Treatment of atypical depression with cognitive therapy or phenelzine: a double-blind, placebo-controlled trial.
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BACKGROUND: Patients with atypical depression are more likely to respond to monoamine oxidase inhibitors than to tricyclic antidepressants. They are frequently offered psychotherapy in the absence of controlled tests. There are no prospective, randomized, controlled trials, to our knowledge, of psychotherapy for atypical depression or of cognitive therapy compared with a monoamine oxidase inhibitor. Since there is only 1 placebo-controlled trial of cognitive therapy, this trial fills a gap in the literature on psychotherapy for depression. METHODS: Outpatients with DSM-III-R major depressive disorder and atypical features (N = 108) were treated in a 10-week, double-blind, randomized, controlled trial comparing acute-phase cognitive therapy or clinical management plus either phenelzine sulfate or placebo. Atypical features were defined as reactive mood plus at least 2 additional symptoms: hypersomnia, hyperphagia, leaden paralysis, or lifetime sensitivity to rejection. RESULTS: With the use of an intention-to-treat strategy, the response rates (21-item Hamilton Rating Scale for Depression score, < or =9) were significantly greater after cognitive therapy (58%) and phenelzine (58%) than after pill placebo (28%). Phenelzine and cognitive therapy also reduced symptoms significantly more than placebo according to contrasts after a repeated-measures analysis of covariance and random regression with the use of the blind evaluator's final Hamilton Rating Scale for Depression score. The scores between cognitive therapy and phenelzine did not differ significantly. Supplemental analyses of other symptom severity measures confirm the finding. CONCLUSIONS: Cognitive therapy may offer an effective alternative to standard acute-phase treatment with a monoamine oxidase inhibitor for outpatients with major depressive disorder and atypical features. (+info)
How disabling is depression? Evidence from a primary care sample. The Counselling Versus Antidepressants In Primary Care Study Group.
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BACKGROUND: Major depression is an illness with a high prevalence and is most commonly seen and treated by general practitioners (GPs). AIM: To determine the level of disability in depressed patients seen in a primary care setting, and to investigate whether the level of disability was associated with the severity of the depression. METHOD: Prospective data collection, using the 36-item Shortened Form (SF-36), from the Medical Outcomes Study, as a measure of disability, and from the Beck Depression Inventory (BDI) in a sample of depressed patients recruited from a Counselling versus Antidepressant in Primary Care (CAPC) study in the Trent Region. All patients met the research diagnostic criteria for major depression. RESULTS: Two hundred and fifty patients were assessed. These patients reported high levels of disability compared both with published norms and with other chronic physical illnesses. Increases in disability were especially noticeable in the domains of the SF-36 that were specific to mental illness. There was a significant correlation between scores on the SF-36 and the BDI. CONCLUSION: This study confirms that depressed patients in primary care report high levels of disability on the SF-36, and that the instrument is both specific to the domains expected to be affected by mental disorder and is sensitive to the severity of mood disturbance. (+info)
Impact of a national campaign on GP education: an evaluation of the Defeat Depression Campaign.
(19/4586)
BACKGROUND: The Defeat Depression Campaign, which was run by the Royal College of Psychiatrists and the Royal College of General Practitioners (RCGP) from 1992 to 1996, aimed to educate general practitioners (GPs) to recognize and manage depression. AIM: To measure the educational impact on GPs of the Defeat Depression Campaign. METHOD: A postal survey using a structured questionnaire was distributed to 2046 GPs obtained by systematically sampling 1 in 14 GPs from alphabetical lists from family health services authorities (FHSAs) in England and Wales. The questionnaire covered awareness of the campaign, awareness and use of campaign materials, and ratings of the usefulness of the campaign in relation to other educational activities. RESULTS: Two-thirds of GPs were aware of the campaign and 40% had definitely or possibly made changes in practice as a result of it. Impact of materials was highest for a consensus statement on the recognition and management of depression in general practice and for guidelines derived from it, each of which had been read in detail by about one quarter of responders and was known of by an additional one third. Impact was low for the other materials. The campaign had the highest impact among younger GPs, members of the RCGP, and (less strongly) among those who had undertaken a six-month post in psychiatry, those who were working in larger practices and fundholding practices, and women; 56% of GPs had attended a teaching session on depression in the past three years. CONCLUSION: A national campaign of this kind can have a useful impact, but it needs to be supplemented by local and practice-based teaching activities. (+info)
'You're depressed'; 'no I'm not': GPs' and patients' different models of depression. UMDS MSc in General Practice Teaching Group.
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Questionnaires concerning models of depression were completed by 90 general practitioners (GPs) and 681 patients. GPs and patients held similar beliefs about the role of mood-related symptoms, psychological causes, and non-medical treatments. However, the GPs reported greater support for somatic symptoms, medical causes, and medical treatments. Therefore, GPs and patients report different models of depression, with GPs favouring a more medical perspective. In addition, the results illustrated a role for personal experience of depression. The implications for diagnosis, adherence, and a 'you are depressed; no I'm not' style of interaction are discussed. (+info)
Increased health burden associated with comorbid depression in older diabetic Mexican Americans. Results from the Hispanic Established Population for the Epidemiologic Study of the Elderly survey.
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OBJECTIVE: To examine the health burden associated with concomitant depressive symptoms and diabetes in older Mexican Americans. RESEARCH DESIGN AND METHODS: Data from the Hispanic Established Population for the Epidemiologic Study of the Elderly were used to assess the association between high levels of depressive symptoms, measured with the Center for Epidemiologic Studies of Depression scale, and comorbid chronic health conditions, diabetic complications, functional disability, health service use, and medication use among 636 older diabetic Mexican Americans, in comparison with 2,196 older nondiabetic Mexican Americans. RESULTS: Overall, 31.1% of the older diabetic individuals reported high levels of depressive symptoms. The risks of comorbid myocardial infarction, hypertension, arthritis, and angina were significantly higher in the presence of concomitant depressive symptoms, as were the risks of diabetic complications, functional disability, incontinence, vision impairment, poorer perceived health status, and health service use among both diabetic and nondiabetic individuals. Rates were substantially higher among depressed diabetic individuals, however, in comparison to depressed nondiabetic individuals. Importantly, this increased health burden was evident even when controlling for sociodemographic risk factors, including sex, age, level of education, marital status, immigrant status, and living arrangements. CONCLUSIONS: The presence of concomitant depressive symptoms among older diabetic Mexican Americans is associated with a substantially greater health burden than is seen among diabetic individuals without depression or depressed individuals without diabetes. This association of depression with higher rates of chronic conditions, poorer functioning, and increased health service use is particularly significant in that this study was conducted among community-dwelling adults and was not confounded by the potential association of health care-seeking behavior that might occur in a medically ill sample. (+info)
The quantity and quality of clinical practice guidelines for the management of depression in primary care in the UK.
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BACKGROUND: Despite research evidence that guidelines can improve patient care, concerns remain over their cost-effectiveness. This is particularly so when there is a proliferation of guidelines for the same condition. Faced with differing recommendations, users will wish to make informed decisions on which guideline to follow. In creating a guideline appraisal instrument we have assessed guidelines developed in the United Kingdom (UK) for the management of a range of disorders including depression in primary care. AIM: To identify the number of UK clinical guidelines for the management of depression in primary care and to describe their quality and clinical content. METHOD: A survey was undertaken to identify all depression guidelines developed in the UK between January 1991 and January 1996. All guidelines produced by national organizations and a random sample of local guidelines were appraised using a validated instrument by six assessors: a national expert in the disease area, a general practitioner, a public health physician, a hospital consultant, a nurse specializing in the disease area, and a researcher on guideline methodology. The clinical content of each guideline was then assessed by one of the researchers (RB) according to a defined framework. RESULTS: Forty-five depression guidelines were identified. While there was a considerable range in the quality of the six national and three local guidelines appraised, at a group level their performance was similar to guidelines for other diseases. Clinical recommendations tended to reflect the joint consensus statement produced by the Royal College of General Practitioners and Royal College of Psychiatrists in 1992. The most obvious difference was in the style in which the guidelines were written and presented. CONCLUSION: A 'national template' was the starting place for most guidelines. Steps need to be taken to ensure that these templates are based on the best possible research evidence and professional opinion. Local clinicians should concentrate on effective dissemination and implementation strategies, rather than creating new guidelines. (+info)
Is atypical depression a moderate severity depression? A 536-case study.
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OBJECTIVE: To determine if atypical depression is less common among outpatients with severe depression than among those with nonsevere depression. DESIGN: Case series. SETTING: Private practice. PATIENTS: Five hundred and thirty-six consecutive outpatients presenting for treatment of unipolar or bipolar II depression. OUTCOME MEASURES: Prevalence of atypical depression among patients with severe depression (Global Assessment of Functioning Scale [GAF] score of 50 or less) and nonsevere depression. RESULTS: There was no significant difference in the prevalence of atypical depression between patients with severe and nonsevere depression. CONCLUSIONS: Results do not support previous studies that atypical depression is usually of moderate severity. A rating scale like the GAF, which assesses both symptom severity and impairment of functioning, may give a more complete assessment of depression severity than a symptoms rating scale (used in previous studies), which does not cover atypical features and does not assess functioning. (+info)
Right frontal lobe slow frequency repetitive transcranial magnetic stimulation (SF r-TMS) is an effective treatment for depression: a case-control pilot study of safety and efficacy.
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Major depression may result from decreased left frontal lobe function with respect to the right. Fast frequency repetitive transcranial magnetic stimulation (FF r-TMS) excites the underlying cortex whereas slow frequency repetitive transcranial magnetic stimulation (SF r-TMS) causes cortical inhibition. Left frontal FF r-TMS attenuates major depression whereas the inhibitory effects of right frontal SF r-TMS are unknown. This study tested the hypothesis that right frontal SF r-TMS would treat depressed patients with minimal effect on controls. A psychiatrist administered the Beck depression inventory and Hamilton D depression rating scales to eight depressed patients and six controls before and after the treatment protocol. Eight sessions of 100 right frontal lobe SF r-TMS were given at motor threshold and 0.5 Hz over a 6 week period. No adverse outcomes were noted in either group. A significant antidepressant effect was noted in depressed patients on the Beck and Hamilton D depression rating scales (p<0.05). No change on either scale was noted in the controls. In conclusion right frontal lobe SF r-TMS is a safe, non-invasive treatment for major depression that deserves further investigation. (+info)