Journal of affective disorders
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Review Meta Analysis
ECT efficacy and treatment course: a systematic review and meta-analysis of twice vs thrice weekly schedules.
Electroconvulsive therapy (ECT) guidelines, across various regulatory bodies, lack consensus as to the optimal frequency of treatment for individual patients. Some authors postulate that twice weekly ECT may have a similar efficacy to thrice weekly, and may have a lower risk of adverse cognitive outcomes. We did a systematic review and a meta-analysis to assess the strength of associations between ECT frequency and depression scores, duration of treatment, number of ECTs, and remission rates. ⋯ Twice weekly ECT is associated with similar efficacy to thrice weekly ECT, may require fewer treatments and may be associated with longer treatment duration when compared to thrice weekly. These epidemiological observations support the routine use of twice weekly ECT in acute courses, though choice of frequency should take into account individual patient factors. These observations have implications for resource utilisation e.g. costs of duration of admission vs cost of provision of ECT, as well as issues of access to inpatient beds and anaesthetist time.
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There have been few studies that have attempted to examine the phenomenology of comorbid depression, in particular the diagnostic value of individual somatic and non-somatic symptoms when attempting to diagnose depression following cancer. ⋯ This research suggests that most somatic symptoms remain influential when diagnosing depression in the context of cancer and hence should not be omitted indiscriminately, even in palliative stages. The optimal symptoms for diagnosing depression will depend on whether a narrow concept of depression or a broad concept of depression is considered clinically important.
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Meta Analysis
Gray matter abnormalities in Major Depressive Disorder: a meta-analysis of voxel based morphometry studies.
Voxel-based morphometry (VBM) has been widely used to quantify structural brain changes associated with Major Depressive Disorder (MDD). While some consistent findings have been reported, individual studies have also varied with respect to the key brain regions affected by the illness, and how these abnormalities are related to patients' clinical characteristics. Here, we aimed to identify those brain regions that most consistently showed gray matter anomalies in MDD, and their clinical correlates, using meta-analytic techniques. ⋯ Gray matter reduction in rostral ACC was the most consistent finding in VBM studies of MDD. The evidence for reductions in other regions within fronto-subcortical and limbic regions was less consistent. The associations between these gray matter anomalies and clinical characteristics, particularly measures relating to illness duration, suggest that chronic MDD has a robust and deleterious, albeit spatially focal, effect on brain structure.