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Treatment for Post-Traumatic Stress Disorder, Operational Stress Injury, or Critical Incident Stress: A Review of Guidelines [Internet]

Critical incidents are events where individuals witness or experience tragedy, death, serious injuries, or threatening situations, which may have strong emotional impact. Emergency service workers and law enforcement workers are often affected by critical incident stress (CIS), which may or may not develop a post-traumatic stress disorders (PTSD) after a critical incident or traumatic event. The signs and symptoms of CIS can be physical (e.g., fatigue, headache, dizziness), cognitive (e.g., confusion, nightmares, poor attention and concentration), emotional (e.g., fear, guilt, anger, depression, chronic anxiety) and behavioral (e.g., restlessness, withdrawal, increased alcohol consumption). Tools for the management of CIS include demobilization, crisis management briefings, defusing, and debriefing.

Rapid Response Report: Summary with Critical Appraisal - Canadian Agency for Drugs and Technologies in Health.

Version: April 27, 2015
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Screening for Depression in Adults and Older Adults in Primary Care: An Updated Systematic Review [Internet]

Depression causes significant suffering and is commonly seen in primary care. Because primary care providers sometimes fail to identify patients as depressed, systematic screening programs in primary care may be of use in improving outcomes in depressed patients. Depression screening is predicated on the notion that identification will allow effective treatments to be delivered and that the benefits of treatment will outweigh the harms. Treatment efficacy of antidepressants and psychotherapy in general adult populations was established in a previous United States Preventive Services Task Force (USPSFT) review on depression screening, but treatment in older adults was not examined specifically. Additionally, harms of screening and treatment were not previously examined in detail.

Evidence Syntheses - Agency for Healthcare Research and Quality (US).

Version: December 2009
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Screening for Depression in Adults: An Updated Systematic Evidence Review for the U.S. Preventive Services Task Force [Internet]

Depression is relatively common in primary care patients but is not always identified by primary care providers.

Evidence Syntheses - Agency for Healthcare Research and Quality (US).

Version: January 2016
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Depression in Children and Young People: Identification and Management in Primary, Community and Secondary Care

This guideline has been developed to advise on the identification and management of depression in children and young people in primary, community and secondary care. The guideline recommendations have been developed by a multidisciplinary team of healthcare professionals, carers, and guideline methodologists after careful consideration of the best available evidence. It is intended that the guidelines will be useful to clinicians and service commissioners in providing and planning high-quality care for children and young people with depression while also emphasising the importance of the experience of care for patients and their families.

NICE Clinical Guidelines - National Collaborating Centre for Mental Health (UK).

Version: 2005
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Dementia: A NICE-SCIE Guideline on Supporting People With Dementia and Their Carers in Health and Social Care

This guideline has been developed to advise on supporting people with dementia and their carers in health and social care. The guideline recommendations have been developed by a multidisciplinary team of health and social care professionals, a person with dementia, carers and guideline methodologists after careful consideration of the best available evidence. It is intended that the guideline will be useful to practitioners and service commissioners in providing and planning high-quality care for those with dementia while also emphasising the importance of the experience of care for people with dementia and carers.

NICE Clinical Guidelines - National Collaborating Centre for Mental Health (UK).

Version: 2007
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Strategies for managing sexual dysfunction caused by antidepressants

Antidepressants can have numerous effects on sexual function including altered sexual desire, erection difficulties and orgasm problems. This systematic review investigated different ways to manage such sexual dysfunction. We included 23 randomised studies, with a total of 1886 participants who had developed their sexual problems while taking antidepressant medication. Twenty‐two of these studies looked at the addition of further medication to the ongoing treatment for depression. For men with antidepressant‐induced erectile dysfunction, the addition of sildenafil (Viagra; three studies, 255 participants) or tadalafil (Cialis; one study, 54 participants) appeared to improve the situation. For women with antidepressant‐induced sexual dysfunction the addition of bupropion (Wellbutrin, Zyban; three studies, 482 participants) at higher doses appears to be the most promising approach studied so far, but further data from randomised trials are likely to be required before it can be recommended confidently. We did not find evidence that any intervention led to a worsening of psychiatric symptoms; however, we cannot be confident of this for many of the interventions studied, as only small numbers of participants have been studied so far.

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

Version: 2013

Comparing Fibromyalgia Drugs

How do drugs for fibromyalgia compare in improving symptoms?

PubMed Clinical Q&A [Internet] - National Center for Biotechnology Information (US).

Version: June 12, 2011

Nonpharmacological Versus Pharmacological Treatments for Adult Patients With Major Depressive Disorder [Internet]

To compare the benefits and harms of second-generation antidepressants (SGAs), psychological, complementary and alternative medicine, and exercise treatment options as first-step interventions for adult outpatients with acute-phase major depressive disorder (MDD), and as second-step interventions for patients with MDD who did not achieve remission after a first treatment attempt with SGAs.

Comparative Effectiveness Reviews - Agency for Healthcare Research and Quality (US).

Version: December 2015
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Assessment of the Need to Update Comparative Effectiveness Reviews: Report of an Initial Rapid Program Assessment (2005–2009) [Internet]

AHRQ recognizes that periodic assessments of the evidence base supporting each of the comparative effectiveness reviews is an important and necessary part of the Effective Health Care (EHC) Program. The rapidity with which new research findings accumulate makes it imperative that the evidence be assessed periodically to determine the need for a full-scale update. The EHC Program, then, initiated concurrent and parallel work to address this need both methodologically and programmatically. The development of methods guidance for updating was initiated to inform the research of systematic reviewers. This methodologic guidance will supplement the EHC Methods Guide for Comparative Effectiveness Reviews (www.effectiveheathcare.gov). In parallel with the methods effort, an initial, rapid program assessment was commissioned to assess the need for the findings of the CERs completed to that point to be updated. The Southern California Evidence-based Practice Center (SCEPC) was tasked with conducting this assessment. Findings from the assessment were presented to AHRQ for consideration within the usual program criteria to prioritize the topics for updating within the EHC Program. This document presents the findings from the assessment for public information and transparency.

Agency for Healthcare Research and Quality (US).

Version: September 10, 2009
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Findings of Bayesian Mixed Treatment Comparison Meta-Analyses: Comparison and Exploration Using Real-World Trial Data and Simulation [Internet]

Specific objectives were to examine the following: (1a) how results of Bayesian mixed treatment comparison (MTC) methods compare with several commonly considered frequentist indirect methods; (1b) how Bayesian MTC methods perform for different evidence network patterns; (2) how meta-regression can be used with Bayesian MTC meta-analysis to explore heterogeneity; and (3) how findings of Bayesian MTC meta-analyses compare for different numbers of studies and different network pattern assumptions. For objectives 1 and 2, we aimed to conduct case studies using data from two recent comparative effectiveness reviews (CERs). For objective 3, we aimed to use simulated data.

Methods Research Reports - Agency for Healthcare Research and Quality (US).

Version: February 2013
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Depression: The Treatment and Management of Depression in Adults (Updated Edition)

This clinical guideline on depression is an updated edition of the previous guidance (published in 2004). It was commissioned by NICE and developed by the National Collaborating Centre for Mental Health, and sets out clear, evidence- and consensus-based recommendations for healthcare staff on how to treat and manage depression in adults.

NICE Clinical Guidelines - National Collaborating Centre for Mental Health (UK).

Version: 2010
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Assessment of a Method to Detect Signals for Updating Systematic Reviews [Internet]

Systematic reviews are a cornerstone of evidence-based medicine. The Agency for Healthcare Research and Quality (AHRQ) has a program to produce systematic reviews. Systematic reviews will become out of date as new evidence gets published. Determining when a systematic review has gone sufficiently out of date to warrant an update is challenging. AHRQ has a surveillance system that uses limited literature searches and expert opinion to detect signals for when a systematic review is out of date. While the surveillance system has face validity, an assessment of predictive validity has not been performed

Research White Papers - Agency for Healthcare Research and Quality (US).

Version: March 2014
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Second Generation Antidepressants for Pediatric Patients with Major Depressive Disorder and Anxiety Disorder: A Review of the Clinical Effectiveness and Safety [Internet]

Major depressive disorders (MDD) and anxiety disorders fall within a spectrum of psychiatric disorders that are characterized by severe and/or persistent symptoms of sadness and irritability that can cause considerable distress and interfere with daily activities. Untreated, they may lead to serious developmental, personal and societal difficulties that may prejudice school success, work productivity, adult development and the forming of relationships. In Canada, it is estimated that approximately 5% of male youth and 12% of female youth have experienced a major depressive episode during their childhood or adolescent years.

Rapid Response Report: Summary with Critical Appraisal - Canadian Agency for Drugs and Technologies in Health.

Version: June 11, 2015
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Antidepressant Treatment of Depression During Pregnancy and the Postpartum Period

To evaluate the benefits and harms of pharmacological therapy for depression in women during pregnancy or the postpartum period.

Evidence Reports/Technology Assessments - Agency for Healthcare Research and Quality (US).

Version: July 2014
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Post-Traumatic Stress Disorder: The Management of PTSD in Adults and Children in Primary and Secondary Care

This guideline has been developed to advise on the treatment and management of post-traumatic stress disorder (PTSD). The guideline recommendations have been developed by a multidisciplinary team of healthcare professionals, PTSD sufferers and guideline methodologists after careful consideration of the best available evidence. (The term ‘PTSD sufferer’ was chosen for use in the guideline on the basis of a survey conducted by sufferer members of the Guideline Development Group. People with the disorder were presented with a range of options such as ‘people with PTSD’, ‘patients with PTSD’ and ‘PTSD sufferer’ and asked to indicate which term they preferred; ‘PTSD sufferer’ was the term favoured by the majority.) It is intended that the guideline will be useful to clinicians and service commissioners in providing and planning high-quality care for those with PTSD while also emphasising the importance of the experience of care for patients and their families.

NICE Clinical Guidelines - National Collaborating Centre for Mental Health (UK).

Version: 2005
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Antidepressants in Elderly Patients with Major and Minor Depression: A Review of Clinical Effectiveness and Guidelines [Internet]

While clinical trials of antidepressants may include some individuals over the age of 65, it is not clear that evidence of safety and efficacy in such subgroup analyses are reflective of this age group more broadly. The generalizability of outcome data across populations can potentially be uncertain and the comparative efficacy of different antidepressants in older adults could potentially differ than what is seen in younger populations. As well, age-related changes that affect the pharmacokinetics and pharmacodynamics of drugs can affect the safety and potential harms with antidepressants in older adults. Older adults are at increased risk of anticholinergic side effects (common to a number of antidepressant classes), and orthostatic and sedative effects. These effects can exacerbate underlying conditions such as cardiovascular disease, cognitive impairment, delirium and can increase the risk of falls and fractures.

Rapid Response Report: Summary with Critical Appraisal - Canadian Agency for Drugs and Technologies in Health.

Version: August 17, 2015
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Screening in Primary Care Settings for Illicit Drug Use: Staged Systematic Review for the United States Preventive Services Task Force [Internet]

Illicit drug use and abuse are serious problems among adolescents, adults, and pregnant women in the United States, and approximately 3.2% of the population age 12 and over meet criteria for a drug use disorder. Many individuals with drug use disorders have co-existing mental and physical health conditions.

Evidence Syntheses - Agency for Healthcare Research and Quality (US).

Version: January 2008
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Social Anxiety Disorder: Recognition, Assessment and Treatment

Social anxiety disorder is very common and often coexists with other mental health problems. It can be severely detrimental to quality of life, with far-reaching consequences for education, employment and relationships. Only a minority of people with social anxiety disorder receive help, but this guideline demonstrates that effective treatments exist and it aims to increase identification and assessment so that people can access interventions to help them overcome this disabling condition.

NICE Clinical Guidelines - National Collaborating Centre for Mental Health (UK).

Version: 2013
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A Systematic Review of Prevention and Intervention Strategies for Populations at High Risk of Engaging in Violent Behaviour: Update 2002–8

It has been estimated that violence accounts for more than 1.6 million deaths worldwide each year and these fatal assaults represent only a fraction of all assaults that actually occur. The problem has widespread consequences for the individual and for the wider society in physical, psychological, social and economic terms. A wide range of pharmacological, psychosocial and organisational interventions have been developed with the aim of addressing the problem. This review was designed to examine the effectiveness of these interventions when they are developed in mental health and criminal justice populations.

Health Technology Assessment - NIHR Journals Library.

Version: February 2012
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Depression in Adults with a Chronic Physical Health Problem: Treatment and Management

This clinical guideline was commissioned by NICE and developed by the National Collaborating Centre for Mental Health. It sets out clear, evidenceand consensus-based recommendations for healthcare staff on how to treat and manage depression in adults with a chronic physical health problem.

NICE Clinical Guidelines - National Collaborating Centre for Mental Health (UK).

Version: 2010
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