Temporal Course of Change of Depression
Two hundred fifty moderately to severely depressed outpatients were randomly assigned to 16 weeks of cognitive-behavioral therapy, interpersonal psychotherapy, imipramine plus clinical management (IMI-CM), or pill placebo plus clinical management. Two hundred thirty-nine patients actually began treatment. The most rapid change in depressive symptoms occurred in the IMI-CM condition, which achieved significantly better results than the other treatments at 8 and 12 weeks on 1 or more variables. Change over the course of treatment on variables hypothesized to be most specifically affected by the respective treatments was found only in the case of pharmacotherapy, in which imipramine produced significantly greater changes on the endogenous measure at 8 and 12 weeks.
Available from: Marcus Huibers
- "O'Hara, 2000 Dobkin, 2011 Grote, 2009 Mynors-Wallis, 1995 Berger, 2011 Fledderus, 2012 ACT-E Watt, 2000 Iteg Fledderus, 2012 ACT-M Scott, 2000 Choi, 2012 Harley, 2008 Vitriol, 2009 Miller, 2002 Watkins, 1993 IPT Serfaty, 2009 Dowrick, 2000 PST Laidlaw, 2008 Watkins, 1993 CBT Ward, 2000 NDC Van Schaik, 2006 Perini, 2009 Miranda, 2003 Dowrick, 2000 CWD Ward, 2001 CBT Talbot, 2011 Haringsma, 2006 Allart-van Dam, 2003 Simpson, 2003 Lynch, 2004 Neugebauer, 2006 Klein, 1985 "
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ABSTRACT: Patients with depression often report impairments in social functioning. From a patient perspective, improvements in social functioning might be an important outcome in psychotherapy for depression. Therefore, it is important to examine the effects of psychotherapy on social functioning in patients with depression.
We conducted a meta-analysis on studies of psychotherapy for depression that reported results for social functioning at post-treatment. Only studies that compared psychotherapy to a control condition were included (31 studies with 2956 patients).
The effect size of psychotherapy on social functioning was small to moderate, before [Hedges' g = 0.46, 95% confidence interval (CI) 0.32-0.60] and after adjusting for publication bias (g = 0.40, 95% CI 0.25-0.55). Univariate moderator analyses revealed that studies using care as usual as a control group versus other control groups yielded lower effect sizes, whereas studies conducted in the USA versus other countries and studies that used clinician-rated instruments versus self-report yielded higher effect sizes. Higher quality studies yielded lower effect sizes whereas the number of treatment sessions and the effect size of depressive symptoms were positively related to the effect size of social functioning. When controlling for these and additional characteristics simultaneously in multivariate meta-regression, the effect size of depressive symptoms, treatment format and number of sessions were significant predictors. The effect size of social functioning remained marginally significant, indicating that improvements in social functioning are not fully explained by improvements in depressive symptoms.
Psychotherapy for depression results in small to moderate improvements in social functioning. These improvements are strongly associated with, but not fully explained by, improvements in depressive symptoms.
Available from: Jeffrey R Lacasse
- "In studies in which Cognitive Behavior Therapy (CBT) is contrasted with antidepressants, antidepressants sometimes achieve response rates faster, but by the end of the study outcomes equalize (Blackburn & Moore, 1997; Elkin et al., 1989; Shea et al., 1992; Simons, Murphy, Levine, & Wetzel, 1986; Watkins et al., 1993). A meta-analysis examining comparative efficacy of CBT versus drugs for the severely depressed found no difference in efficacy, although effect sizes were greater for the CBT group (DeRubeis, Gelfand, Tang, Simons, 1999). "
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ABSTRACT: Questions regarding the efficacy of antidepressant drugs has been a recent focus of attention in the national news both in print and in the television media. Many clients will have questions regarding what they can believe and how they can address mood problems. Social workers constitute a greater percentage of the mental health work force than any other profession. Thus, social workers will probably be asked by clients about these issues. This paper presents information on the efficacy of antidepressants for both the short and long term. It covers adverse effects and withdrawal symptoms. Clients’ self-determination should be honored. However, social workers can be of assistance in supplying facts relevant to decision making.
Available from: ncbi.nlm.nih.gov
- "For example, a meta-analysis of a large sample of individuals (n = 2,431) pooled from numerous psychotherapy studies found that half of the patients studied achieved symptom relief within eight sessions of open-ended treatment (Howard et al. 1986). Conventional wisdom suggests that pharmacotherapy alleviates depressive symptoms more quickly than psychotherapy (Watkins et al. 1993). However, it is possible that patients and therapists work harder and faster when the number of psychotherapy sessions is limited from the outset (Reynolds et al. 1996), thereby hastening the onset of psychotherapy's antidepressant effects. "
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ABSTRACT: Intervening with depressed women during their childbearing years, especially with those on low incomes, is critically important. Not only do mothers and expectant mothers suffer unnecessarily, but their untreated depression has critical negative consequences for their families. Despite this, these women have proven especially difficult to engage in psychotherapy. In this paper we describe several adaptations and additions we have made to a brief form of Interpersonal Psychotherapy (IPT) to meet the needs of mothers and expectant mothers living on low incomes in the community who suffer from depression, but face significant practical, psychological, and cultural barriers to engaging in and staying in treatment. In addition, we present some preliminary data on the extent to which our enhanced, brief IPT approach promotes improvements in treatment engagement and retention relative to usual care for expectant mothers on low incomes.
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