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The articles we select for Evidence-Based Mental Health must pass two stages: first they must pass our basic validity criteria and then the editors assess each article for clinical relevance. A number of articles meet the inclusion criteria but are not abstracted due to lack of space. We will highlight the most interesting of these here and list the rest.
There is a broad consensus that children and adolescents can, and do, become depressed. However that consensus falls apart when it comes to treatment. Antidepressants are considered dangerous by some and essential by others. To add to that, selective publication of drug company data has undermined confidence in the available evidence—even the authors of clinical guidelines seem confused. Which is why the TADS (Treatment for Adolescents with Depression Study) findings are so important (see Evid Based Ment Health 2007;10:100–2): here they report on outcomes for fluoxetine, CBT or the two combined after 36 weeks of treatment (Arch Gen Psychiatry 2007;64:1132–44). All three interventions were effective but fluoxetine (with or without CBT) got the quicker response. Notably, adding CBT seemed to ameliorate the suicidal thinking associated with fluoxetine. So combined treatment may be best, but given the absence of a therapist in every clinic fluoxetine can, and should, be used.
Macular degeneration is rarely found in younger people but it is a prevalent disease of ageing and predictably leads to comorbid depression, with an incidence of about 30%. Rather than treating that depression, this RCT used problem-solving therapy as a preventive intervention in patients with recent visual loss (Arch Gen Psychiatry 2007;64:886–92). The good news was that compared to treatment as usual it worked with a 50% reduction in the rate of new episodes after two months (NNT = 9). The bad news: the intervention delayed rather …
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