Abstract:
BACKGROUND:Depressive illness in older people causes significant suffering and health service utilisation. Relapse and recurrence rates are high. OBJECTIVES:To examine the efficacy of antidepressants and psychological therapies in preventing the relapse and recurrence of depression in older people. SEARCH METHODS:Search of the Cochrane Depression, Anxiety and Neurosis Review Group's specialized register (the CCDANCTR) up to 22 June 2012. The CCDANCTR includes relevant randomised controlled trials from the following bibliographic databases: The Cochrane Library (all years), EMBASE, (1974 to date) MEDLINE (1950 to date) and PsycINFO (1967 to date). We handsearched relevant journals, contacted experts in the field and examined reference lists, conference proceedings and bibliographies. SELECTION CRITERIA:Both review authors independently selected studies. We included randomised controlled trials (RCTs) involving people aged 60 and over successfully treated for an episode of depression and randomised to receive continuation and maintenance treatment with antidepressants, psychological therapies, or combination. DATA COLLECTION AND ANALYSIS:Data were extracted independently by the two authors.The primary outcome was relapse/recurrence rate of depression (reaching a cut-off on any depression rating scale) at six-monthly intervals. Secondary outcomes included global impression of change, social functioning, and deaths. Meta-analysis was performed using risk ratio for dichotomous outcomes and mean differences (MD) for continuous outcomes, with 95% confidence intervals. MAIN RESULTS:Seven studies met the inclusion criteria (803 participants). Six compared antidepressant medication with placebo; two involved psychological therapies. There was marked heterogeneity between the studies.Comparing antidepressants with placebo, at six months follow-up there was no significant difference. At 12 months follow-up there was a statistically significant difference favouring antidepressants in reducing recurrence compared with placebo (three RCTs, N = 247, RR = 0.67, 95% CI 0.55 to 0.82; NNTB = five). At 24 months there was no significant difference for antidepressants overall, however, for the subgroup of tricyclic antidepressants there was significant benefit (three RCTs, N = 169, RR = 0.70, 95% CI 0.50 to 0.99; NNTB = five). At 36 months there was no significant difference for antidepressants overall. There was no difference in treatment acceptability or death rates between antidepressant and placebo.There was no significant difference between psychological treatment and antidepressant in recurrence rates at 12, 24, and 36 months (one RCT, N = 53) or between combination and antidepressant alone.Overall, the included studies were at low risk of bias. AUTHORS' CONCLUSIONS:The long-term benefits of continuing antidepressant medication in the prevention of recurrence of depression in older people are not clear and no firm treatment recommendations can be made on the basis of this review. Continuing antidepressant medication for 12 months appears to be helpful but this is based on only three small studies with relatively few participants using differing classes of antidepressants in clinically heterogeneous populations. Comparisons at other time points did not reach statistical significance. Data on psychological therapies and combined treatments are too limited to draw any conclusions.
journal_name
Cochrane Database Syst Revjournal_title
The Cochrane database of systematic reviewsauthors
Wilkinson P,Izmeth Zdoi
10.1002/14651858.CD006727.pub2subject
Has Abstractpub_date
2012-11-14 00:00:00pages
CD006727issn
1469-493Xjournal_volume
11pub_type
杂志文章,meta分析,评审abstract:BACKGROUND:The current COVID-19 pandemic has been identified as a possible trigger for increases in loneliness and social isolation among older people due to the restrictions on movement that many countries have put in place. Loneliness and social isolation are consistently identified as risk factors for poor mental an...
journal_title:The Cochrane database of systematic reviews
pub_type: 杂志文章,meta分析
doi:10.1002/14651858.CD013632
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journal_title:The Cochrane database of systematic reviews
pub_type: 杂志文章,meta分析,评审
doi:10.1002/14651858.CD006649.pub5
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abstract:BACKGROUND:Cervical priming before first-trimester surgical abortion is recommended in certain groups of women. Nitric oxide (NO) donors induce cervical ripening without uterine contractions, but the efficacy and side effects are of concern. OBJECTIVES:To evaluate efficacy, side effects and complications of NO donors ...
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doi:10.1002/14651858.CD007444.pub2
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journal_title:The Cochrane database of systematic reviews
pub_type: 杂志文章,meta分析,评审
doi:10.1002/14651858.CD011153.pub2
更新日期:2017-03-03 00:00:00
abstract:BACKGROUND:Various aspects of the clinical management of infantile esotropia (IE) are unclear - mainly, the most effective type of intervention and the age at intervention. OBJECTIVES:The objective of this review was to assess the effectiveness of various surgical and non-surgical interventions for IE and to determine...
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doi:10.1002/14651858.CD004917.pub2
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journal_title:The Cochrane database of systematic reviews
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doi:10.1002/14651858.CD007904.pub3
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journal_title:The Cochrane database of systematic reviews
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doi:10.1002/14651858.CD003195
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abstract:BACKGROUND:A giant retinal tear (GRT) is a full-thickness neurosensory retinal break extending for 90° or more in the presence of a posterior vitreous detachment. OBJECTIVES:To evaluate the effectiveness and safety of pars plana vitrectomy combined with scleral buckle versus pars plana vitrectomy alone for eyes with g...
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journal_title:The Cochrane database of systematic reviews
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doi:10.1002/14651858.CD000545.pub2
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更新日期:2016-09-09 00:00:00
abstract:BACKGROUND:Carnitine, a quaternary amino acid, plays an important role in the oxidation of long chain fatty acids. Both breast milk and infant formulas contain carnitine. However, it is not routinely provided in parenteral nutrition solutions. Non supplemented parenterally fed infants have very low tissue carnitine lev...
journal_title:The Cochrane database of systematic reviews
pub_type: 杂志文章,评审
doi:10.1002/14651858.CD000950
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journal_title:The Cochrane database of systematic reviews
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journal_title:The Cochrane database of systematic reviews
pub_type: 杂志文章,meta分析
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journal_title:The Cochrane database of systematic reviews
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journal_title:The Cochrane database of systematic reviews
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journal_title:The Cochrane database of systematic reviews
pub_type: 杂志文章,评审
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更新日期:2002-01-01 00:00:00
abstract:BACKGROUND:Bone metastases manifest through pain, which can arise even before the injury is radiologically detected. Pain occurs as a result of bone destruction and, as more destruction ensues, more pain can be experienced. Radiculopathies, plexopathies and shrinkage of spinal nerves due to tumour growth and fractures ...
journal_title:The Cochrane database of systematic reviews
pub_type: 杂志文章,评审
doi:10.1002/14651858.CD003347
更新日期:2003-01-01 00:00:00