The Effectiveness Of Psychological Treatments For Treatment Resistant

By Author: Ibrahim Machiwala
Total Articles: 396
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Depression: A Systematic Review

A systematic review of all studies (controlled and uncontrolled) to evaluate psychological interventions with treatment-resistant depression. One systematic review and two subsequent RCTs including persons 58 years or older with all grades of depressive disorders showed that tricyclic antidepressants, SSRIs, or MAOIs reduced the proportion of persons who did not recover over 28 to 51days compared with placebo.

Background:
About 30% of people with depression do not respond to an antidepressant at the recommended dose and can be described as having treatment-refractory depression.

Chronicity of Major Depressive Disorder involves many interacting variables
Resistance to anti-depressant medications

Research issues:
Definitions used for treatment resistance
Under treatment leading to pseudo-resistance
Inconsistencies in defining non-response
Lack of RCTs / controlled studies
To examine the effectiveness of psychological treatment interventions for treatment-resistant depression including all controlled and uncontrolled designs ...
...

Inclusion Criteria:
Failure to respond to at least one previous trial of anti-depressant pharmacotherapy
Participants 18 and above
‘Talking treatments' used as a central component
Any design and language

Exclusion Criteria:
Failure to explicitly show non-response to medications in participants prior to study intervention
Absence of diagnostic criteria fulfillment for depression ( >14 on HRSD or >19 for Beck Depressive Inventory)
National Health Services (NHS) Centre for Research and Dissemination guidelines for conduct of systematic reviews
Journals hand-searched (duration mentioned)
Websites
Researchers in the field contacted (grey literature)
Terms ‘depression' and ‘psychological',' depression' and ‘psychotherapy', ‘refractory' and ‘depression', ‘chronic' and ‘depression', ‘resistant' and ‘depression'
Language Bias
Methodological quality was not used for exclusion
Use of checklist (next slide)
Publication bias was addressed - using grey literature
Data extraction was done by one reviewer and checked by second
Sample size
Checklist for assessing quality of both randomized and non-randomized health care intervention studies developed by Downs and Black 1998
Maximum score 32
Score