Objective To assess the effectiveness of psychotherapy for depression in older patients. Methods We searched the Cochrane Central Register of Controlled Trials (1990 to August 2007), MEDLINE (1966 to August 2007), EMbase (1980 to August 2007), and CMB-disk (1990 to August 2007) to collect randomized controlled trials (RCTs) in which psychotherapy was used to treat depression in older patients. We screened the retrieved studies according to the predefined inclusion and exclusion criteria, evaluated the quality of included studies, and performed meta-analyses by using The Cochrane Collaboration’s RevMan 4.2 software. Results Ten RCTs were included. Compared with placebo, psychotherapy was more effective in decreasing depression score (SMD 0.63, 95%CI – 0.84 to – 0.42). Subgroup analysis showed that cognitive-behavioral therapy, reminiscence therapy, and general psychological therapy were more effective than placebo (SMD – 0.70, 95%CI – 1.12 to – 0.27; SMD – 0.54, 95%CI – 0.81 to – 0.26; SMD – 0.84, 95%CI – 1.34 to – 0.34, respectively). However, psychotherapy as an adjunct treatment could not significantly improve the effectiveness of antidepressant medication (SMD – 0.35, 95%CI – 0.74 to 0.05). There was no significant difference between cognitive-behavioral therapy and reminiscence therapy in improving depression symptoms (SMD 0.13, 95%CI – 0.30 to 0.56). The dropout rate was similar between patients treated with or without psychotherapy (RR 1.03, 95%CI 0.55 to 1.94). Conclusion Various kinds of psychotherapy are effective for depression in older patients. But psychotherapy as an adjunct treatment could not significantly improve the effectiveness of antidepressant medication.
Objective To systematically evaluate the efficacy and safety of duloxetine versus paroxetine for adults’ depression. Methods A search was conducted in The Cochrane Library (Issue 6, 2011), Pubmed (1998 to June 2011), CNKI (1998 to June 2011), VIP (1998 to June 2011), CBM (1998 to June 2011), Wanfang database (1998 to June 2011), MEDLINE (1996 to June 2011) and Science Direct (1998 to June 2011). The randomized controlled trials (RCTs) on duloxetine versus paroxetine for adults’ depression were collected. The quality of the included trials was assessed according to the Cochrane Handbook 5.0, and the systematic analysis was conducted by using RevMan 5.0 software. Results Six RCTs involving 1 106 patients were included. The results of meta-analysis showed that: a) After eight-week treatment, there were no significant differences in the effective rate (RR=0.96, 95%CI 0.89 to 1.05, P=0.39) and the final cure rate (RR=0.99, 95%CI 0.86 to 1.15, P=0.93) between the duloxetine and paroxetine groups; b) Adverse reaction: The incidence rate of somnolence in the duloxetine group was lower than that of the paroxetine group (RR=0.63, 95%CI 0.41 to 0.96, P=0.03), oppositely, the incidence rate of abnormal ECG was higher in the duloxetine group (RR=1.91, 95%CI, 1.02 to 3.58, P=0.04). And the other common adverse reactions were not significantly different between the two groups (Pgt;0.05). Conclusion After eight-week treatment, there are no significant differences in the effective rate and the final cure rate between duloxetine and paroxetine. Duloxetine tends easily to induce the abnormal ECG compared with paroxetine.
Objective To investigate the family burden of depression inpatients, analyze the influencing factors and explore the approach to reduce the family burden. Methods On-the-spot investigation was conducted for the family members of 200 depression inpatients in Mental Health Center of West China Hospital of Sichuan University from January to December, 2008. Following questionnaires used for investigation were all self-scale and filled out by the family members: “Basic Information Scale of Patients and Family Members”, “Family Burden Scale of Patients with Depression” revised from Pai’s scale of “Burden on the Family of Disease” (scoring 0-48 points and covering 24 items under 6 dimensions, namely, financial burden, disruption of routine family activities, disruption of family leisure, disruption of family interactions, effect on physical health of family members, and effect on mental health of family members; rating each item on a 3-class scale, namely, zero for no burden, one for moderate burden, and two for severe burden) , and Xiao Shuiyuan’s “Social Support Scale” (10 items in total, a higher score indicates a better social support). SPSS 13.0 software was adopted to perform statistical analyses. Results The total score of family burden was 26.3±12.6, the positive answer rate of family burden was 100.0%, and the positive answer rate of the every dimension was above 80%. The score of family burden for parents and spouse was higher than that of children (Plt;0.05). The total score of social support was 40.22±9.06, and the correlation coefficient between family burden and family social support was –0.485 (Plt;0.001). Conclusion It is common for family members of depression patients to get family burden at different levels. The more social support family members get, the less the family burden is.
Objective To assess the efficacy and safety of mirtazapine and fluoxetine on depression. Methods We searched The Cochrane Library (Issue 2, 2009), MEDLINE (1980 to Dec.2008), EMbase (1980 to Dec.2008), CBM (1980 to Dec.2008), VIP (1980 to Dec.2008), CNKI (1980 to Dec.2008) and Wanfang database (1980 to Dec.2008) to search randomized controlled trials (RCTs) comparing mirtazapine with fluoxetine for depression. The quality of the included trials was assessed and meta-analysis was conducted by RevMan 5.0 software. Results Five RCTs involving 695 patients were included. The results of meta-analyses showed that: (1) After one-week treatment and two-week treatment, effectiveness of the mirtazapine group was significantly higher than that of the fluoxetine group [one-week treatment: RR=2.00, 95%CI (1.30, 3.10), P=0.002; two-week treatment: RR=1.49, 95%CI (1.08, 2.06), P=0.02]. But after six-week treatment, there was no significant difference of the efficacy between the mirtazapine and the fluoxetine groups with RR=1.21 and 95%CI 0.89 to 1.63 (P=0.23), and the cure rate of the mirtazapine group was a little higher than that of the fluoxetine group with RR=1.40 and 95%CI 1.09 to 1.80 (P=0.009). (2) Side reaction: The somnolence and weight gain rates of the mirtazapine group was higher than those of the fluoxetine group with RR=1.78 and 95%CI 1.18 to 2.70 (P=0.006) and RR=5.91 and 95%CI 2.21 to 15.83 (P=0.000 4). But fluoxetine more easily induced nausea and insomnia with RR=0.47 and 95%CI 0.31 to 0.71 (P=0.000 3); RR=0.39 and 95%CI 0.17 to 0.89 (P=0.03) than mirtazapine. And the other common side reactions were all not significantly different between the two groups (Pgt;0.05). Conclusion Mirtazapine is more effective than fluoxetine and works faster. Mirtazapine could more easily induce somnolence and weight gain, and is with lower nausea or insomnia rate when compared with fluoxetine. And there is no significant difference in comparison of other common side reactions.
Objective To systematically evaluate the effects of psychotherapy for cancer patients with depression. Methods We searched The Cochrane Library, PubMed, EMbase, Chinese Biomedical Literature Database, Chinese Scientific Journals Full-text Database, and Chinese Journal Full-text Database up to October 2010 to identify randomized controlled trials (RCTs) comparing psychotherapy plus conventional treatment with conventional treatment alone. The data were analyzed by using RevMan 5.0 software. Results Eleven RCTs involving 1 670 participants were included. The results of meta-analyses showed: (1) A significant difference was found between psychotherapy plus conventional treatment and conventional treatment alone in decrease of depression score (SMD= – 0.40, 95%CI – 0.70 to – 0.11); (2) No difference was observed between the two groups in decrease of anxiety score (SMD= – 0.68, 95%CI – 1.37 to 0.01), but the result was changed when a sensitivity analysis was done (SMD= – 0.30, 95%CI – 0.52 to -0.08). Conclusion Compared with conventional treatment alone, psychotherapy combined with conventional treatment could improve depressive states in cancer patients, but the result still needs to be confirmed by high-quality and large-sample RCTs.
Objective To evaluate the effectiveness and safety of both olanzapine combined with fluoxetine (combination therapy) and fluoxetine (monotherapy) for refractory depression. Methods According to the computer retrieval from PubMed (1966 to September 2009), Cochrane Library (Issue 3, 2009), EMbase (1974 to September 2009), SCI (1974 to September 2009), CNKI (1994 to September 2009), CBM (1978 to September 2009), CSJD (1989 to September 2009) and Wanfang Database (1997 to September 2009), and the manual retrieval from related journals and conference proceedings were conducted, to include randomized controlled trials of comparison in between olanzapine combined with fluoxetine and fluoxetine in treating refractory depression. We collected the valid data after assessing the methodology quality of included studies on the basis of Jadad scoring standard, and conducted meta-analysis with RevMan 5.0 software. Results A total of 7 studies with 1 230 patients were included. The meta-analysis showed that, there was no significant difference between two groups about the scores of HAMA (Hamilton Anxiety Scale) at the end of the 1st week, but the olanzapine combined with fluoxetine in trial group was much better for relieving anxiety situation compared to fluoxetine in control group at the end of the 2nd, 4th, 8th and 12th week. In accordance with the scores of CGI (Clinical Global Impression Scale), there was no significant difference at the end of 2nd and 4th week after treatment, but there was a significant difference at the end of 8th and 12th week. As to the changes of MADRS (Montgomery and Asberg Depression Rating Scale), the trial group was much distinct than control group at the end of the 1st, 2nd, 4th and 8th week. In summary, the clinical effect of trial group was superior to that of control group, and there was no significant difference in adverse reactions between two groups (RR=1.10, 95%CI 0.99 to 1.23). Conclusion Current evidence shows that, the clinical effect and safety of olanzapine combined with fluoxetine in treating refractory depression is obviously superior to that of fluoxetine.
Objective To assess the efficacy of acupuncture versus western medicine in the treatment of depression in China. Methods Randomized controlled trials (RCTs) involving acupuncture versus western medicine in the treatment of depression in China were identified from CNKI (1979 to 2007), VIP (1989 to 2007), WANFANG Database (1998 to 2007) and CBM (1978 to 2007). We also hand searched relevant journals and conference proceedings. Data were extracted and evaluated by two reviewers independently with a specially designed extraction form. The Cochrane Collaboration’s RevMan4.2.8 software was used for data analyses. Results A total of 8 trials involving 619 patients were included. Meta-analyses showed that the total effective rate in the acupuncture group was similar when compared with fluoxetine (RR 1.03, 95%CI 0.94 to 1.14), doxepin (RR 1.14, 95%CI 0.91 to 1.43), amitriptyline (RR 0.95, 95%CI 0.70 to 1.29) and venlafaxine (RR 1.02, 95%CI 0.90 to 1.16). As for the HAMD score at week 2, no significant difference was noted between acupuncture and fluoxetine (WMD 0.03, 95%CI -1.26 to 1.31) or amitriptyline (WMD –?0.33, 95%CI –?1.88 to 1.23); for the HAMD score at week 4, no significant difference was observed between acupuncture and fluoxetine (WMD –?0.24, 95%CI –?1.85 to 1.37) or amitriptyline (WMD –?0.57, 95%CI –?2.02 to 0.88); for the HAMD score at week 6, acupuncture also had similar effects to fluoxetine (WMD –?0.19, 95%CI –?1.51 to 1.13). In terms of the SDS scores at week 2, 4, 6 and 8, no significant differences were noted between acupuncture and fluoxetine. Two trials reported adverse events and these observed no adverse events in the acupuncture group, but 31 and 25 patients experienced adverse events in the western medicine groups of these two trials. Conclusion Acupuncture is not inferior to western medicine, and it is worth noting that acupuncture is associated with few adverse reactions. Further large-scale trials are required to define the role of acupuncture in the treatment of depression.
Objective To evaluate the therapeutic effect and safety of Bupropion hydrochloride sustained-release tablets in the treatment of depression. Methods A total of 48 patients meeting the diagnostic criteria of depression of CCMD-3 were randomly treated with Bupropion hydrochloride sustained-release tablets or Fluoxetine tablets for 42 days. Hamilton depression rating scale, Hamilton anxiety rating scale, clinical global impression and treatment emergent symptom scale were used to evaluate the therapeutic effect. Blood routine test, urine routine test and electrocardiogram were examined before and after the treatment. Results The effective rate of Bupropion hydrochloride sustained-release tablets [83% (20/ 24) ] was higher than that of Fluoxetine tablets [63% (15/ 24)], with a P value of 0.104. The incidence of adverse reactions was 46% (11/24) in both groups. Conclusion The therapeutic effect of Bupropion hydrochloride sustained-release tablets on depression is similar to that of Fluoxetine tablets, with mild adverse reactions to both treatments.
Objective To investigate the characteristics of cognitive function and its correlation to neuroendocrine status in patients with refractory depression. Methods A total of 41 patients diagnosed by ICD-10 as depression onset who have been treated with more than two antidepressants drugs, fulfilled the criteria of refractory depression. Another 40 patients diagnosed by ICD-10 as depression onset but who have not been treated, or have been treated with only one antidepressant drug were selected as controls. Patients in both groups were evaluated by WAIS-RC, STROOP, VF, TRAILS A, B, TOH and M-WCST, and the concentrations of CORT, ACTH, T3, FT3, T4, FT4, TSH were also determined. Results A significant difference was found in VF between the refractory depression group and the control group. This showed that the damage to short-term memory, attention and interference rejection capability was much more serious in the refractory depression group. The ACTH concentration in the refractory depression group was significantly different from that of the control group, which indicated that the damage to the Hypothalamic-pituitary-adrenal axis was more serious in the refractory depression group. In particular in relation to memory and attention defect. Conclusion Changes in the levels of CORT, ACTH, TSH, FT3 and T4 may be correlated to cognitive function damage in patients with refractory depression.
Objective To evaluate the clinical effectiveness and safety of escitalopram in the treatment of major depression. Methods A randomized double-blind active-drug controlled trial was used to observe 56 patients with major depression. They were randomly divided into the treatment group (escitalopram, 28 patients) and the control group (citalopram, 28 patients). We used HAMD,CGI-I, and HAMA to evaluate clinical effectiveness and symptom-recording to evaluate safety. All outcomes were measured before treatment and at 14 days, 28 days and 42 days after treatment. Results According to an intention-to-treat (ITT) analysis in the Full Analysis Set with last observation carried forward (LOCF), the HAMD score decreased from baseline by 15.1±7.8 in the treatment group, and 12.1±7.7 in the control group. There was no significant difference between the two groups(t=1.42,P=0.1613). The rate of effectiveness, based on the percentage decrease of HAMD is 78.6% in the treatment group, and 67.9% in the control group(χ2 = 0.8195,P=0.3653). The HAMA score decreased from 15.1±3.7 to 3.3±4.5 in the treatment group, and from 14.0±4.1 to 5.0±3.7 in the control group(t=1.5756, P=0.1223). From the point of CGI, there was no significant difference between these two groups at any follow-up. At the end of the trial, the proportion of patients assessed to have a great improvement or more was 90.0% in the treatment group, and 87.8% in the control group (CMH=1.5013,P=0.2205). Side effects were recorded for 32.5% of the treatment group and 30.8% of the control group(χ2 =0.0770, P=0.7814). The most frequent side effects were nausea(11.7%), dry mouth(9.2%), dizziness(5.8%), insomnia(3.3%), hypodynamia(2.5%), transaminase elevation(1.7%), palpitation(1.7%), and constipation(1.7%). Conclusion The therapeutic action of escitalopram for the treatment of major depression is confirmed with less side effects than the well-proven antidepressant- citalopram.