Review of Maintenance Trials for Major Depressive Disorder

Borges, Stephanie Carvalho; Chen, Yeh-Fong; Laughren, Thomas; Temple, Robert; Patel, Hiren; David, Paul A.; Mathis, Mitchell; Unger, Ellis F.; Yang, Pei‐Ling; Khin, Ni A.

doi:10.4088/jcp.13r08722

Cited by 101 publications

(54 citation statements)

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“…Continuation phase CT aims to prevent relapse among responders to acute phase treatments, and a growing literature supports continuation CT’s efficacy (e.g., Beshai et al, 2011; Vittengl & Jarrett, 2014). Meta-analyses suggest that continuation CT reduces relapse and recurrence by roughly 25–35% compared to inactive control conditions over 10–18 months, on average (Piet & Hougaard, 2011; Vittengl et al, 2007), comparable to (if not somewhat larger than) the average benefit of continuation pharmacotherapy versus placebo (e.g., Borges et al, 2014). However, the benefits of continuation CT may be larger for patients with greater illness liabilities (e.g., more prior MDEs, unstable response or remission of the index episode, greater residual symptoms; Piet & Hougaard, 2011; Vittengl et al, 2010) and when it is preceded by acute phase treatment (Biesheuvel-Leliefeld et al, 2015).…”

Section: To What Extent Does Cognitive Behavioral Therapy Reduce Relamentioning

confidence: 92%

Cognitive therapy to prevent depressive relapse in adults

Vittengl

Jarrett²

2015

Current Opinion in Psychology

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The high prevalence, frequent relapse, and recurrence of major depressive disorder (MDD) increase its personal and societal costs. Cognitive therapy (CT) aims to decrease depressive symptoms and prevent relapse/recurrence. We review prevention evidence for acute, continuation, and maintenance CTs for patients whose depression is active, remitted, and recovered, respectively. Evidence suggests that patients relapse less often after discontinuing acute phase CT versus discontinuing pharmacotherapy. Continuation CT further decreases relapse relative to inactive controls and similarly to active pharmacotherapy. Maintenance CT may decrease recurrence but needs rigorous evaluation. Post-acute CT’s preventive effects appear greater for higher-risk patients (e.g., with residual depressive symptoms, unstable acute-phase treatment response, childhood trauma, more prior depressive episodes), although risks may vary by specific CTs.

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Section: To What Extent Does Cognitive Behavioral Therapy Reduce Relamentioning

confidence: 92%

Cognitive therapy to prevent depressive relapse in adults

Vittengl

Jarrett²

2015

Current Opinion in Psychology

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“…Limited information from published trials on the longer-term consequences of online intervention use was available beyond this timeframe. Additionally, the length of time to continue antidepressant treatment beyond 6 months after recovery from a depressive episode remains unclear [ 28 ]. In Australia, Internet-delivered or e-mental health (e-MH) programs can be accessed directly by the public through specialized or general online portals.…”

Section: Methodsmentioning

confidence: 99%

e-CBT (myCompass), Antidepressant Medication, and Face-to-Face Psychological Treatment for Depression in Australia: A Cost-Effectiveness Comparison

Solomon

Proudfoot²,

Clarke³

et al. 2015

J Med Internet Res

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BackgroundThe economic cost of depression is becoming an ever more important determinant for health policy and decision makers. Internet-based interventions with and without therapist support have been found to be effective options for the treatment of mild to moderate depression. With increasing demands on health resources and shortages of mental health care professionals, the integration of cost-effective treatment options such as Internet-based programs into primary health care could increase efficiency in terms of resource use and costs.ObjectiveOur aim was to evaluate the cost-effectiveness of an Internet-based intervention (myCompass) for the treatment of mild-to-moderate depression compared to treatment as usual and cognitive behavior therapy in a stepped care model.MethodsA decision model was constructed using a cost utility framework to show both costs and health outcomes. In accordance with current treatment guidelines, a stepped care model included myCompass as the first low-intervention step in care for a proportion of the model cohort, with participants beginning from a low-intensity intervention to increasing levels of treatment. Model parameters were based on data from the recent randomized controlled trial of myCompass, which showed that the intervention reduced symptoms of depression, anxiety, and stress and improved work and social functioning for people with symptoms in the mild-to-moderate range.ResultsThe average net monetary benefit (NMB) was calculated, identifying myCompass as the strategy with the highest net benefit. The mean incremental NMB per individual for the myCompass group was AUD 1165.88 compared to treatment as usual and AUD 522.58 for the cognitive behavioral therapy model.ConclusionsInternet-based interventions can provide cost-effective access to treatment when provided as part of a stepped care model. Widespread dissemination of Internet-based programs can potentially reduce demands on primary and tertiary services and reduce unmet need.

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“…Los Inhibidores Selectivos de la Recaptura de Serotonina (ISRS) como citalopram, escitalopram, fluoxetina, paroxetina, sertralina tienen mayor tolerabilidad por menores efectos colaterales que el resto de los antidepresivos (1++ Nivel de evidencia para estudios de terapia por NICE) 21 .…”

Section: Tratamiento Farmacológicounclassified

Depresión: Situación Actual

Toshi¹,

Eileen²

2017

RFMH

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RESUMENLa depresión es uno de los trastornos más frecuentes y crónicos de la población a nivel mundial, es de alto riesgo cuando evoluciona a un Trastorno Depresivo Mayor, debido a que puede manifestarse en un desenlace fatal como el suicidio o en una limitación social y cognitiva. Se han planteado diferentes hipótesis etiológicas y se han asociado importantes factores desencadenantes y de riesgo que nos han permitido mejorar la prevención y el manejo de esta patología; sin embargo, a través de esta revisión no solo ponemos en manifiesto los avances, sino también los espacios en blanco y las poblaciones vulnerables que deben ser estudiadas. Palabras clave: Depresión; Trastorno Depresivo Mayor; Suicidio; DSM 5. (fuente: DeCS BIREME) ABSTRACTDepression is one of the most frequent and chronic disorders of the population worldwide, it is high risk when it evolves into a Major Depressive Disorder, because it may manifest itself in a fatal outcome such as suicide or in a social and cognitive limitation. Different etiological hypotheses have been proposed and important triggers and risk factors have been associated, which have allowed us to improve the prevention and management of this pathology. However, this review not only describes the advances, but also the spaces in blank and vulnerable populations that need to be studied. INTRODUCCIÓNLa depresión es una enfermedad frecuente en todo el mundo, y se calcula que afecta a más de 300 millones de personas. El 7 de abril del 2017, con ocasión del Día Mundial de la Salud, la OMS puso en acción una campaña anual titulada: "Hablemos de depresión". Mostrando así la gran preocupación que genera este tema.La depresión es un trastorno mental, que se manifiesta según la OMS con la presencia de tristeza, pérdida de interés o placer, sentimientos de culpa o falta de autoestima, trastornos del sueño o del apetito, sensación de cansancio y disminución de la concentración.La depresión puede cronificarse y dificultar considerablemente el desempeño laboral, cognitivo y la capacidad de afrontar la vida diaria. En su forma más grave, puede conducir al suicidio; en el Perú, durante el 2015 se suicidaron aproximadamente 9.2 personas por cada 100 000, de las cuales 2 de cada 3 tenían antecedente de depresión Debido al gran impacto de este trastorno y con el objetivo de conocer los factores biológicos y ambientales que contribuyen a su origen; han surgido diversas hipótesis, tales como la de las monoaminas, la dopaminérgica, gabaérgica y la teoría de la diátesis-estrés, entre otras 3 . Sin embargo, a pesar de que ninguna es absoluta, cada una nos encamina a desarrollar nuevas rutas de investigación etiológica, así como a poner en práctica estrategias de tratamiento y prevención para nuestra población.

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Review of Maintenance Trials for Major Depressive Disorder

Cited by 101 publications

References 0 publications

Cognitive therapy to prevent depressive relapse in adults

Cognitive therapy to prevent depressive relapse in adults

e-CBT (myCompass), Antidepressant Medication, and Face-to-Face Psychological Treatment for Depression in Australia: A Cost-Effectiveness Comparison

Depresión: Situación Actual

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