The scientific basis for information about depression
What do you know about Persistent Depressive Disorder?
Persistent depressive disorder (PDD) refers to four diagnostic subgroups
Mood Modulation Disorder
Chronic depression
Recurrent depression
Double depression
It is defined as persistent depression of illness for a minimum of two years, including
Persistent depression accounts for a significant proportion of depressive disorders, with lifetime incidence rates ranging from 3% to 6% in Western countries. The reason for the increased lifetime incidence is that PDD is hypersensitive to some acute interventions, such as a combination of psychological and pharmacological treatments. Nonetheless, given the high relapse rate and recurrence of depression after responding to acute treatments Long-term continuation and maintenance therapy is very important.
In the paper presented, the effects of pharmacological and psychological (alone or in combination) continuation and maintenance therapy for PDD are examined. The purpose of this paper is to evaluate the effects of pharmacological and psychological (alone or in combination) continuation and maintenance therapy for PDD compared to each other, placebo, and treatment as usual (TAU).
Continuation therapy is defined as people who are currently in remission
(Remission is defined as depressive symptoms below the case level.
(Remission is defined as depressive symptoms below the case level.) Alternatively, it is defined as treatment given to people who have previously responded to antidepressant treatment.
Maintenance therapy is a method used during recovery.
(This is defined as a remission that lasts longer than six months.
What are the studies?
There will be 840 participants from 10 studies. Five of the studies examined continuous treatment, and five studies examined maintenance treatment. Five studies examined continuous therapy and five studies examined maintenance therapy.
Pharmacological continuation and maintenance therapy
Antidepressants vs. placebo tablets (5 studies)
Participants taking antidepressants were less likely to experience relapse or recurrence compared to participants in the placebo group at the end of the intervention.(13.9% vs. 33.8%, RR 0.41, 95% CI 0.21 to 0.79; participants = 383. number of trials = 4, I 2 = 54%, moderate quality evidence)
The overall dropout rate may be similar between participants in the medication and placebo groups.(23.0% vs. 25.5%, RR 0.90, 95% CI 0.39 to 2.11, RCT = 4, participants = 386, I² = 64%, low quality evidence)
However, sensitivity analysis showed that the primary outcome (relapse/recurrence rate) did not differ between groups when only studies with a low risk of bias were included. In addition, no studies compared pharmacological or psychological treatments compared to TAU.
Psychological continuation and maintenance therapy
Psychotherapy was compared with attention placebo/non-specific control.
The results of studies that included psychotherapy suggest that psychotherapy continuation or maintenance may be a useful intervention compared to no treatment or antidepressant medication.
However, the body of evidence for these comparisons was too small to draw any high quality conclusions.
Combination of psychological and pharmacological continuation and maintenance therapy
Three studies compared psychological and pharmacological therapies with pharmacological therapy alone. However, the evidence base for these comparisons was uncertain and did not allow for high quality conclusions.
Comparison of different antidepressants
Two studies reported data on the direct comparison of two antidepressants. However, the body of evidence for this comparison was too small to draw high quality conclusions.
Machmutow K, Meister R, Jansen A, Kriston L, Watzke B, Härter MC, Liebherz S. Comparison of the efficacy of continuous and maintenance therapy for persistent depressive disorder in adults. Cochrane Database of Systematic Reviews 2019, Issue 5 Number: CD012855. doi: 10.1002 / 14651858.CD012855.pub2.
Psychological analysis of training
The study was conducted on tennis players to see how high-intensity training affected their psychological state. The study was conducted on tennis players. This is a study of the psychological effects of high-intensity training on tennis players.
In general, there is a need to manage the motivation of players throughout their training. This is a good paper to get a measure of how much training should be done, because otherwise the training will not produce results and the athlete will continue to exercise with psychological anxiety. This is a good paper to know how much training should be done.
What is the study?
Thirty players, averaging 15.78 years old, were divided into three groups.
They were divided into three groups.
Tennis training increased RSA by 8.3%.
Tennis training, increased RSA by 16.6%.
Tennis training only.
RSA refers to the training of repetitive sprinting ability, so-called reflexes and agility.
During the program, which ran for seven weeks, a questionnaire was administered to measure the mood of the players.
How often is this related to depression?
In terms of the results of this study, the groups that increased their practice by 8.3% and 16.6% had higher levels of fatigue, but the group that increased their practice by 16.6% had a confirmed tendency toward mood disorders such as depression. Since the questionnaires were sent out every week, the peak of the mood disorder was also found.
The peak was at 3~4 weeks.
The peak was at 3~4 weeks, after which the mood disturbance did not increase, but the program was conducted with a sense of tension.
The RSA training that was conducted was as follows
A 6x20m sequence was performed three times.
A round trip was conducted between five cones set up 2m from the starting point.
While doing this, we performed a tennis shot, and after hitting it, we dashed back to the starting point. This was to be completed in three minutes, with a 30-second break in between.
If you add 16.6% to the total amount of practice to implement these workouts
The data showed that if we added 16.6% to the total amount of training, mood disorders would occur, but we would also lose energy.
This study has shown that we need to manage not only the quality of our practice, but also the time and quantity.
https://doi.org/10.1016/j.rlp.2015.09.003
Phototherapy for non-seasonal depression
Phototherapy, as the name implies, is a method of affecting the human body with flashes of light. As you can imagine, it's a good method that can be done tomorrow morning, so it's easy and cost effective.
I'd like to introduce the evidence on whether such phototherapy is beneficial for non-seasonal depression. Here is some evidence on the benefits of phototherapy for non-seasonal depression.
Studies
Twenty studies (49 reports) were included in the review.
Most studies shed a bright light on pharmacotherapy, sleep deprivation, or both as adjunctive treatments. In general, the quality of reporting is poor, and many reviews do not systematically report adverse effects.
The treatment response of the bright light group was better than that of the control treatment group, but does not reach statistical significance.
The results are based primarily on studies of less than eight days of treatment.
The response to bright light was better in the morning light treatment (SMD - 0.38, CI -0.62 to -0.14)
Sleep deprivation responders (SMD -1.02, CI -1.60 to -0.45)
Conclusion.
For patients suffering from non-seasonal depression, light therapy provides a modest but promising antidepressant effect, especially when administered in the first week of treatment, in the morning, and as adjunctive treatment to sleep-deprived counterparts. Light Hygiene as a potential side effect should be considered. Due to the limited data and the heterogeneity of the studies, these results should be interpreted with caution.
Tuunainen A, Kripke DF, Endo T. Phototherapy for non-seasonal depression. Cochrane Database of Systematic Reviews 2004, No. 2. Number: CD004050. doi: 10.1002 / 14651858.CD004050.pub2.
Seasonal Affective Disorder (SAD)
I've written about the evidence on how to treat seasonal affective disorder. What is Seasonal Affective Disorder? In this article, I will explain what seasonal affective disorder is.
Overview
SAD is a type of depression that generally occurs in winter.
Causes
SAD tends to occur in people in their teens, and is more common in women than men. It is also said that people living in areas with long-lasting winters are more prone to it.
Symptoms
Some symptoms are the same as those of other forms of depression.
Hopelessness
Increased appetite due to weight gain
Increased sleep
Less energy and ability to concentrate
Loss of interest in work or other activities
Sluggishness in movement
Social withdrawal
Unhappiness and irritability
These symptoms are thought to be transient, but
Some may progress to depression or a condition that may be bipolar disorder.
How to deal with it
Antidepressants and talking therapies are thought to be effective.
What about self-control?
Get enough sleep.
Eat healthy foods.
Take your medications in the right way.
Learn about depression.
Pay attention to the early signs and make a plan for coping if it gets worse.
Exercise more often.
Do not use alcohol or illegal drugs.
These can worsen depression and may cause you to think about suicide.
Tips
When you are suffering from symptoms, talk about how you are feeling with someone you trust. It is a good idea to visit a compassionate person who can empathize with your situation and not seek a solution. Volunteering and participating in group activities is also a good way to cope with symptoms.
Phototherapy
Phototherapy is the use of special lamps with very bright light that mimics sunlight.
The treatment is started in the fall or early winter before the symptoms of SAD begin. Follow the instructions of the professional on how to use the phototherapy.
One recommended method is to sit 60 cm away from the light box for about 30 minutes daily. This treatment is most often done in the early morning to mimic sunrise. Do not look directly at the light source with your eyes open.
If phototherapy is helpful, symptoms should improve within three to four weeks.
The side effects of phototherapy are as follows
Eye strain or headache
Mania (rare)
Do not use phototherapy if you are taking medications that make you light sensitive, such as certain psoriasis medications, antibiotics, or antipsychotics.
A checkup by an ophthalmologist is recommended before starting treatment.
Without treatment, symptoms usually improve spontaneously with the change of seasons. With treatment, the symptoms will improve more quickly.
Alcohol and the prevention of depression
Gea A,et al.Alcohol intake, wine consumption and the development of depression:the PREDIMED study.BMC Med. 2013;11:192.
Study.
The study included 5,505 subjects who participated in the PREDIMED trial in Spain.
The subjects had no history of depression and had ruled out any medical problems related to alcohol.
Results.
As a result, 443 people developed depression.
One of the factors cited for the result of less than 5% of the subjects was that those who consumed alcohol in moderation were less likely to develop the disease. Those who consumed 5-15g of pure alcohol and had 2-7 drinks per week had a lower risk of developing the disease.
Interventions to help people return to work
Study Description
The review will include 45 studies with 88 study groups including 12,109 participants with either depressive disorder or high levels of depressive symptoms.
Work-oriented interventions
Work-oriented interventions combined with clinical interventions
A combination of work-oriented and clinical interventions has the potential to reduce the number of days missed due to illness within the first year of follow-up.
This intervention has the potential to reduce depressive symptoms and has a small impact on job functioning.
Stand-alone work-oriented interventions
Specific work-oriented interventions alone may result in more sick days missed compared to regular work-oriented care. It may have no effect on depressive symptoms within the first year of follow-up and may still have no effect on depressive symptoms after one year.
This intervention may not lead to improved functioning.
Psychological intervention
Psychological interventions, either face-to-face or mental health interventions, with or without professional guidance, may reduce the number of sick days missed when compared to usual care. And it has the potential to reduce depressive symptoms.
However, it is unclear whether this method of psychological intervention improves work performance.
Psychological interventions combined with antidepressants
Two studies have compared the effects of psychological interventions combined with antidepressants to antidepressants alone.
In one study, tricyclic antidepressants (TCAs) were combined with psychodynamic therapy. Another study combined a selective serotonin reuptake inhibitor (SSRI) with cognitive behavioral therapy (CBT) administered over the phone.
It is not clear whether this intervention will reduce the number of sick days missed.
However, we found that it may have no effect on depressive symptoms.
Antidepressants only
Three studies compared the effectiveness of SSRIs with selective norepinephrine reuptake inhibitor (SNRI) medications in reducing absenteeism due to illness.
However, it has also been suggested that these are inconsistent.
Exercise therapy
Professionally provided strength exercises were found to reduce the number of days of sickness absence compared to relaxation. However, aerobic exercise was not found to be more effective than relaxation or stretching.
Reviewer's conclusion
The combination of work-driven and clinical interventions will probably reduce the number of sick days missed, but at the end of a year or more of follow-up, this will not lead to more people in the intervention group being at work. Interventions may also reduce depressive symptoms and possibly enhance job functioning more than usual care. Interventions directed at specific jobs may not be as effective as just care directed at regular jobs. Psychological interventions have the potential to reduce the number of sick days missed compared to usual care. Interventions to improve clinical care, compared to usual care, will likely result in fewer sick days absent and lower levels of depression. There was no evidence of a difference in the effect of one antidepressant compared to another on absence of illness.
Nieuwenhuijsen K, Verbeek JH, Neumeyer-Gromen A, Verhoeven AC, BültmannU, FaberB. Interventions to improve return to work for people with depression. Cochrane Database of Systematic Reviews 2020, No. 10. Art. No.: CD006237. doi: 10.1002 /14651858.CD006237.pub4.
Pharmacotherapy for Persistent Depressive Disorder
Study details
This review included 10 studies with 840 participants, of which 5 studies examined continuous therapy and 5 studies examined maintenance therapy.
Pharmacological continuation and maintenance therapy
The most common comparison was between antidepressants and pill placebos.
Participants taking antidepressants were probably less likely to experience relapses or recurrent episodes than those in the placebo group at the end of the intervention.
However, sensitivity analyses showed that the primary outcome (relapse/recurrence rate) showed no evidence of a difference between groups when only studies with a low risk of bias were included.
No studies have compared TAU with pharmacological or psychological treatments.
Psychological continuation and maintenance therapy
One study compared psychotherapy with attention placebo/non-specific control.
One study compared psychotherapy with pharmacotherapy.
The results of studies that included psychotherapy may indicate that continued or maintained psychotherapy may be a useful intervention compared to no treatment or antidepressant medication.
Combination of Psychological and Pharmacological Continuation and Maintenance Therapies
Three studies compared combined psychological and pharmacological therapy with pharmacological therapy alone.
One study compared combined psychotherapy and pharmacotherapy with psychotherapy alone. However, the body of evidence for these comparisons was too small and uncertain to draw high quality conclusions.
Comparison of different antidepressants
Two studies reported data on direct comparisons of two antidepressants.
However, the body of evidence for this comparison was too small and uncertain to draw high quality conclusions.
Conclusions
It is currently unclear whether continuation or maintenance (or both) of pharmacotherapy with the reviewed antidepressants is a powerful treatment to prevent relapse and recurrence in patients with PDD due to moderate or high bias bias and clinical heterogeneity in the studies analyzed. For all other comparisons, the evidence was too small to draw any final conclusions, but continuation or maintenance of psychotherapy may be more effective than no treatment. There is a need for more quality trials of psychological interventions. Further studies need to more accurately address health-related quality of life and adverse events and evaluate follow-up data.
Machmutow K, Meister R, Janssen A, Christon L, Watzke B, Harter MC, Liebherz S. Comparison of the effectiveness of continuous and maintenance treatment for persistent depressive disorder in adults. Cochrane Database of Systematic Reviews 2019, No. 5. Number: CD012855. doi: 10.1002 / 14651858.CD012855.pub2.
Does dancing help with depression?
The conclusion of this article, which reviews several studies and others, states that "dance therapy for depression may have some benefit.
A few details.
The paper examined the efficacy and effectiveness of dance movement therapy with and without standard treatment compared to no treatment, standard treatment alone, psychotherapy, medication, and other physical interventions.
Three studies with 147 participants were reviewed.
74 people participated in DMT treatment.
Hamilton Depression Rating Scale (HAM-D), Symptom Checklist-90-R (SCL-90-R) (self-rating scale)
The results of the subgroup analysis did not confirm a reliable effect of DMT.
Subgroup analysis showed a positive effect in adults, but the effect did not meet clinical significance (SMD-7.33).
The odds ratio of 1.82 was not significant according to the dropout rate report.
One study showed no effect on quality of life or self-esteem.
Meekums B, Karkou V, Nelson EA. dance exercise therapy for depression Cochrane Database of Systematic Reviews 2015, No. 2 Art. Number: CD009895. doi: 10.1002 / 14651858.CD009895.pub2.
