Last updated on 22nd June 2012
"There's nothing so practical as a good theory". Kurt Lewin
"There's nothing so practical as a good theory". Kurt Lewin
Looking back over relevant research papers that caught my attention last month, some stand out for me more than the others. Here are three on depression that stood out and got me thinking. The Fergusson et al paper looks at links between alcohol abuse and major depression. There has been debate for years on whether alcohol dependence leads to depression or depression leads to alcohol dependence. In this kind of debate, it's usually a good bet that both pathways contain some truth. What this study adds is that often it is the alcohol dependence that is primary. As the authors state " ... the associations between AAD (alcohol abuse or dependence) and MD (major depression) were best explained by a causal model in which problems with alcohol led to increased risk of MD as opposed to a self-medication model in which MD led to increased risk of AAD."
This set of five papers documents, in part, our mixed viewpoints on depression. Worryingly, Mehta & colleagues show deteriorating public attitudes towards mental illness in England (and to a lesser extent Scotland) between 1994 and 2003. Meanwhile Blumner et al demonstrate a shift towards a more biological view on causes and treatment of depression in the US between 1996 and 2006.
In contrast, Miranda et al's editorial (and Grote et al's research) highlight the growing evidence showing psychotherapies for depression can be "very effective for low-income and minority populations in the United States and abroad" - extending their validity well beyond more privileged groups in developed countries. Andersson too discusses a further way to make psychotherapies more widely available and helpful - in this case, the increasing literature documenting the widespread value of delivering cognitive behavioural therapy via the internet.
This is the eleventh and final post about the Moroccan trip - a reflection once I was back in Scotland.
So it's before breakfast on Tuesday morning in Edinburgh. We got back about 36 hours ago. I'm now mostly into the swing of "normal, everyday life" again. 150 plus emails, piles of post, phone messages - the usual "welcome back" after being away. I said at the end of the first post about this trip (just 12 days ago) " ... it feels a fun, slightly crazy thing to attempt - to try to combine/construct something that's a mix of adventure, holiday, time with good friends, and also a meditation retreat. Like trying to play some strange mix of musical styles." We achieved this well. Good. And now what's been brought back with us?
Cipriani and colleagues published a major multiple-treatments meta-analysis of new generation antidepressants last week - see abstract below. As Parikh wrote in his linked editorial (see below) "Andrea Cipriani and colleagues provide the field with a major answer. Free of any potential funding bias (and including an analysis of studies based on pharmaceutical-company sponsorship), these researchers used a newer methodology, multiple treatments meta-analysis, to examine 117 head-to-head randomised trials in almost 26 000 patients ... Of 12 newer antidepressants, four emerged as superior in efficacy: escitalopram, mirtazapine, sertraline, and venlafaxine ... In terms of acceptability, four agents were better tolerated: bupropion, citalopram, escitalopram, and sertraline. Balancing efficacy and acceptability and lower drug costs, the researchers concluded that sertraline might be particularly appropriate as a first-choice treatment ... " This is superbly useful information. Parikh's editorial goes on to raise helpful queries about next step questions, however Cipriani et al have done antidepressant prescribers and users a major service with this very important paper.
Here are five papers on difficulties experienced by adolescents. A couple of the papers are follow-up studies. Colman et al looked at the multiple negative personal & relationship outcomes in a UK national cohort of adolescents with conduct problems followed over 40 years. Wentz et al studied the somewhat more encouraging 18 year outcomes of a group of adolescents suffering from anorexia.
A couple of the papers are about depression. Kennard and colleagues report again on the well-known Treatment for Adolescents with Depression Study (TADS) comparing antidepressants, cognitive-behavioural therapy and combined treatment. By about six months there was little difference between the three forms of treatment. At nine months the remission rate for intent-to-treat cases was 60% overall. Primack et al investigated the association between electronic media use in adolescence and subsequent depression in young adulthood. They reported "Controlling for all covariates including baseline Center for Epidemiologic Studies-Depression Scale score, those reporting more television use had significantly greater odds of developing depression."
Here are a few handouts that I've put together over the years to provide background information about depression. The development & maintenance diagram is probably the handout here that I use most - both to explain issues about depression and also for many other psychological disorders as well.
Development & maintenance of distressed states - I use this Powerpoint diagram a lot when discussing with people why they are in a distressed state. The diagram applies to depression but it also applies to nearly all other distressed psychological states as well. It can be helpful in highlighting the importance of maintaining, precipitating and vulnerability factors. I also point out that therapeutic gains can be made working with all three of these general sets of factors - for example, emotional processing work for past experience (both precipitating and vulnerability factors) and more standard cognitive-behavioural approaches for maintaining factors.
Here are five papers on lifestyle and the benefits of making healthy choices. The first by Cohen et al on sleep habits and susceptibility to the common cold, showed increased risk of developing a cold after infection for those with shorter sleep duration. Interestingly the increased risk was even greater for those with poor sleep efficiency. Sleep efficiency is calculated by dividing the time spent asleep by the time spent in bed trying to sleep. The Good Knowledge section of this website contains useful information on assessing and treating sleep difficulties.
Here are a couple of very interesting, helpful websites that I've been reminded of recently. They illustrate in a fun way the diversity and possibilities of the internet.