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Persisting symptoms after treatment for major depressive disorder (MDD) contribute to ongoing impairment and relapse risk. Whether cognitive behavior therapy (CBT) or antidepressant medications result in different profiles of residual symptoms after treatment is largely unknown.
Three hundred fifteen adults with MDD randomized to treatment with either CBT or antidepressant medication in the Predictors of Remission in Depression to Individual and Combined Treatments (PReDICT) study were analyzed for the frequency of residual symptoms using the Montgomery Asberg Depression Rating Scale (MADRS) item scores at the end of the 12-week treatment period. Separate comparisons were made for treatment responders and non-responders.
Among treatment completers (n = 250) who responded to CBT or antidepressant medication, there were no significant differences in the persistence of residual MADRS symptoms. However, non-responders treated with medication were significantly less likely to endorse suicidal ideation (SI) at week 12 compared with those treated with CBT (non-responders to medication: 0/54, 0%, non-responders to CBT: 8/30, 26.7%; p = .001). Among patients who terminated the trial early (n = 65), residual MADRS item scores did not significantly differ between the CBT- and medication-treated groups.
Depressed adults who respond to CBT or antidepressant medication have similar residual symptom profiles. Antidepressant medications reduce SI, even among patients for whom the medication provides little overall benefit.
Suicide rates continue to increase globally. The volume of research in this field has also expanded rapidly. In A Concise Guide to Understanding Suicide, leading researchers and clinicians provide a concise review of recent literature, report solutions achieved and give practical guidance for patient care to aid understanding and help prevent suicide. Each chapter is highly focused to provide pertinent information covering all major aspects of the field, from epidemiology and theories of causation through to treatment and prevention. This text will educate practising clinicians (psychologists, psychiatrists, nurses, counsellors, and emergency room personnel) and other health care workers and researchers, as well as providing a pathway for undergraduate and graduate students interested in furthering their understanding of the complexities surrounding suicide. Further, mental health professionals and those in the social sciences will be extremely interested in this monograph, as will the University community, armed forces and interested lay public.
This chapter delineates the developmental trauma disorder (DTD) diagnosis proposed by the National Child Traumatic Stress DSM-V Taskforce. The numerous clinical expressions of the damage resulting from childhood interpersonal trauma are currently relegated to a whole variety of seemingly unrelated comorbidities, such as conduct disorder, attention-deficit hyperactivity disorder (ADHD) and separation anxiety. The chapter discusses the effects of childhood interpersonal trauma on brain activity, self-awareness and social functioning. Several large-sample studies have examined the causal relationship between childhood interpersonal trauma and DTD symptoms. These studies have documented the correlations of age of first trauma exposure, trauma severity and duration of exposure with DTD symptoms. Contemporary neuroscience research suggests that effective treatment needs to involve learning to modulate arousal, learning to tolerate feelings and sensations by increasing the capacity for interoception and learning that, after confrontation with physical helplessness, it is essential to engage in taking effective action.