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Vagus Nerve Stimulation for chronic major depressive episodes Public Summary Document Application No. 1491 - Vagus Nerve Stimulation (VNS) for chronic major depressive episodes Applicant: LivaNova Australia Pty Ltd Date of MSAC consideration: MSAC 73 rd Meeting, 26-27 July 2018 Context for decision: MSAC makes its advice in accordance with its Terms of Reference, visit the MSAC website 1. Purpose of application An application requesting Medicare Benefit Schedule (MBS) listing for Vagus Nerve (...) Stimulation (VNS) for chronic major depressive episodes was received from LivaNova Australia Pty Ltd by the Department of Health. 2. MSAC’s advice to the Minister After considering the strength of the available evidence in relation to comparative safety, clinical effectiveness and cost-effectiveness, MSAC did not support MBS funding of VNS for chronic major depressive episodes. MSAC accepted that there was a clinical need for more treatment options for this patient population. However, MSAC had concerns
Effectiveness of psychological treatments for depression and alcohol use disorder delivered by community-based counsellors: two pragmatic randomised controlled trials within primary healthcare in Nepal Evidence shows benefits of psychological treatments in low-resource countries, yet few government health systems include psychological services.AimEvaluating the clinical value of adding psychological treatments, delivered by community-based counsellors, to primary care-based mental health (...) services for depression and alcohol use disorder (AUD), as recommended by the Mental Health Gap Action Programme (mhGAP).Two randomised controlled trials, separately for depression and AUD, were carried out. Participants were randomly allocated (1:1) to mental healthcare delivered by mhGAP-trained primary care workers (psychoeducation and psychotropic medicines when indicated), or the same services plus individual psychological treatments (Healthy Activity Program for depression and Counselling
Effects of Light Therapy on Mood and Insulin Sensitivity in Patients With Type 2 Diabetes and Depression: Results From a Randomized Placebo-Controlled Trial Depression is common in patients with type 2 diabetes and adversely affects quality of life and diabetes outcomes. We assessed whether light therapy, an antidepressant, improves mood and insulin sensitivity in patients with depression and type 2 diabetes.This randomized, double-blind, placebo-controlled trial included 83 patients (...) with depression and type 2 diabetes. The intervention comprised 4 weeks of light therapy (10,000 lux) or placebo light therapy daily at home. Primary outcomes included depressive symptoms (Inventory of Depressive Symptomatology [IDS]) and insulin sensitivity (M-value derived from the results of a hyperinsulinemic-euglycemic clamp). Secondary outcomes were related psychological and glucometabolic measures.Intention-to-treat analysis showed that light therapy was not superior to placebo in reducing depressive
Bright light therapy for depression in Parkinson disease: A randomized controlled trial To assess the efficacy of bright light therapy (BLT) in reducing depressive symptoms in patients with Parkinson disease (PD) and major depressive disorder (MDD) compared to a control light.In this double-blind controlled trial, we randomized patients with PD and MDD to treatment with BLT (±10,000 lux) or a control light (±200 lux). Participants were treated for 3 months, followed by a 6-month naturalistic (...) follow-up. The primary outcome of the study was the Hamilton Depression Rating Scale (HDRS) score. Secondary outcomes were objective and subjective sleep measures and salivary melatonin and cortisol concentrations. Assessments were repeated halfway, at the end of treatment, and 1, 3, and 6 months after treatment. Data were analyzed with a linear mixed-model analysis.We enrolled 83 participants. HDRS scores decreased in both groups without a significant between-group difference at the end of treatment
Comparative Efficacy of Therapies for Treatment of Depression for Patients Undergoing Maintenance Hemodialysis: A Randomized Clinical Trial. Although depression is common among patients receiving maintenance hemodialysis, data on their acceptance of treatment and on the comparative efficacy of various therapies are limited.To determine the effect of an engagement interview on treatment acceptance (phase 1) and to compare the efficacy of cognitive behavioral therapy (CBT) versus sertraline (...) (phase 2) for treating depression in patients receiving hemodialysis.Multicenter, parallel-group, open-label, randomized controlled trial. (ClinicalTrials.gov: NCT02358343).41 dialysis facilities in 3 U.S. metropolitan areas.Patients who had been receiving hemodialysis for at least 3 months and had a Beck Depression Inventory-II score of 15 or greater; 184 patients participated in phase 1, and 120 subsequently participated in phase 2.Engagement interview versus control visit (phase 1) and 12 weeks
Management of perinatal depression with non-drug interventions. Perinatal depression is a common disorder that has been associated with serious risks to mother and child. Recently, screening for depression in pregnant and postpartum women has increased, as has the development of new psychotherapy and non-drug treatment modalities. Matching patients to treatments can be challenging, and although research into personalized treatment of major depression in the general population has increased (...) , no published guidelines focus on personalized treatment approaches to perinatal depression. In particular, guidelines on non-drug treatments are lacking. This review summarizes the evidence on personalized non-drug treatment of perinatal depression, how to incorporate patients' preferences, novel treatments under investigation, and the potential role of biomarkers in matching patients to treatment. The review provides recommendations for future research in personalized care of perinatal
Interventions to Prevent Perinatal Depression: US Preventive Services Task Force Recommendation Statement. Perinatal depression, which is the occurrence of a depressive disorder during pregnancy or following childbirth, affects as many as 1 in 7 women and is one of the most common complications of pregnancy and the postpartum period. It is well established that perinatal depression can result in adverse short- and long-term effects on both the woman and child.To issue a new US Preventive (...) Services Task Force (USPSTF) recommendation on interventions to prevent perinatal depression.The USPSTF reviewed the evidence on the benefits and harms of preventive interventions for perinatal depression in pregnant or postpartum women or their children. The USPSTF reviewed contextual information on the accuracy of tools used to identify women at increased risk of perinatal depression and the most effective timing for preventive interventions. Interventions reviewed included counseling, health system
Postnatal depression Postnatal depression - Symptoms, diagnosis and treatment | BMJ Best Practice You'll need a subscription to access all of BMJ Best Practice Search Postnatal depression Last reviewed: February 2019 Last updated: February 2019 Summary Refers to the development of a depressive illness following childbirth and may form part of a unipolar or, less frequently, a bipolar illness. The Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5) does not recognise (...) postnatal depression as a separate diagnosis; rather, patients must meet the criteria for a major depressive episode and the criteria for the perinatal-onset specifier. The definition according to DSM-5 is, therefore, a major depressive episode with an onset in pregnancy or within 4 weeks of delivery. However there is no established consensus as to the length of postnatal period, and some authorities define postnatal depression as occurring within the first 12 months after delivery. Aetiology is poorly
Efficacy of Internet-Delivered Mindfulness for Improving Depression in Caregivers of People With Spinal Cord Injuries and Chronic Neuropathic Pain: A Randomized Controlled Feasibility Trial To explore the feasibility and efficacy of web-based mindfulness training for carers of people with spinal cord injury (SCI).Randomized controlled feasibility study with 3-month follow-up.Community setting.Spouses or family caregivers (N=55) of people with SCI and chronic neuropathic pain were recruited via (...) , totaling 960 minutes. The control group received a weekly e-mail with psychoeducational materials (based on the established elements) on SCI and pain for 8 weeks.Depression severity.Mindfulness reduced depression severity more than psychoeducation at T2 (mean difference= -.891; 95% confidence interval,-1.48 to -.30) and T3 (mean difference=-1.96; 95% confidence interval, -2.94 to -.97). Mindfulness training also reduced anxiety at T2 (mean difference=-.888; 95% confidence interval, -1.40 to -.38
Patient-controlled intravenous tramadol versus patient-controlled intravenous hydromorphone for analgesia after secondary cesarean delivery: a randomized controlled trial to compare analgesic, anti-anxiety and anti-depression effects This study aimed to compare the postoperative analgesic effects of tramadol and hydromorphone for secondary cesarean delivery (CD) as well as their anti-anxiety and anti-depression properties.A total of 106 patients receiving secondary CD under spinal anesthesia (...) were randomly allocated to the tramadol group (n=53) and the hydromorphone group (n=53). Each group received patient-controlled intravenous analgesia using flurbiprofen 4 mg/kg combined with tramadol (4 mg/kg) or hydromorphone (0.04 mg/kg) immediately after the surgery. Postoperative pain numerical rating scale (NRS) for incision and visceral pain, hospital anxiety and depression scale (HADS), early walking time and length of hospital stay were assessed.Patients in the tramadol and hydromorphone
Effects of Sahaj Samadhi meditation on heart rate variability and depressive symptoms in patients with late-life depression Late-life depression (LLD) is a disabling disorder and antidepressants are ineffective in as many as 60% of cases. Converging evidence shows a strong correlation between LLD and subsequent risk of cardiovascular disease. There is a need for new, well-tolerated, non-pharmacological augmentation interventions that can treat depressive symptoms as well as improve heart rate (...) variability (HRV), an important prognostic marker for development of subsequent cardiovascular disease. Meditation-based techniques are of interest based on positive findings in other samples.AimsWe aimed to assess the efficacy of Sahaj Samadhi meditation (SSM), an underevaluated, standardised and manualised meditation intervention, on HRV and depressive symptoms.Eighty-three men and women aged 60-85 years, with mild to moderate depression and receiving treatment as usual (TAU) were randomised to either
Standardized Library of Depression Outcome Measures Standardized Library of Depression Outcome Measures | Effective Health Care Program Search Effective Health Care website Submit search Toggle navigation Select site to search Search Effective Health Care website Submit search Standardized Library of Depression Outcome Measures Michelle B. Leavy, M.P.H. Fang Li, MD, M.S. * OM1 On behalf of the Outcome Measures Framework (OMF) Depression Workgroup. Abstract Significant variation exists in both (...) conditions; it is intended to serve as a content model for developing harmonized outcome measures for specific clinical areas. AHRQ assessed the feasibility of using the OMF to develop standardized libraries of outcome measures in five clinical areas: atrial fibrillation, asthma, depression, lung cancer, and lumbar spondylolisthesis. These clinical areas represent diverse populations and care settings, different treatment modalities, and varying levels of harmonization. For each clinical area
Efficacy of Regular Exercise During Pregnancy on the Prevention of Postpartum Depression: The PAMELA Randomized Clinical Trial Interventions to reduce postpartum depression have mainly focused on enhancing screening to increase treatment rates among women. Preventive approaches are timely from a population health perspective, particularly in low- and middle-income countries where access to mental health services is limited.To assess the efficacy of regular exercise during pregnancy (...) via computer-generated randomization using a block size of 9. Data were analyzed from March 7 to May 2, 2018.Participants assigned to the intervention were engaged in a 16-week supervised exercise program including aerobic and resistance training delivered in 60-minute sessions 3 times per week.Postpartum depressive symptoms were assessed with the Edinburgh Postnatal Depression Scale 3 months after birth. A score of 12 or greater was defined as screening positive for postpartum depression. Primary
The depressing evidence for antidepressants in the elderly Tools for Practice is proudly sponsored by the Alberta College of Family Physicians (ACFP). ACFP is a provincial, professional voluntary organization, representing more than 5,000 family physicians, family medicine residents, and medical students in Alberta. Established over sixty years ago, the ACFP strives for excellence in family practice through advocacy, continuing medical education and primary care research. www.acfp.ca February 4 (...) , 2019 The depressing evidence for antidepressants in the elderly Clinical Question: How effective are antidepressants for treating depression in the elderly? Bottom Line: The efficacy of antidepressants in the elderly is inconsistent and may decrease as patients age. From 80% to 40% of elderly patients will recover with antidepressants, with some studies showing no difference from placebo response rates. Harms of antidepressants are common, with ~20% stopping due to adverse effects. Evidence: • 5
Management of Major Depressive Disorder (2nd Ediiton) MOH/P/PAK/423.19(GU)-e 2019 CLINICAL PRACTICE GUIDELINES 2019 MOH/P/PAK/423.19(GU)-e Management of Major Depressive Disorder (Second Edition) Published by: Malaysian Health Technology Assessment Section (MaHTAS) Medical Development Division, Ministry of Health Malaysia Level 4, Block E1, Precinct 1 Federal Government Administrative Centre 62590 Putrajaya, Malaysia Copyright The copyright owner of this publication is MaHTAS. Content may (...) OF INTENT These clinical practice guidelines (CPG) are meant to be guides for clinical practice, based on the best available evidence at the time of development. Adherence to these guidelines may not necessarily guar- antee the best outcome in every case. Every healthcare provider is responsible for the management of his/her unique patient based on the clinical picture presented by the patient and the management options available locally. Management of Major Depressive Disorder (Second Edition) UPDATING
A 24-week double-blind placebo-controlled study of the efficacy and safety of the AMPA modulator S47445 in patients with mild to moderate Alzheimer's disease and depressive symptoms. S47445 is a novel positive allosteric modulator of alpha-amino-3-hydroxy-5-methyl-4-isoxazole-propionic acid receptors that may emerge as a favorable candidate for the symptomatic treatment of cognitive and depressive disorders in patients suffering from Alzheimer's disease (AD) of mild to moderate severity (...) and with depressive symptoms.For this double-blind, placebo-controlled 24-week phase II trial, 520 outpatients aged between 55 and 85 years, with probable AD at mild to moderate stages (a Mini-Mental State Examination score of 24-15 inclusive) and exhibiting depressive symptoms (Cornell Scale for Depression in Dementia [CSDD] ≥ 8) were recruited in twelve countries and randomized to 3 doses of S47445 (5-15-50 mg) or placebo. The primary end point was the change from baseline in the 11-item Alzheimer's Disease
Refractory depression - cost-effectiveness of radically open dialectical behaviour therapy: findings of economic evaluation of RefraMED trial. Refractory depression is a major contributor to the economic burden of depression. Radically open dialectical behaviour therapy (RO DBT) is an unevaluated new treatment targeting overcontrolled personality, common in refractory depression, but it is not yet known whether the additional expense of RO DBT is good value for money.AimsTo estimate the cost (...) -effectiveness of RO DBT plus treatment as usual (TAU) compared with TAU alone in people with refractory depression (trial registration: ISRCTN85784627).We undertook a cost-effectiveness analysis alongside a randomised trial evaluating RO DBT plus TAU versus TAU alone for refractory depression in three UK secondary care centres. Our economic evaluation, 12 months after randomisation, adopted the perspective of the UK National Health Service (NHS) and personal social services. It evaluated cost-effectiveness
Stepped care programme in primary care to prevent anxiety and depression: a randomised clinical trial. 30792364 2019 11 20 1024-2708 25 Suppl 3 1 2019 Feb Hong Kong medical journal = Xianggang yi xue za zhi Hong Kong Med J Stepped care programme in primary care to prevent anxiety and depression: a randomised clinical trial. 9-10 Wong S Ys SY The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong. Tang W K WK Department of Psychiatry, Faculty of Medicine
The effect of group exercises on balance, mobility, and depressive symptoms in older adults with mild cognitive impairment: a randomized controlled trial To determine the effects of group exercises on balance, mobility, and depressive symptoms in community-dwelling older adults with mild cognitive impairment.Single blinded, randomized, matched pairs clinical trial.Four primary healthcare units.Fifty-two sedentary subjects with mild cognitive impairment were paired (age, sex, body mass index (...) , and Addenbrooke's Cognitive Examination Revised score), tested, and then randomized into an intervention group ( n = 26) and a control group ( n = 26).The intervention group performed strength (ankle weights, elastic bands, and dumbbells) and aerobic exercises (walking) in their communities' public spaces, twice a week (60 minutes each), during 24 weeks. The control group maintained its usual routine.Balance (Berg Balance Scale (BBS)), mobility (Timed Up and Go Test (TUG)), and depressive symptoms (Geriatric