Depression: Howard L

Anderson IM, Ferrier IN, Baldwin RC, Cowen PJ, Howard L, Lewis G, Matthews K, McAllister-Williams RH, Peveler RC, Scott J, Tylee A. · Senior Lecturer and Honorary Consultant Psychiatrist, Neuroscience and Psychiatry Unit, University of Manchester, UK. · J Psychopharmacol. · Pubmed #18413657 No free full text.

Abstract: A revision of the 2000 British Association for Psychopharmacology evidence-based guidelines for treating depressive disorders with antidepressants was undertaken to incorporate new evidence and to update the recommendations where appropriate. A consensus meeting involving experts in depressive disorders and their management was held in May 2006. Key areas in treating depression were reviewed, and the strength of evidence and clinical implications were considered. The guidelines were drawn up after extensive feedback from participants and interested parties. A literature review is provided, which identifies the quality of evidence to inform the recommendations, the strength of which are based on the level of evidence. These guidelines cover the nature and detection of depressive disorders, acute treatment with antidepressant drugs, choice of drug versus alternative treatment, practical issues in prescribing and management, next-step treatment, relapse prevention, treatment of relapse, and stopping treatment.

Howard L. · Health Services Research Department, Institute of Psychiatry, London, UK. · Clin Evid. · Pubmed #16973070 No free full text.

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Howard L. · Health Services Research Department, Institute of Psychiatry, London, UK. · Clin Evid. · Pubmed #16620472 No free full text.

This publication has no abstract.

Howard L. · Health Services Research Department, Institute of Psychiatry, London, UK. · Clin Evid. · Pubmed #15865767 No free full text.

This publication has no abstract.

Howard L. · Health Services Research Department, Institute of Psychiatry, London, UK. · Clin Evid. · Pubmed #15652086 No free full text.

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Hoffbrand S, Howard L, Crawley H. · Department of Primary Care & Poulation Sciences, Royal Free & University College Medical School, University College London, Archway Campus, Holborn Union Building, Highgate Hill, London N19 3UA. · Cochrane Database Syst Rev. · Pubmed #11406023 No free full text.

Abstract: BACKGROUND: Postnatal depression is a common disorder, which can have profound short and long term effects on maternal morbidity, the new infant and the family as a whole. Social factors appear to be particularly important in the aetiology and prognosis of postnatal depression and treatment is often largely social support and psychological interventions. It is not known whether antidepressants are an effective and safe choice for treatment of this disorder. OBJECTIVES: To evaluate the effectiveness of different antidepressant drugs and compare their effectiveness with other forms of treatment. To assess any adverse effects of antidepressants in the mother or the nursing baby. SEARCH STRATEGY: The registers of clinical trials maintained and updated by the Cochrane Depression, Anxiety and Neurosis Group and the Cochrane Pregnancy and Childbirth Group were searched. Other databases (outlined below) were also searched and contacts were made with pharmaceutical companies and experts in the field. SELECTION CRITERIA: All trials were considered in which women with depression in the first six months postpartum were randomised to receive antidepressants alone or in combination with another treatment, or to receive any other treatment including placebo. DATA COLLECTION AND ANALYSIS: Data was extracted independently from the trial reports by the reviewers. Missing information was requested from investigators wherever possible. Data was sought to allow an "intention to treat" analysis. MAIN RESULTS: Only one trial could be included in this review, leaving most of the objectives of the review unfulfilled. Appleby et al (1997) reported that Fluoxetine was significantly more effective than placebo and, after an initial session of counselling, as effective as a full course of cognitive-behavioural counselling in the treatment of postnatal depression. There was no interaction between medication and counselling. REVIEWER'S CONCLUSIONS: Women with postnatal depression can be effectively treated with fluoxetine, which is as effective as a course of cognitive-behavioural counselling in the short-term. However, more trials with a longer follow-up period are needed to compare different antidepressants in the treatment of postnatal depression, and to compare antidepressant treatment with psychosocial interventions. This is an area that has been neglected despite the large public health impact described above.

Howard L, Wessely S, Leese M, Page L, McCrone P, Husain K, Tong J, Dowson A. · Health Services Research Department, Institute of Psychiatry, London SE5 8AF, UK. · J Neurol Neurosurg Psychiatry. · Pubmed #16227551 links to  free full text

Abstract: OBJECTIVES: Aims were to investigate (a) whether neuroimaging in patients with chronic daily headache reassures patients or fails to reassure them and/or worsens outcome, impacting on service use, costs, health anxieties, and symptoms, and (b) whether this reassurance process occurs differentially in patients with different levels of psychological morbidity. METHODS: Design: randomised controlled trial; setting: headache clinic in secondary care, South London; participants: 150 patients fulfilling criteria for chronic daily headache, stratified using the Hospital Anxiety and Depression Scale (HADS); intervention: treatment as usual or the offer of an MRI brain scan; main outcome measures: use of services, costs, and health anxiety. RESULTS: Seventy six patients were randomised to the offer of a brain scan and 74 patients to treatment as usual. One hundred and thirty seven (91%) primary care case notes were examined at 1 year, 103 (69%) patients completed questionnaires at 3 months and 96 (64%) at 1 year. Sixty six (44%) patients were HADS positive (scored >11 on either subscale). Patients offered a scan were less worried about a serious cause of the headaches at 3 months (p = 0.004), but this was not maintained at 1 year; other health anxiety measures did not differ by scan status. However, at 1 year HADS positive patients offered a scan cost significantly less, by 465 pounds Sterling (95% confidence interval (CI): -1028 pounds Sterling to -104 pounds Sterling), than such patients not offered a scan, due to lower utilisation of medical resources. CONCLUSIONS: Neuroimaging significantly reduces costs for patients with high levels of psychiatric morbidity, possibly by changing subsequent referral patterns of the general practitioner.

Smith CE, Curtas S, Werkowitch M, Kleinbeck SV, Howard L. · School of Nursing, University of Kansas Medical Center, Kansas City 66160, USA. · JPEN J Parenter Enteral Nutr. · Pubmed #12005455 No free full text.

Abstract: BACKGROUND: For patients receiving home parenteral nutrition (HPN), catheter-related bloodstream infection (CRBSI) and reactive depression may significantly impact quality-of-life. This study evaluated the influence of patient affiliation with a national organization promoting HPN education and peer support on these outcome variables. METHODS: Using a case-control design, we compared 2 groups of affiliated patients with nonaffiliated controls, who were matched for diagnosis, HPN duration, sex, and age. Group 1 data were obtained from patients in large HPN medical practice programs. Group 2 data were obtained from patients in small medical practices with a small number of HPN patients. All participants were evaluated by structured interviews every 6 months over 18 months. RESULTS: In both data collection groups, affiliated patients (A) had significantly higher (mean +/- SD) quality-of-life scores compared with nonaffiliated patients (NA): (Gr 1: A, 19.8 +/- 4.7 versus NA, 17.6 +/- 5.6, p = .05; Gr 2: A, 20.4 +/- 5.2 versus NA, 17.3 +/- 4.8, p = .05). Affiliated patients also had lower depression scores (Gr 1: A, 10.9 +/- 10.4 versus NA, 20.4 +/- 13.6, p = .01; Gr 2: A, 12.5 +/- 9.6 versus NA, 18.5 +/- 10.8, p = .03) and a lower incidence of catheter-related infections (Gr 1: A, 0.10 +/- 0.3 versus NA, 0.60 +/- 0.55, p = .01; Gr 2: A, 0.27 +/- 0.55 versus NA, 0.71 +/- 0.64, p = .02) than nonaffiliated patients. CONCLUSIONS: Affiliation with an organization that provides ongoing HPN education and peer support was associated with significantly better HPN outcomes. Alternative explanations are discussed in relation to limitations of the case-control design.

Hoffbrand S, Howard L, Crawley H. · No affiliation provided · Nurs Times. · Pubmed #11966146 No free full text.

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Alger SA, Malone M, Cerulli J, Fein S, Howard L. · Division of Clinical Nutrition, Albany Medical College and Albany College of Pharmacy, NY 12208, USA. · Obes Res. · Pubmed #10509604 No free full text.

Abstract: OBJECTIVE: The purpose of this study was to compare the impact of drug therapy on weight loss, Beck Depression Inventory (BDI) scores, and binge eating patterns (BES) between obese binge eaters and non-binge eaters. RESEARCH METHODS AND PROCEDURES: 22 severe binge eaters, 17 moderate binge eaters, and 16 non-binge eaters received phentermine resin 15mg/day and dl-fenfluramine 20mg three times daily over a 6 month period for weight loss. All data are reported as mean+/-S. RESULTS: The percent weight loss compared to baseline within the 3 groups ranged from 8.9% to 11.3% at 3 months and 10.6% to 14.9% at 6 months. After 6 months, 73% of the severe binge eaters, 59% of moderate binge eaters and 69% of non-binge eaters had experienced more than 10% weight loss. BDI scores were significantly higher in the severe group at baseline when compared to non-binge eaters (p<0.006). After 3 and 6 months BDI scores improved in all groups but remained significantly different between the severe and non-binge eaters until the 6-month assessment. BES scores declined in all groups over the 6-month period. Echocardiograms were performed in 35 of 55 subjects following reports of a possible association between fenfluramine and valvular changes. Fifteen (43%) of subjects had no abnormal findings and 20 (57%) had evidence of valvular insufficiency occurring in one or more valves. Seven patients (20%) had significant valve damage according to the DHHS and FDA criteria. CONCLUSION: After 24 weeks of treatment severe binge eaters improved their eating pattern, depression scores, and achieved weight loss similar to non-binge eaters. These data suggest that pharmacologic intervention for weight loss and subsequent weight maintenance can be as successful in binge eaters as non-binge eaters. A relationship was seen between duration of drug treatment and valvular insufficiency in subjects treated for an average of 52 weeks. These findings validate the FDA requirement for studies of at least 1 year duration to evaluate both the safety and efficacy of pharmacologic treatment for obesity.