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"Depressive Disorder -- therapy"
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Treatment plans and interventions for depression and anxiety disorders
\"_This widely used book is packed with indispensable tools for treating the most common clinical problems encountered in outpatient mental health practice. Chapters provide basic information on depression and the six major anxiety disorders; step-by-step instructions for evidence-based assessment and intervention; illustrative case examples; and practical guidance for writing reports and dealing with third-party payers. In a convenient large-size format, the book features 125 reproducible client handouts, homework sheets, and therapist forms for assessment and record keeping. The included CD-ROM enables clinicians to rapidly generate individualized treatment plans, print extra copies of the forms, and find information on frequently prescribed medications._New to This Edition*The latest research on each disorder and its treatment.*Innovative techniques that draw on cognitive, behavioral, mindfulness, and acceptance-based approaches.*Two chapters offering expanded descriptions of basic behavioral and cognitive techniques.*47 of the 125 reproducibles are entirely new. __\"--Provided by publisher.
Book
Ketamine versus ECT for Nonpsychotic Treatment-Resistant Major Depression
This randomized, noninferiority trial compared ketamine with electroconvulsive therapy in treatment-resistant depression. Ketamine was noninferior to ECT for treatment-resistant depression without psychosis.
Journal Article
Depression in the Primary Care Setting
Screening for depression and suicidality is important in primary care. Major depressive disorder should be distinguished from bipolar disorder (for which treatment is different). Psychotherapy (for mild depression) and pharmacotherapy are effective therapies.
Journal Article
Depression: Managing Resistance and Partial Response to Treatment
Treatment-resistant depression is defined as absence of remission despite trials of two or more antidepressant medications and can occur in up to 31% of patients with major depressive disorder. Partial response to treatment is defined as less than 50% reduction in depression-rating scores. Before diagnosing treatment-resistant depression or partial response to treatment, adherence to adequate doses and duration of medications should be confirmed. Management strategies include adding psychotherapy, switching antidepressant medication class, or augmenting with additional medications. Current guidelines recommend augmentation with a second-generation antidepressant, an atypical antipsychotic, tricyclic antidepressants, lithium, or a triiodothyronine medication as pharmacologic options. Ketamine and esketamine can also be used as augmentation for treatment-resistant depression and may help reduce suicidal ideation. Electroconvulsive therapy and repetitive transcranial magnetic stimulation may be effective. Pharmacogenetic testing has limited evidence and is not recommended. Nonpharmacologic therapies include psychotherapy, exercise, and focused dietary changes.
Journal Article
Psilocybin-assisted therapy for treatment-resistant depression in the US: a model-based cost-effectiveness analysis
Psilocybin-assisted therapy (PAT) has been shown in early trials to reduce the symptoms of treatment-resistant depression (TRD). This study evaluated the cost-effectiveness of PAT as a third-line treatment for major depressive disorder compared to standard of care (SOC). We used an individual-level, probabilistic simulation model that portrays representative US adults with TRD who receive SOC (pharmacotherapy, psychotherapy, electroconvulsive therapy, and esketamine nasal spray) and PAT over 12 months. We assumed the total cost of PAT was $5000, which we varied in sensitivity analyses ($3000–20,000). We calculated total costs, health effects (in terms of quality-adjusted life years [QALYs] gained), and incremental cost-effectiveness ratio (ICER) from limited healthcare and societal perspectives. PAT leads to an additional 0.031 QALYs and $3639 costs compared to SOC over 12 months, giving an ICER of $117,517 per QALY gained from a limited healthcare perspective. Using a $150,000 cost-effectiveness threshold, PAT had a 75% probability of being the cost-effective choice, and it was associated with a lower expected loss than SOC ($301 vs. $1307). Results were sensitive to uncertainty in model parameters, particularly the cost of PAT. PAT had a 1% probability of being cost-effective when its overall costs were $10,000 and 95% when its costs were $3000. This cost-effectiveness analysis found that when its costs are $5000 or less, PAT may offer economic value compared to available TRD treatments. Future studies can explore ways to reduce the cost of PAT and to understand its long-term effectiveness in maintaining remission and reducing the risk of relapse.
Journal Article
Group treatment manual for persistent depression : cognitive behavioral analysis system of psychotherapy (CBASP) : therapist's guide
This manual is a treatment guide for mental health professionals working with persistently depressed individuals. It provides a clear step-by-step application of CBASP as a group treatment modality, the research findings supporting the effectiveness of this treatment, and suggested methods of assessing outcome as well as possible applications or adaptations of the treatment to different settings and disorders.
Book
Treatment-Resistant Depression
Up to two thirds of patients with major unipolar depression will not respond to the first medication prescribed. Depression may be considered resistant to treatment when at least two trials with antidepressants from different pharmacologic classes (adequate in dose, duration, and compliance) fail to produce a significant clinical improvement. Evidence regarding the effectiveness of psychotherapy for treatment-resistant depression is limited. A recent high-quality trial found that patients who did not respond to citalopram and who received cognitive behavior therapy (with or without continued citalopram) had similar response and remission rates to those who received other medication regimens. Initial remission rates in that trial were 37 percent, and even after three additional trials of different drugs or cognitive behavior therapy, the cumulative remission rate was only 67 percent. In general, patients who require more treatment steps have higher relapse rates, and fewer than one half of patients achieve sustained remission. No treatment strategy appears to be better than another. Electroconvulsive therapy is effective as short-term therapy of treatment-resistant depression. There is no good-quality evidence that vagal nerve stimulation is an effective treatment for this condition. ( Am Fam Physician. 2009;80(2):167-172. Copyright © 2009 American Academy of Family Physicians.)
Journal Article