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  • 1.
    Andersson, Gerhard
    et al.
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.
    Hesser, Hugo
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.
    Veilord, Andrea
    Linköping University, Department of Medical and Health Sciences. Linköping University, Faculty of Health Sciences.
    Svedling, Linn
    Linköping University, Department of Behavioural Sciences and Learning. Linköping University, Faculty of Arts and Sciences.
    Andersson, Fredrik
    Linköping University, Department of Behavioural Sciences and Learning. Linköping University, Faculty of Arts and Sciences.
    Sleman, Owe
    Linköping University, Department of Behavioural Sciences and Learning. Linköping University, Faculty of Arts and Sciences.
    Mauritzson, Lena
    Linköping University, Department of Behavioural Sciences and Learning. Linköping University, Faculty of Arts and Sciences.
    Sarkohi, Ali
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.
    Claesson, Elisabet
    Linköping University, Department of Behavioural Sciences and Learning. Linköping University, Faculty of Arts and Sciences.
    Zetterqvist, Vendela
    Linköping University, Department of Behavioural Sciences and Learning. Linköping University, Faculty of Arts and Sciences.
    Lamminen, Mailen
    Redakliniken, Linkoping, Sweden .
    Eriksson, Thomas
    Redakliniken, Linkoping, Sweden .
    Carlbring, Per
    Stockholm University, Sweden .
    Randomised controlled non-inferiority trial with 3-year follow-up of internet-delivered versus face-to-face group cognitive behavioural therapy for depression2013In: Journal of Affective Disorders, ISSN 0165-0327, E-ISSN 1573-2517, Vol. 151, no 3, p. 986-994Article in journal (Refereed)
    Abstract [en]

    Background: Guided internet-delivered cognitive behaviour therapy (ICBT) has been found to be effective in the treatment of mild to moderate depression, but there have been no direct comparisons with the more established group-based CBT with a long-term follow-up. less thanbrgreater than less thanbrgreater thanMethod: Participants with mild to moderate depression were recruited from the general population and randomized to either guided ICBT (n =33) or to live group treatment (n=36). Measures were completed before and after the intervention to assess depression, anxiety, and quality of life. Follow-ups were conducted at one-year and three-year after the treatment had ended. Results: Data were analysed on an intention-to-treat basis using linear mixed-effects regression analysis. less thanbrgreater than less thanbrgreater thanResults on the self-rated version of the Montgomery-Asberg Depression Scale showed significant improvements in both groups across time indicating non-inferiority of guided ICBT, and there was even a tendency for the guided ICBT group to be superior to group-based CBT at three year follow-up. Within-group effect sizes for the ICBT condition at post treatment showed a Cohens d=1.46, with a similar large effect at 3-year follow-up, d=1.78. For the group CBT the corresponding within group effects were d =0.99 and d=1.34, respectively. less thanbrgreater than less thanbrgreater thanLimitations: The study was small with two active treatments and there was no placebo or credible control condition. less thanbrgreater than less thanbrgreater thanConclusions: Guided ICBT is at least as effective as group based CBT and long-term effects can be sustained up to 3 years after treatment.

  • 2.
    Carlbring, Per
    et al.
    Stockholm University, Sweden .
    Hagglund, Malin
    Umeå University, Sweden .
    Luthstrom, Anne
    Umeå University, Sweden .
    Dahlin, Mats
    Psykologpartners, Linkoping, Sweden .
    Kadowaki, Asa
    Psykologpartners, Linkoping, Sweden .
    Vernmark, Kristofer
    Psykologpartners, Linkoping, Sweden .
    Andersson, Gerhard
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.
    Internet-based behavioral activation and acceptance-based treatment for depression: A randomized controlled trial2013In: Journal of Affective Disorders, ISSN 0165-0327, E-ISSN 1573-2517, Vol. 148, no 2-3, p. 331-337Article in journal (Refereed)
    Abstract [en]

    Background: Internet-based cognitive behavior therapy for depression has been tested in several trials but there are no internet studies on behavioral activation (BA), and no studies on BA over the internet including components of acceptance and commitment therapy (ACT). The aim of this study was to develop and test the effects of internet-delivered BA combined with ACT against a waiting list control condition as a first test of the effects of treatment. less thanbrgreater than less thanbrgreater thanMethods: Selection took place with a computerized screening interview and a subsequent semi-structured telephone interview. A total of 80 individuals from the general public were randomized to one of two conditions. The treatment lasted for 8 weeks after which both groups were assessed. We also included a 3 month follow-up. The treatment included interactive elements online and a CD-ROM for mindfulness and acceptance exercises. In addition, written support and feedback was given by a therapist every week. less thanbrgreater than less thanbrgreater thanResults: Results at posttreatment showed a large between group effect size on the Beck Depression inventory II d = 0.98 (95%CI = 0.51-1.44). In the treated group 25% (10/40) reached remission defined as a BDI score andlt;= 10 vs. 5% (2/40) in the control group. Results on secondary measures were smaller. While few dropped out from the study (N = 2) at posttreatment, the average number of completed modules was M = 5.1 out of the seven modules. less thanbrgreater than less thanbrgreater thanLimitations: The study only included a waiting-list comparison and it is not possible to determine which treatment components were the most effective. less thanbrgreater than less thanbrgreater thanConclusions: We conclude that there is initial evidence that BA with components of ACT can be effective in reducing symptoms of depression.

  • 3.
    Cuijpers, Pim
    et al.
    VU University Amsterdam, The Netherlands.
    de Beurs, Derek P.
    VU University Amsterdam, The Netherlands.
    van Spijker, Bregje A. J.
    VU University Amsterdam, The Netherlands.
    Berking, Matthias
    Philipps-University Marburg, Germany.
    Andersson, Gerhard
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.
    Kerkhof, Ad J. F. M.
    VU University Amsterdam, The Netherlands.
    The effects of psychotherapy for adult depression on suicidality and hopelessness: a systematic review and meta-analysis2013In: Journal of Affective Disorders, ISSN 0165-0327, E-ISSN 1573-2517, Vol. 144, no 3, p. 183-190Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Although treatment guidelines suggest that suicidal patients with depression should be treated for depression with psychotherapy, it is not clear whether these psychological treatments actually reduce suicidal ideation or suicide risk.

    METHODS: We conducted a systematic review and meta-analysis of studies on psychotherapy for depression in which outcomes on suicidality were reported. We also focused on outcomes on hopelessness because this is strongly associated with suicidal behavior in depression.

    RESULTS: Thirteen studies (with 616 patients) were included, three of which examined the effects of psychotherapy for depression on suicidal ideation and suicide risk, and eleven on hopelessness. No studies were found with suicide attempts or completed suicides as the outcome variables. The effects on suicidal ideation and suicide risk were small (g=0.12; 95% CI: -0.20-0.44) and not statistically significant. A power calculation showed that these studies only had sufficient power to find an effect size of g=0.47. The effects on hopelessness were large (g=1.10; 95% CI: 0.72-1.48) and significant, although heterogeneity was very high. Furthermore, significant publication bias was found. After adjustment of publication bias the effect size was reduced to g=0.60.

    DISCUSSION: At this point, there is insufficient evidence for the assumption that suicidality in depressed patients can be reduced with psychotherapy for depression. Although psychotherapy of depression may have small positive effects on suicidality, available data suggest that psychotherapy for depression cannot be considered to be a sufficient treatment. The effects on hopelessness are probably higher.

  • 4.
    Cuijpers, Pim
    et al.
    Vrije University of Amsterdam, Netherlands .
    Huibers, Marcus
    Vrije University of Amsterdam, Netherlands .
    Daniel Ebert, David
    Leuphana University, Germany .
    Koole, Sander L.
    Vrije University of Amsterdam, Netherlands .
    Andersson, Gerhard
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.
    How much psychotherapy is needed to treat depression? A metaregression analysis2013In: Journal of Affective Disorders, ISSN 0165-0327, E-ISSN 1573-2517, Vol. 149, no 1-3, p. 1-13Article, review/survey (Refereed)
    Abstract [en]

    Background: Although psychotherapies are effective in the treatment of adult depression it is not clear how this treatment effect is related to amount, frequency and intensity of therapy. less thanbrgreater than less thanbrgreater thanMethods: To fill this gap in knowledge, the present metaregression analysis examined the association between the effects of psychotherapy for adult depression and several indicators of amount, frequency and intensity of therapy. The analysis included 70 studies (92 comparisons) with 5403 patients, in which individual psychotherapy was compared with a control group (e.g. waiting list, care-as-usual). less thanbrgreater than less thanbrgreater thanResults: There was only a small association between number of therapy sessions and effect size, and this association was no longer significant when the analysis adjusted for other characteristics of the studies. The multivariable analyses also found no significant association with the total contact time or duration of the therapy. However, there was a strong association between number of sessions per week and effect size. An increase from one to two sessions per week increased the effect size with g=0.45, while keeping the total number of treatment sessions constant. less thanbrgreater than less thanbrgreater thanDiscussion: More research is needed to establish the robustness of this finding. Based on these findings, it may be advisable to concentrate psychotherapy sessions within a brief time frame.

  • 5.
    Cuijpers, Pim
    et al.
    Vrije University of Amsterdam, Netherlands Vrije University of Amsterdam, Netherlands Vrije University of Amsterdam, Netherlands Leuphana University, Germany .
    Karyotaki, Eirini
    Vrije University of Amsterdam, Netherlands Vrije University of Amsterdam, Netherlands Vrije University of Amsterdam, Netherlands .
    Weitz, Erica
    Vrije University of Amsterdam, Netherlands Vrije University of Amsterdam, Netherlands Vrije University of Amsterdam, Netherlands .
    Andersson, Gerhard
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.
    Hollon, Steven D.
    Vanderbilt University, TN 37235 USA .
    van Straten, Annemieke
    Vrije University of Amsterdam, Netherlands Vrije University of Amsterdam, Netherlands Vrije University of Amsterdam, Netherlands .
    The effects of psychotherapies for major depression in adults on remission, recovery and improvement: A meta-analysis2014In: Journal of Affective Disorders, ISSN 0165-0327, E-ISSN 1573-2517, Vol. 159, p. 118-126Article, review/survey (Refereed)
    Abstract [en]

    Background: Standardised effect sizes have been criticized because they are difficult to interpret and offer little clinical information. This meta-analyses examine the extent of actual improvement, the absolute numbers of patients no longer meeting criteria for major depression, and absolute rates of response and remission. Methods: We conducted a meta-analysis of 92 studies with 181 conditions (134 psychotherapy and 47 control conditions) with 6937 patients meeting criteria for major depressive disorder. Within these conditions, we calculated the absolute number of patients no longer meeting criteria for major depression, rates of response and remission, and the absolute reduction on the BDI, BDI-II and HAM-D. Results: After treatment, 62% of patients no longer met criteria for MDD in the psychotherapy conditions. However, 43% of participants in the control conditions and 48% of people in the care-as-usual conditions no longer met criteria for MDD, suggesting that the additional value of psychotherapy compared to care-as-usual would be 14%. For response and remission, comparable results were found, with less than half of the patients meeting criteria for response and remission after psychotherapy. Additionally, a considerable proportion of response and remission was also found in control conditions. In the psychotherapy conditions, scores on the BDl were reduced by 13.42 points, 15.12 points on the BDI-II, and 10.28 points on the HAM-D. In the control conditions, these reductions were 4.56, 4.68, and 5.29. Discussion: Psychotherapy contributes to improvement in depressed patients, but improvement in control conditions is also considerable.

  • 6. Engström, Christer
    et al.
    Brändström, Sven
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Neuroscience and Locomotion, Psychiatry.
    Sigvardsson, Sören
    Cloninger, Robert
    Nylander, Per-Olof
    Bipolar disorder: I. Temperament and character2004In: Journal of Affective Disorders, ISSN 0165-0327, E-ISSN 1573-2517, Vol. 82, no 1, p. 131-134Article in journal (Refereed)
    Abstract [en]

    Background: The nature of the relationship between personality and bipolar affective disorders is an important but unanswered question. Methods: We have studied personality in bipolar patients by using the Temperament and Character Inventory (TCI). TCI were administered to 100 euthymic bipolar patients and 100 controls from the normal population. Results: Bipolar patients were significantly higher in harm avoidance (HA) and lower in reward dependence (RD), self-directedness (SD), and cooperativeness (CO) than controls. Bipolar patients are more fatigable, less sentimental, more independent, less purposeful, less resourceful, less empathic, less helpful, less pure-hearted, and have less impulse control than controls. Bipolar II patients are more impulsive, more fatigable, less resourceful, and have less impulse control than bipolar I patients. Limitations: Our results are limited to euthymic bipolar patients and cannot be generalized to affective disorders. Conclusions: Even when clinically euthymic on lithium maintenance, bipolar patients continue to have a characteristic cognitive deficit. This is in agreement with cognitive theories about cognitive deficits in depression that are regarded as important vulnerability factors in mood disorders.

  • 7.
    Hedman, Erik
    et al.
    Karolinska Institute, Sweden Karolinska Institute, Sweden Karolinska Institute, Sweden .
    Ljotsson, Brjann
    Karolinska Institute, Sweden Karolinska Institute, Sweden .
    Kaldo, Viktor
    Karolinska Institute, Sweden .
    Hesser, Hugo
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.
    El Alaoui, Samir
    Karolinska Institute, Sweden .
    Kraepelien, Martin
    Karolinska Institute, Sweden .
    Andersson, Evelyn
    Karolinska Institute, Sweden .
    Ruck, Christian
    Karolinska Institute, Sweden .
    Svanborg, Cecilia
    Karolinska Institute, Sweden .
    Andersson, Gerhard
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.
    Lindefors, Nils
    Karolinska Institute, Sweden .
    Effectiveness of Internet-based cognitive behaviour therapy for depression in routine psychiatric care2014In: Journal of Affective Disorders, ISSN 0165-0327, E-ISSN 1573-2517, Vol. 155, p. 49-58Article in journal (Refereed)
    Abstract [en]

    Background: Efficacy of guided Internet-based cognitive behaviour therapy (ICBT) for depression has been demonstrated in several randomised controlled trials. Knowledge on the effectiveness of the treatment, i.e. how it works when delivered within routine care, is however scarce. The aim of this study was to investigate the effectiveness of ICBT for depression. Methods: We conducted a cohort study investigating all patients (N =1203) who had received guided ICBT for depression between 2007 and 2013 in a routine care setting at an outpatient psychiatric clinic providing Internet-based treatment The primary outcome measure was the Montgomery Asberg Depression Rating Scale-Self rated (MADRS-S). Results: Patients made large improvements from pre-treatment assessments to post-treatment on the primary outcome (effect size d on the MADRS-S = 1.27, 99% CI, 1.14-1.39). Participants were significantly improved in terms of suicidal ideation and sleep difficulties improvements were sustained at 6-month follow-up. Limitations: Attrition was rather large at 6-month follow-up. However, additional data was collected through telephone interviews with dropouts and advanced statistical models indicated that missing data did not bias the findings. Conclusions: ICBT for depression can be highly effective when delivered within the context of routine psychiatric care. This study suggests that the effect sizes are at least as high when the treatment is delivered in routine psychiatric care by qualified staff as when delivered in a controlled trial setting.

  • 8.
    Karanti, Alina
    et al.
    University of Gothenburg, Sweden.
    Bobeck, Christian
    Linköping University, Department of Computer and Information Science, Statistics. Linköping University, The Institute of Technology.
    Osterman, Maja
    Linköping University, Department of Computer and Information Science, Statistics. Linköping University, The Institute of Technology.
    Kardell, Mathias
    University of Gothenburg, Sweden.
    Tidemalm, Dag
    Karolinska Institute, Sweden.
    Runeson, Bo
    Karolinska Institute, Sweden.
    Lichtenstein, Paul
    Karolinska Institute, Sweden.
    Landen, Mikael
    University of Gothenburg, Sweden; Karolinska Institute, Sweden.
    Gender differences in the treatment of patients with bipolar disorder: A study of 7354 patients2015In: Journal of Affective Disorders, ISSN 0165-0327, E-ISSN 1573-2517, Vol. 174, p. 303-309Article in journal (Refereed)
    Abstract [en]

    Background: Gender differences in treatment that are not supported by empirical evidence have been reported in several areas of medicine. Here, the aim was to evaluate potential gender differences in the treatment for bipolar disorder. Methods: Data was collected from the Swedish National Quality Assurance Register for bipolar disorder (BipolaR). Baseline registrations from the period 2004-2011 of 7354 patients were analyzed. Multiple logistic regression analysis was used to study the impact of gender on interventions. Results: Women were more often treated with antidepressants, lamotrigine, electroconvulsive therapy, benzodiazepines, and psychotherapy. Men were more often treated with lithium. There were no gender differences in treatment with mood stabilizers as a group, neuroleptics, or valproate. Subgroup analyses revealed that ECT was more common in women only in the bipolar l subgroup. Contrariwise, lamotrigine was more common in women only in the bipolar II subgroup. Limitations: As BipolaR contains data on outpatient treatment of persons with bipolar disorder in Sweden, it is unclear if these Findings translate to inpatient care and to outpatient treatment in other countries. Conclusions: Men and women with bipolar disorder receive different treatments in routine clinical settings in Sweden. Gender differences in level of functioning, bipolar subtype, or severity of bipolar disorder could not explain the higher prevalence of pharmacological treatment, electroconvulsive therapy, and psychotherapy in women. Our results suggest that clinicians treatment decisions are to some extent unduly influenced by patients gender. (C) 2014 Elsevier B.V. All rights reserved.

  • 9.
    Lilliecreutz, Caroline
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Gynecology and Obstetrics in Linköping.
    Sydsjö, Gunilla
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Gynecology and Obstetrics in Linköping.
    Josefsson, Ann
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Gynecology and Obstetrics in Linköping.
    Obstetric and perinatal outcomes among women with blood- and injection phobia during pregnancy2011In: Journal of Affective Disorders, ISSN 0165-0327, E-ISSN 1573-2517, Vol. 129, no 1-3, p. 289-295Article in journal (Refereed)
    Abstract [en]

    Backgroun: Little is known about how anxiety disorders affect pregnancy outcomes. Therefore we investigated the impact of one anxiety disorder, blood- and injection phobia, on obstetric and neonatal outcomes.

    Method: From a population-based prospectively collected cohort we compared an index group of 110 women with blood- and injection phobia with a control group of 220 women. Standardized medical records were used to collect data. Obstetric and neonatal outcomes e.g. elective cesarean, prematurity, and small for gestational age were used as the main outcome measures.

    Result: Women with blood- and injection phobia stated more often a fear of childbirth (p < 0.001) and were more frequently delivered by elective cesarean section (p = 0.032). The incidence of premature delivery (p = 0.028), neonatal morbidity (p = 0.001) and the risk of having a baby born small for gestational age (p = 0.009) was higher among women with blood- and injection phobia.

    Limitation: The medical records, from which all information is drawn, despite standardization, sometimes may lack some information. However, this dilemma exists in both groups.

    Conclusions: Women with an anxiety disorder such as blood- and injection phobia are at increased risk for adverse obstetric outcomes, premature delivery and for having a baby born with higher neonatal morbidity. It therefore seems important to identify and treat women with anxiety disorders without delay early during pregnancy in an effort to minimize risks of complications for the woman herself and the child.

  • 10.
    Mattisson, C
    et al.
    Lund University Hospital.
    Bogren, M
    Lund University Hospital.
    Nettelbladt, Per
    Lund University Hospital.
    Munk-Jorgensen, P
    Aarhus University Hospital.
    Bhugra, D
    David Goldberg Centre.
    First incidence depression in the Lundby Study: a comparison of the two time periods 1947-1972 and 1972 -1997.2005In: Journal of Affective Disorders, ISSN 0165-0327, E-ISSN 1573-2517, Vol. 87, no 2-3, p. 151-160Article in journal (Refereed)
  • 11.
    Nyström, Markus B T
    et al.
    Umeå University, Department of Psychology, Umeå University, SE-901 87 Umeå, Sweden.
    Stenling, Andreas
    Umeå University, Department of Psychology, Umeå University, SE-901 87 Umeå, Sweden.
    Sjöström, Emma
    Umeå University, Department of Psychology, Umeå University, SE-901 87 Umeå, Sweden.
    Neely, Gregory
    Umeå University, Department of Psychology, Umeå University, SE-901 87 Umeå, Sweden.
    Lindner, Philip
    Department of Psychology, Stockholm University, Sweden.
    Hassmén, Peter
    Umeå University, Department of Psychology, Umeå University, SE-901 87 Umeå, Sweden;School of Health and Human Sciences, Southern Cross University, Australia .
    Andersson, Gerhard
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences. Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
    Martell, Christopher
    Department of Psychology, University of Wisconsin, USA.
    Carlbring, Per
    Department of Psychology, Stockholm University, Sweden.
    Behavioral activation versus physical activity via the internet: A randomized controlled trial.2017In: Journal of Affective Disorders, ISSN 0165-0327, E-ISSN 1573-2517, Vol. 215, p. 85-93, article id S0165-0327(16)32224-8Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: A major problem today is that only about fifty percent of those affected by depression seeks help. One way to reach more sufferers would be by offering easily accessible internet based treatments. The purpose of this study was to compare/evaluate four therapist supported internet administered treatments.

    METHOD/RESULTS: Two hundred eighty six participants were included. The treatment period lasted twelve weeks, consisting of the following treatments: 1) physical activity without treatment rational, 2) physical activity with treatment rational, 3) behavioral activation without treatment rational and 4) behavioral activation with treatment rational. All groups (including a control-group) showed a significant decrease in depressive symptoms. When the treatment groups were pooled and compared to the control group, there were significant differences from pretest to posttest (Hedges gav treatment =1.01, control group =0.47). This held true also when each of the four treatment groups was compared to the control group, with one exception: Physical activity without treatment rationale.

    LIMITATIONS: The differences between how many modules the participants completed could indicate that there are other factors than the treatments that caused the symptom reduction, however, the dose-response analysis did not detect any significant differences on account of modules completed.

    CONCLUSIONS: The results support the positive effects of internet administered treatments for depression, and highlights the importance of psychoeducation, which tends to affect both the treatment outcome and the probability of remaining in treatment. These aspects need to be considered when developing and conducting new treatments for depression, since they would increase the likelihood of positive treatment outcomes.

  • 12.
    Popiolek, Katarzyna
    et al.
    Örebro University, Sweden.
    Brus, Ole
    Örebro University, Sweden.
    Elvin, Tove
    Örebro University, Sweden.
    Landen, Mikael
    Karolinska Institute, Sweden; Gothenburg University, Sweden.
    Lundberg, Johan
    Karolinska Institute, Sweden; Stockholm County Council, Sweden.
    Nordanskog, Pia
    Linköping University, Department of Clinical and Experimental Medicine, Center for Social and Affective Neuroscience. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Local Health Care Services in Central Östergötland, Department of Psychiatry.
    Nordenskjold, Axel
    Örebro University, Sweden.
    Rehospitalization and suicide following electroconvulsive therapy for bipolar depression-A population-based register study2018In: Journal of Affective Disorders, ISSN 0165-0327, E-ISSN 1573-2517, Vol. 226, p. 146-154Article in journal (Refereed)
    Abstract [en]

    Background: Electroconvulsive therapy (ECT) is effective in bipolar depression, but relapse is common. The aim of the study was (i) to identify prognostic factors (ii) and to determine the impact of pharmacological approaches on the risk for rehospitalization or suicide. Methods: This register study analyzed data from individuals treated with inpatient ECT for bipolar depression. Subjects were identified using the Swedish National Patient Register between 2011 and 2014 and the Swedish National Quality Register for ECT. Other national registers provided data on psychopharmacotherapy, socio-demographic factors, and causes of death. The endpoint was the composite of rehospitalization for any psychiatric disorder, suicide attempt or completed suicide (RoS). Cox regression was used to calculate hazard ratios in univariate and multivariate models. Results: Data from 1255 patients were analyzed. The mean period of follow-up was 346 days. A total of 29%, 41%, and 52% of patients reached RoS at 3, 6, and 12 months post-discharge. A history of multiple psychiatric admissions, lower age, and post-discharge treatment with antipsychotics or benzodiazepines was associated with RoS. Limitations: Indication bias may have affected the results. Conclusions: A history of multiple hospital admissions and lower age are key predictors of the composite of rehospitalization or suicide in patients treated with ECT for bipolar depression. Lithium might be effective. By contrast, antipsychotics and benzodiazepines were associated with increased risk, but possibly this finding was influenced by indication bias.

  • 13.
    Reis, Margareta
    et al.
    Linköping University, Department of Medicine and Care, Clinical Pharmacology. Linköping University, Faculty of Health Sciences.
    Åberg-Wistedt, Anna
    Karolinska Institute, Department of Psychiatry, Stockholm, Sweden.
    Ågren, Hans
    Karolinska Institute, Neurote Department, Division of Psychiatry, Huddinge, Sweden.
    Åkerblad, Ann-Charlotte
    Department of Neuroscience, Psychiatry, Uppsala University, Uppsala, Sweden.
    Bengtsson, Finn
    Linköping University, Department of Medicine and Care, Clinical Pharmacology. Linköping University, Faculty of Health Sciences.
    Compliance with SSRI medication during 6 months of treatment for major depression: an evaluation by determination of repeated serum drug concentrations2004In: Journal of Affective Disorders, ISSN 0165-0327, E-ISSN 1573-2517, Vol. 82, no 3, p. 443-446Article in journal (Refereed)
    Abstract [en]

    Background: A recent estimation in a psychiatric cohort showed numbers of noncompliance between 10% and 60%. Therapeutic drug monitoring (TDM) is one method assessing compliance by analysis of drug concentration in the blood.

    Method: During a 24-week phase IV clinical trial, five repeated serum samples of sertraline (SERT) and N-desmethylsertraline (DSERT), trough values in steady state, were collected per patient. Previous results show that the intraindividual variation over time of the ratio DSERT/SERT is low. Hence, we hypothesized that significant partial noncompliance could be scrutinized further by an assessment of the DSERT/SERT ratio. The main aim was to test the applicability of a novel type of TDM procedure based on repeated metabolite/parent compound ratio measurements.

    Result: 9.4% of the per-protocol population in the trial (n=96) were in either hidden total (n=4) or hidden partial (n=5) noncompliance. Only by using the novel TDM ratio screening method could a majority of these patients be identified.

  • 14.
    Rundgren, Sara
    et al.
    Orebro Univ, Sweden.
    Brus, Ole
    Orebro Univ, Sweden.
    Bave, Ullvi
    Karolinska Inst, Sweden; Stockholm Cty Council, Sweden.
    Landen, Mikael
    Karolinska Inst, Sweden; Gothenburg Univ, Sweden.
    Lundberg, Johan
    Karolinska Inst, Sweden; Stockholm Cty Council, Sweden.
    Nordanskog, Pia
    Linköping University, Center for Social and Affective Neuroscience (CSAN). Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Local Health Care Services in Central Östergötland, Department of Psychiatry.
    Nordenskjold, Axel
    Orebro Univ, Sweden.
    Improvement of postpartum depression and psychosis after electroconvulsive therapy: A population-based study with a matched comparison group2018In: Journal of Affective Disorders, ISSN 0165-0327, E-ISSN 1573-2517, Vol. 235, p. 258-264Article in journal (Refereed)
    Abstract [en]

    Introduction: Electroconvulsive therapy (ECT) is used to treat postpartum depression and psychosis based on clinical experience and small observational studies. Aims: The primary aim was to test the hypothesis that the response rate to ECT for depression and psychosis is higher during the postpartum period than outside this period. The secondary aim was to identify predictors of a response to ECT during the postpartum period. Materials and methods: Cases with postpartum depression and/or psychosis received ECT within 6 months of delivery. A matched comparison group with depression and/or psychosis (not within the postpartum period) was identified from the Swedish National Quality Register for ECT. The improvement 1 week after ECT was classified according to the Clinical Global Impressions Scale - Improvement scale (CGI-I) as responder (CGI-I score 1-2) or non-responder (CGI-I score 3-7). Results: 185 cases and 185 comparison group subjects were included (46% with psychosis in each groups). More cases (87.0%) than comparison group subjects (73.5%) responded to ECT (p = 0.001). Adjusted binary regression analysis revealed that more severe symptoms prior to treatment were the only statistically significant predictor of response. Limitations: There was no control group without ECT treatment. Conclusion: The response rate of those with postpartum depression and/or psychosis to ECT was high. The response rate of patients with psychosis or depression was higher during the postpartum period than outside it. This study supports the use of ECT for severe forms of postpartum depression and/or psychosis.

  • 15.
    Tham, Anne
    et al.
    Department of Clinical Neuroscience, Psychiatry Section, Karolinska Institutet, Stockholm, Sweden.
    Jonsson, Ulf
    Department of Clinical Neuroscience, Division of Insurance Medicine, Karolinska Institutet, Stockholm, Sweden; Department of Neuroscience, Child and Adolescent Psychiatry, Uppsala University, Uppsala, Sweden.
    Andersson, Gerhard
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences. Department of Clinical Neuroscience, Psychiatry Section, Karolinska Institutet, Stockholm, Sweden.
    Söderlund, Anne
    School of Health, Care and Social Welfare, Physiotherapy, Mälardalen University, Västerås, Sweden.
    Allard, Per
    Swedish Agency for Health Technology Assessment and Assessment of Social Services, Stockholm, Sweden.
    Bertilsson, Göran
    Swedish Agency for Health Technology Assessment and Assessment of Social Services, Stockholm, Sweden.
    Efficacy and tolerability of antidepressants in people aged 65 years or older with major depressive disorder - A systematic review and a meta-analysis.2016In: Journal of Affective Disorders, ISSN 0165-0327, E-ISSN 1573-2517, Vol. 205, p. 1-12Article, review/survey (Refereed)
    Abstract [en]

    BACKGROUND: There has been a steady increase in the prescription of antidepressants for the elderly. This study comprises a systematic review of randomized, placebo-controlled trials of antidepressants for treatment of depressive disorder in people aged 65 years or more.

    METHODS: PubMed, EMBASE, Cochrane Library, CINAL, and PsycINFO were searched until May 2016. Where appropriate, the results were synthesized in meta-analyses.

    RESULTS: Twelve trials met the inclusion criteria. For patients with major depressive disorder, selective serotonin re-uptake inhibitors (SSRI) were not superior to placebo in achieving remission (OR: 0.79, 95% CI: 0.61-1.03) or response (OR=0.86, 95% CI: 0.51-1.10) after 8 weeks of treatment (three trials). However, maintenance treatment with SSRIs was superior to placebo in preventing relapse (OR: 0.22, 95% CI: 0.13-0.36; NNT=5, 95% CI: 3-6; two trials). Duloxetine was superior to placebo in achieving remission (OR: 1.78, 95% CI: 1.20-2.65; NNT=9, 95% CI: 6-20; three trials) and response (OR: 1.83, 95% CI: 1.96-4.08; two trials) in recurrent major depression after 8 weeks, but increased the risk of adverse events that can be problematic in the elderly.

    LIMITATIONS: The quality of evidence was generally low or moderate, emphasizing the uncertainty of the results. Study populations only partly covered the heterogeneous population of elderly with depressed mood, limiting the generalizability.

    CONCLUSION: The results underscore the importance of close monitoring of the effects of antidepressants in treatment of elderly patients with a depressive disorder. Methods for early detection of non-responders and effective treatment options for this group are needed.

  • 16.
    Ventorp, F.
    et al.
    Lund University, Sweden; Michigan State University, MI USA.
    Barzilay, R.
    Tel Aviv University, Israel; Geha Mental Health Centre, Israel.
    Erhardt, S.
    Karolinska Institute, Sweden.
    Samuelsson, Martin
    Linköping University, Department of Clinical and Experimental Medicine, Division of Neuro and Inflammation Science. Region Östergötland, Local Health Care Services in Central Östergötland, Department of Psychiatry. Linköping University, Faculty of Medicine and Health Sciences.
    Traskman-Bendz, L.
    Lund University, Sweden.
    Janelidze, S.
    Lund University, Sweden.
    Weizman, A.
    Geha Mental Health Centre, Israel; Tel Aviv University, Israel.
    Offen, D.
    Tel Aviv University, Israel.
    Brundin, L.
    Lund University, Sweden; Michigan State University, MI USA; Van Andel Research Institute, MI USA.
    The CD44 ligand hyaluronic acid is elevated in the cerebrospinal fluid of suicide attempters and is associated with increased blood-brain barrier permeability2016In: Journal of Affective Disorders, ISSN 0165-0327, E-ISSN 1573-2517, Vol. 193, p. 349-354Article in journal (Refereed)
    Abstract [en]

    Background: The glycosaminoglycan hyaluronic acid (HA) is an important component of the extracellular matrix (ECM) in the brain. CD44 is a cell adhesion molecule that binds to HA in the ECM and is present on astrocytes, microglia and certain neurons. Cell adhesion molecules have been reported to be involved in anxiety and mood disorders. CD44 levels are decreased in the cerebrospinal fluid (CSF) of depressed individuals, and the CD44 gene has been identified in brain GWAS studies as a possible risk gene for suicidal behavior. Method: We measured the CSF levels of HA and the soluble CD44 (sCD44) in suicide attempters (n=94) and in healthy controls (n=45) using ELISA and electrochemiluminescence assays. We also investigated other proteins known to interact with CD44, such as osteopontin and the matrix metalloproteinases MMP1, MMP3 and MMP9. Results: The suicide attempters had higher CSF levels of HA (p=.003) and MMP9 (p=.004). The CSF levels of HA correlated with BBB-permeability (rho=0.410, p&lt;.001) and MMP9 correlated with sCD44 levels (rho=0.260, p=.005). Limitations: Other relevant biological contributors to suicidal behavior is not addressed in parallel to the specific role of CD44-HA signaling. The gender distribution of the patients from whom CSF was analyzed was uneven. Conclusions: Increased BBB-permeability and HA levels might be a results of increased neuroinflammation and can play a role in the pathobiology of suicidal behavior. The CD44 signaling pathway might be considered a novel target for intervention in mood disorders. (C) 2016 Elsevier B.V. All rights reserved.

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