72.3%. The prevalence of self-reported hypertension (41.2%) and diabetes mellitus (23.3%) are high. Only 14.4% of older people considered their health as excellent or good in comparison with others at this age. The prevalence of osteoporosis (T score≤-2.5) was 57.4% in women and 16.1% in men, and 38.2 % of older people were vitamin D deficient (<20 ng/ml). Researchers interested in using the information are invited to contact the principal investigator Seyed Reza Hosseini (hosseinim46@yahoo.com).

Objective Although the average depressed patient benefits moderately from cognitive-behavioral therapy (CBT) or pharmacotherapy, some experience divergent outcomes. We tested frequencies, predictors, and moderators of negative (deterioration, extreme non-response) and unusually-positive (superior improvement, superior response) symptomatic outcomes. Method Sixteen randomized clinical trials comparing CBT versus pharmacotherapy for unipolar depression provided individual patients’ (N=1700) Hamilton Rating Scale of Depression (HAM-D) and/or Beck Depression Inventory (BDI) scores pre- and post-treatment. We tested demographic and clinical predictors and treatment moderators of any deterioration (increases ≥1 HAM-D or BDI points), reliable deterioration (increases ≥8 HAM-D or ≥9 BDI points), extreme non-response (post-treatment HAM-D ≥21 or BDI ≥31), superior improvement (HAM-D or BDI decreases ≥95%), and superior response (post-treatment HAM-D or BDI =0) using multilevel models. Results About 5–7% of patients showed any deterioration, 1% reliable deterioration, 4–5% extreme non-response, 6–10% superior improvement, and 4–5% superior response on the HAM-D or BDI. Superior improvement on the HAM-D (OR=1.67) only and attrition (OR=1.67) were more frequent in pharmacotherapy versus CBT. Patients with deterioration and superior response had lower, whereas patients with extreme non-response and superior improvement had higher, symptoms pre-treatment. Conclusions Deterioration and extreme non-response (a) occur infrequently in randomized clinical trials comparing CBT versus pharmacotherapy for depression, and (b) mirror superior improvement and superior response in distributions of symptom changes and end-states, respectively. Pre-treatment symptom levels help forecast negative and unusually-positive outcomes but do not guide selection of CBT versus pharmacotherapy. Pharmacotherapy may produce clinician-rated superior improvement and attrition more frequently than does CBT.