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Second‐generation antipsychotic drugs for major depressive disorder 

This review found 28 studies on five second‐generation antipsychotic drugs (amisulpride, aripiprazole, olanzapine, quetiapine and risperidone) comparing the effects of the drugs alone or adding them or placebo to antidepressants for major depressive disorder and dysthymia. There is evidence that amisulpride might lead to symptom reduction in dysthymia, while no important differences were seen for major depression. There is limited evidence that aripiprazole leads to symptom reduction when added to antidepressants. Olanzapine had no beneficial effects for treatment of depression when compared to antidepressants or compared to placebo but there was limited evidence for the benefits of olanzapine as additional treatment. Data on quetiapine indicated beneficial effects for quetiapine alone or as additional treatment when compared to placebo; data on quetiapine versus duloxetine did not show beneficial effects in terms of symptom reduction for either group, but quetiapine treatment was less well tolerated. The data, however, are very limited. Slight benefits of risperidone as additional treatment, in terms of symptom reduction, are also based on a rather small number of randomised participants. Generally, treatment with second‐generation antipsychotic drugs was associated with worse tolerability, mainly due to sedation, weight gain or laboratory values such as prolactin increase.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2012

Antidepressants plus benzodiazepines for major depression

The reviewers report that a combination of benzodiazepines with antidepressants works in favour for the treatment of depression, because it decreases drop outs from treatment and it increases short‐term response up to four weeks. However, there are downsides to this combination therapy because benzodiazepines can induce dependence, which is estimated to occur in one third of patients, as well as a decline in the drug's effect over time. Benzodiazepines have been associated with an increase in accident proneness.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2009

Fluvoxamine versus other anti‐depressive agents for depression

Major depression is a severe mental illness characterised by a persistent and unreactive low mood and loss of all interest and pleasure, usually accompanied by a range of symptoms including appetite change, sleep disturbance, fatigue, loss of energy, poor concentration, psychomotor symptoms, inappropriate guilt and morbid thoughts of death. Although pharmacological and psychological interventions are both effective for major depression, antidepressant (AD) drugs remain the mainstay for treatment of moderate or severe depression. Fluvoxamine is one of the oldest selective serotonin reuptake inhibitors (SSRIs) and is prescribed to patients with major depression in many countries. This review reports trials comparing fluvoxamine with other antidepressants for treatment of major depression. We found no strong evidence that fluvoxamine was either superior or inferior to any other antidepressants in terms of efficacy and tolerability in the acute phase treatment of depression. However, there is evidence of differing side‐effect profiles, especially when comparing gastrointestinal side effects between fluvoxamine and tricyclic antidepressants (TCAs). Based on these findings, we conclude that clinicians should focus on practical or clinically relevant considerations including these differences in side effect profiles.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2013

Paroxetine versus other anti‐depressive agents for depression

Major depression is a severe mental illness characterised by a persistent and unreactive low mood and loss of all interest and pleasure, usually accompanied by a range of symptoms such as appetite change, sleep disturbance, fatigue, loss of energy, poor concentration, inappropriate guilt and morbid thoughts of death. Although medication and psychological treatments are both effective for major depression, antidepressant drugs remain the mainstay of treatment in moderate to severe major depression. However, head‐to‐head comparisons of such drugs provide contrasting findings as to whether they are effective.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2014

Inositol for depression

Inositol is a nutritional supplement that has been suggested as a treatment for depressive disorders. The reviewers found the current evidence is unclear whether or not inositol is of benefit in the treatment of depression. There are ongoing studies that should reduce this uncertainty.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2009

Psychotherapy for depression among cancer patients who are incurable

Depressive states represent frequent complications among cancer patients and are more common amongst advanced cancer patients. Psychotherapy comprises of various interventions for ameliorating or preventing psychological distress conducted by direct verbal or interactive communication, or both, and is delivered by health care professionals. It is a patient‐preferred and promising strategy for treating depressive states among cancer patients. Several systematic reviews have investigated the effectiveness of psychotherapy for treating depressive states among cancer patients. However, the findings are conflicting, and no review has focused on depressive states among patients with incurable cancer. The review authors conducted a systematic review of randomised controlled trials to investigate the effects of psychotherapy on the treatment of depressive states among patients with advanced cancer. The review authors found that psychotherapy was useful for treating depressive states in advanced cancer patients. However, little evidence supports the effectiveness of psychotherapy for patients with clinically diagnosed depression including major depressive disorder. Future studies to investigate and clarify the usefulness of psychotherapy for treating clinically diagnosed depression in terminally ill patients are needed.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2016

Lithium versus antidepressants in the long‐term treatment of unipolar affective disorder

This systematic review investigated the efficacy and tolerability of lithium compared to antidepressants for the long‐term treatment of unipolar affective disorder. Eight randomised studies (reporting on 475 participants) were included in the review. We found no reliable evidence of any robust differences between lithium and antidepressants but nor could we reliably exclude the possibility of clinically significant differences. In this review some studies included a mixed group of participants with either bipolar or unipolar disorder. The review suggests that, while lithium may be of benefit in preventing relapse in unipolar affective disorder, there remains uncertainty about the treatment effect in comparison with antidepressants. Interpretation of this review should consider that the number of participants in the studies was small and the included studies had methodological shortcomings.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2009

Electroconvulsive therapy (ECT) for depression in elderly people

Antidepressant drugs often cause side effects in elderly people, which may limit the effectiveness of treatment for depression. ECT can be an important alternative to drug treatment for depressed elderly people. This review involved searching the literature for well‐conducted (randomised) studies that compared ECT to both simulated ECT and to antidepressants. The review found only four studies, all of which had serious problems in their methods. At present, therefore, it is not possible to draw firm conclusions on whether ECT is more effective than antidepressants,.or on the safety or side effects of ECT in elderly people with depression.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2015

Folate for depression

This systematic review was undertaken to see if giving folate to people with depressive disorders reduced their depressive symptoms. Three randomized trials were identified, involving a total of 247 people. In all three trials, folate was well tolerated. In two of these trials, folate was added to other antidepressant drug treatment and there was limited evidence that folate helped. In the third trial, folate was compared to trazodone, an antidepressant drug. No difference was found. There is therefore limited evidence that adding folate to other antidepressant may be helpful, but larger trials are needed before patients and clinicians can be confident that it will be helpful.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2009

Amitriptyline for the treatment of depression

Amitriptyline is a tricyclic antidepressant drug that has been used for decades in the treatment of depression. The current review includes 39 trials with a total of 3509 participants and confirms its efficacy compared to placebo or no treatment. This finding is important, because the efficacy of antidepressants has recently been questioned. However, the review also demonstrated that amitriptyline produces a number of side effects such as vision problems, constipation and sedation. It is a limitation of this review that many studies have been poorly reported, which might have led to bias.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2012

Pharmacological treatment for psychotic depression

Psychotic depression is a severe depression with psychotic features (i.e. delusions and/or hallucinations). Uncertainty surrounds the most effective drug treatment for psychotic depression: with an antidepressant alone, with an antipsychotic alone or with the combination of an antidepressant plus an antipsychotic.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2015

Milnacipran versus other antidepressive agents for depression

Major depression, also known as major depressive disorder or unipolar depression, is a common mental disorder characterised by a combination of symptoms that interfere with a person's ability to work, sleep, study, eat, and enjoy pleasurable activities. An episode of major depression may occur only once in a person's lifetime, but more often, it recurs throughout a person's life.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2015

Treatments for preventing the recurrence of depression in children and adolescents

Many children and adolescents diagnosed with a depressive disorder will experience a relapse or recurrence of their symptoms. Little is known about what treatment approach works best to prevent this from occurring, once a child or adolescent has initially remitted or recovered from a depressive episode. This review aimed to determine the efficacy of early interventions, including psychological, social and pharmacological interventions to prevent relapse or recurrence of depressive disorders in children and adolescents.The review included nine studies that assessed the efficacy of antidepressant medication and psychological therapies in reducing the risk of a future depressive episode in children and adolescents. Trials varied in their quality and methodological design, limiting conclusions that could be drawn from the result. Overall, the review found that antidepressant medication reduces the chance that children and adolescents will experience another episode of depression, compared with a pill placebo. Psychological therapies also look promising as a treatment to prevent future depressive episodes, however given the aforementioned issues concerning trial quality and design, along with the small number of trials included in the review, it is unclear how effective these therapies are at present.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2014

St. John's wort for treating depression.

Depression is characterised by depressed mood and/or loss of interest or pleasure in nearly all activities and a variety of other symptoms for periods longer than two weeks. Extracts of St. John's wort (botanical name Hypericum perforatum L.) are prescribed widely for the treatment of depression.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2009

Antidepressants for the treatment of depression in people with cancer

Depressive states are frequent complications among people suffering from cancer. Often depressive symptoms are a normal reaction or a direct effect of such a severe and life‐threatening illness. It is therefore not easy to establish when depressive symptoms become a proper disorder and need to be treated with drugs. Current scientific literature reveals that depressive symptoms, even when mild, can have a relevant impact on the course of cancer, reducing the overall quality of life and affecting compliance with anti‐cancer treatment, as well as possibly increasing the cancer mortality rate.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2016

Omega‐3 fatty acids for bipolar disorder

This systematic review investigated the efficacy of omega‐3 fatty acids for bipolar disorder. Five randomised controlled trials met inclusion criteria for the review. Only one trial provided data that could be analysed, investigating ethyl‐EPA as an adjunctive treatment in a mixed outpatient population. Some positive benefits were found for depressive symptoms but not for mania, and no adverse events were reported. There is currently insufficient evidence on which to base any clear recommendations concerning omega‐3 fatty acids for bipolar disorder. However, given the general health benefits and safety of omega‐3, the preliminary evidence from this review provides a strong case for well‐powered, high‐quality trials in specific index populations.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2009

Comparing Talk Therapy and Other Depression Treatments With Antidepressant Medicines: A Review of the Research for Adults

What is depression? What have researchers found about how antidepressants compare with talk therapy (also called counseling) and other depression treatments (exercise programs, acupuncture, and dietary supplements)? What should I ask my health care professional about treating my depression?

Comparative Effectiveness Review Summary Guides for Consumers [Internet] - Agency for Healthcare Research and Quality (US).

Version: September 13, 2016

Topiramate for acute affective episodes in bipolar disorder

People with bipolar disorder and their healthcare providers.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2016

Omega‐3 fatty acids for depression in adults

Major depressive disorder (MDD) is characterised by depressed mood and/or a markedly decreased pleasure or interest in all activities. It has negative impacts on the individual and on society, often over the long term. One possible treatment for MDD is n‐3 polyunsaturated fatty acids (n‐3PUFAs), also known as omega‐3 oils, naturally found in fatty fish, some other seafood and some nuts and seeds. Various lines of evidence suggests that n‐3PUFAs may impact on depressive symptoms, but a lot of studies have different findings, making it difficult to draw conclusions.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2017

S‐adenosyl methionine for depression in adults

Depression is a common, recurrent mood disorder. Usually, affected people experience symptoms such as low mood and a loss of interest or pleasure. People with depression also often experience some of the following symptoms: weight loss or gain; a decrease or increase in appetite, insomnia or hypersomnia; restlessness or fatigue as well as excessive guilt; feelings of worthlessness, poor concentration and indecisiveness; recurrent thoughts of death and suicidal thoughts. The medicines most often used in the treatment of depression are antidepressants.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2016

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