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| Joined: 01 Jun 2013 |
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Depression: A Systematic Review
A systematic review of all studies (controlled and uncontrolled) to evaluate [link widoczny dla zalogowanych] psychological interventions with treatment-resistant depression. One systematic review and two subsequent RCTs including persons 58 years or older [link widoczny dla zalogowanych] with all grades of depressive disorders showed that tricyclic antidepressants, SSRIs, or MAOIs reduced the proportion of persons who did not recover over 28 to 51days [link widoczny dla zalogowanych] compared with placebo.
Background:
About 30% of people with depression do not respond to an [link widoczny dla zalogowanych] antidepressant at the recommended dose and can be described as having treatment-refractory depression.
• Chronicity of Major Depressive Disorder involves many interacting variables
[link widoczny dla zalogowanych] • Resistance to anti-depressant medications
Research issues:
[link widoczny dla zalogowanych] • Definitions used for “treatment resistance”
• Under treatment leading to “pseudo-resistance”
• Inconsistencies in defining “non-response”
• Lack of [link widoczny dla zalogowanych] RCTs / controlled studies
• To examine the effectiveness of psychological treatment interventions for treatment-resistant depression including all controlled [link widoczny dla zalogowanych] and uncontrolled designs
Inclusion Criteria:
• Failure to respond to at least [link widoczny dla zalogowanych] one previous trial of anti-depressant pharmacotherapy
• Participants 18 and above
• ‘Talking treatments’ used as [link widoczny dla zalogowanych] a central component
• Any design and language
Exclusion Criteria:
• Failure to explicitly show non-response to medications in participants prior to study intervention
• Absence of diagnostic criteria fulfillment for depression ( >14 on HRSD or >19 for Beck [link widoczny dla zalogowanych] Depressive Inventory)
[link widoczny dla zalogowanych] • National Health Services (NHS) Centre for Research and Dissemination guidelines for conduct [link widoczny dla zalogowanych] of systematic reviews
• Journals hand-searched (duration mentioned)
• Websites [link widoczny dla zalogowanych]
• Researchers in the field contacted [link widoczny dla zalogowanych] (grey literature)
• Terms ‘depression’ and ‘psychological’,’ depression’ and ‘psychotherapy’, ‘refractory’ and ‘depression’, ‘chronic’ and ‘depression’, ‘resistant’ and ‘depression’
• Language Bias
• Methodological quality was not used for exclusion
• Use of checklist (next slide)
• Publication bias was addressed – using grey literature
• Data extraction was done by one reviewer and checked by second
• Sample size
• Checklist for assessing quality of both randomized and non-randomized health care intervention studies developed [link widoczny dla zalogowanych] by Downs and Black 1998
• Maximum score 32
• Score
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[link widoczny dla zalogowanych] |
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