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Antidepressant medication and interpersonal psychotherapy (IPT) are both recommended interventions in depression treatment guidelines based on literature reviews and meta-analyses. However, ‘conventional’ meta-analyses comparing their efficacy are limited by their reliance on reported study-level information and a narrow focus on depression outcome measures assessed at treatment completion. Individual participant data (IPD) meta-analysis, considered the gold standard in evidence synthesis, can improve the quality of the analyses when compared with conventional meta-analysis.
We describe the protocol for a systematic review and IPD meta-analysis comparing the efficacy of antidepressants and IPT for adult acute-phase depression across a range of outcome measures, including depressive symptom severity as well as functioning and well-being, at both post-treatment and follow-up (PROSPERO: CRD42020219891).
We will conduct a systematic literature search in PubMed, PsycINFO, Embase and the Cochrane Library to identify randomised clinical trials comparing antidepressants and IPT in the acute-phase treatment of adults with depression. We will invite the authors of these studies to share the participant-level data of their trials. One-stage IPD meta-analyses will be conducted using mixed-effects models to assess treatment effects at post-treatment and follow-up for all outcome measures that are assessed in at least two studies.
This will be the first IPD meta-analysis examining antidepressants versus IPT efficacy. This study has the potential to enhance our knowledge of depression treatment by comparing the short- and long-term effects of two widely used interventions across a range of outcome measures using state-of-the-art statistical techniques.
Premenstrual dysphoric disorder (PMDD) is defined in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) as the presence of at least 5 of 11 symptoms with at least one of the symptoms being depressed mood, anxiety, affective lability, or irritability. The other symptoms include decreased interest in usual activities, poor concentration, fatigue, increased appetite, change in sleep, a sense of being overwhelmed or out of control, and physical symptoms such as breast tenderness. The symptoms must be present in the luteal (premenstrual) phase of the menstrual cycle, must resolve during the first few days of menses, and must have been present for at least 1 year. The symptoms should be severe enough to disrupt social and role functioning. The DSM-IV PMDD criteria include the recommendation that women prospectively rate their symptoms daily for two menstrual cycles to confirm the timing of the symptoms and the absence of a chronic underlying Axis I disorder. Many studies have identified irritability as the most frequently reported premenstrual symptom. It has been proposed that women with PMDD may comprise two subsets; one with predominant depressive symptoms, and another with predominant irritability.
This chapter reviews the diagnostic issues, epidemiological variables, pathogenetic hypotheses and the treatment options available to treat premenstrual syndrome (PMS). Premenstrual dysphoric disorder (PMDD) is the diagnosis in the DSM-IV that describes the severest form of PMS in menstruating women. Epidemiological studies of women with PMS or PMDD examining age, menstrual cycle characteristics, socioeconomic variables, lifestyle variables or cognitive attributions fail to show a consistent association with PMS. Although the symptoms of PMS clearly vary with the phases of the menstrual cycle, studies of the hypothalamic-pituitary-gonadal (HPG) axis in women with PMS have not yet consistently shown a specific abnormality or a definite relationship with symptoms. Hormonal strategies for the treatment of PMS and PMDD have been fairly extensively studied. Positive efficacy is most impressive with selective serotonin reuptake inhibitors (SSRIs) and Gonadotropin-releasing hormone (GnRH) agonists, the former medications having the advantages of oral administration and fewer long-term health risks.
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