Review: benefits of antidepressants over placebo limited except in very severe depression.
University of Hull, Hull, UK.Evidence-based mental health 05/2010; 13(2):49. DOI: 10.1136/ebmh.13.2.49
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ABSTRACT: Application of Sustainability Principles to the Healthcare System The definition of sustainability appeared in 2006 at the UK Journal Nutrition Practitioner: "A complex system of interacting approaches to the restoration, management and optimization of human health that has an ecological base, that is environmentally, economically and socially viable indefinitely, that functions harmoniously both with the human body and the non-human environment, and which does not result in unfair or disproportionate impacts on any significant contributory element of the healthcare system." Generally, definitions of sustainability refer to those approaches that provide the best outcomes for both the human and natural environments, both now, and in the indefinite future. Sustainability is a robust concept that has proven its worth across a range of different industries including energy, agriculture, forestry and even construction and tourism. Contemporary healthcare in western countries is presently dominated by use of pharmaceutical drugs—and most indicators would suggest that these approaches have had very limited value in dealing with some of the greatest scourges facing human health, including chronic diseases, psychiatric diseases and even certain infectious diseases. The term should apply also to the conduct of medical practices, which should emphasize preventative healthcare in order to reduce the future burden on the healthcare sector, particularly by largely or partially preventable, chronic diseases such as heart disease, cancer, obesity, diabetes and osteoporosis, which currently represent the greatest burden.03/2013, Degree: Maters of Science in Health Administration (MHA), Supervisor: Prof. E Barsoum
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ABSTRACT: Clinically significant depression is present in one of every four people with type 2 diabetes mellitus (T2DM). Depression increases the risk of the development of T2DM and the subsequent risks of hyperglycemia, insulin resistance, and micro- and macrovascular complications. Conversely, a diagnosis of T2DM increases the risk of incident depression and can contribute to a more severe course of depression. This linkage reflects a shared etiology consisting of complex bidirectional interactions among multiple variables, a process that may include autonomic and neurohormonal dysregulation, weight gain, inflammation, and hippocampal structural alterations. Two recent meta-analyses of randomized controlled depression treatment trials in patients with T2DM concluded that psychotherapy and antidepressant medication (ADM) were each moderately effective for depression and that cognitive behavior therapy (CBT) had beneficial effects on glycemic control. However, the number of studies (and patients exposed to randomized treatment) included in these analyses is extremely small and limits the certainty of conclusions that can be drawn from the data. Ultimately, there is no escaping the paucity of the evidence base and the need for additional controlled trials that specifically address depression management in T2DM. Future trials should determine both the effects of treatment and the change in depression during treatment on measures of mood, glycemic control, and medical outcome.Drugs 04/2015; 75(6). DOI:10.1007/s40265-015-0347-4
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