MH wk 7 Flashcards
according to NICE guidelines, the same treatments are offered to those with mild and sever depression. WHY?
because they differ in their order. e.g. guided self help would be offered first in mild depression, but last in severe
Treatment options are listed in order of recommended use, based on
the committee’s interpretation of their clinical and cost effectiveness and consideration of implementation factors.
what do meta analyses suggest ab pharmaceutical interventions in anxiety
Pharmacotherapies appear to effective at reducing symptoms of anxiety, however the size of the effects are mixed.
However, acceptability across active comparisons largely involved drugs with acceptability profiles worse than placebo.
e.g. in the long term, people failed to take their medication when compared to placebo
what do meta analyses suggest ab pharmaceutical interventions in depression
Cipriani et al (2018) meta-analysis (n = 522 RCTs; 116 477 patients)
Small effect (SMD = 0.30) favouring pharmacotherapy in comparison to placebo.
All active drugs were associated with higher withdrawal rates than placebo with ORs ranging between 1·64 and 4·44,
3 main limitations of paralogical therapies
- study design
- bias
- follow up
study design
While results are effective meta-analyses predominantly compare results to placebo or non intervention controls
bias as limitation
Studies are often completed by pharmaceutical companies.
follow up period as limitation
Slee et al (2019) noted that follow up period ranged from 4 to 26 weeks.
BUT spme ppl only acc benefit from drug trials after 6 months
Exercise based interventions uk guidelines
group exercise/increase any form of physical activity
evidence for exercise based interventions on anxiety
While evidence suggests that exercise may be effective for reducing symptoms of anxiety, although effect sizes are small (g = 0.3-0.4) (Aylett et al., 2018; Gordon et al., 2017)
evidence for exercise based interventions on depression
Evidence from systematic reviews and meta-analyses indicate that exercise is associated with a decrease in symptoms of depression and may be associated with large effects in patients with MDD (Heissel et al., 2023; Noetel et al., 2024; Schuch et al., 2016; Gordon et al., 2018).
what is the link between exercise intensity and reduction in sypotoms of depression
higher intensive may have greater effects
Network meta analysis
Can compare three or more interventions.
Combines both direct and indirect evidence across a network of studies.
Goes a step further. It can compare three or more interventions at once, even if not all of them have been directly compared in studies.
Effect of exercise for depression: A Network Meta-Analysis
Exercise had moderate effect on depression vs active control (both alone or in combination i.e., with CBT)
Mode
Most effective modalities were walking/jogging, yoga, strength training and dancing.
Walking/jogging were effective for both men and women.
Strength training was more effective for women.
Yoga was more effective for men.
Intensity
Benefits were proportional to exercise intensity. Exercise with greater intensity were associated with greater benefit
psyhological and drug therapy mixed Cujippers
for depression
combined had a greater response rate and remission rate
psyhological and drug therapy mixed Cujippers
for anxiety
lack of sufficient evidence
psyhological and drug therapy mixed Cujippers
for panic, OCD
See a greater response to treatment when combined
exercise + psychological intervention
what is used to study this
(cardiac rehabillitation)
after a cardiac event.
This involves
- exercise
-Education - stress management/relaxation
(1 in 3 have clinically signif anxiety and or depression)
cardiac rehabilitation.
what did Richards et al find
small reduction in anxiety small reduction in depression.
Found studies used multifaceted interventions (e.g. some relaxation, self-awareness…)
Pathway trial
compare cardiac rehabilitation alone vs combined with MCT therapy in reducing anxiety + depression.
found
significant difference after 4 months. MCT combo was better.
12 months:
slight increase in A n D lvls in combo, but still a lot lower than CR alone
deterioration
when MCT combined, the deterioration % cuts in half
implications of MCT + CR efficacy
improved MH outcomes
Group-MCT+CR improved patients mental health outcomes for 1 in 3 patients and halved the deterioration rate.
Increased access to psychological therapies
Group-MCT provided access to psychological support within CR where psychological support is minimal or unavailable.
Meets patients Needs.
Patients described engaging in chronic worry and rumination, and how current CR techniques felt superficial and difficult to apply in real life. MCT overcomes limitations with current psychological support in CR.
CardioActive
trial study (evaluate feasibility and acceptability of CR programme in children and young ppl with heart conditions)
