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Treatment for major depressive disorder pdf, sudden extreme fatigue third trimester - For Begninners

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Scielo Espana es una biblioteca virtual formada por una coleccion de revistas cientificas espanolas de ciencias de la salud seleccionadas de acuerdo a unos criterios de calidad preestablecidos. El proyecto contempla la aplicacion y desarrollo de una metodologia comun para la preparacion, almacenamiento, difusion y evaluacion de la literatura cientifica en formato electronico.
Comparative efficacy of cognitive therapy and pharmacotherapy in the treatment of depressed outpatients. Medications versus cognitive behavior therapy for severely depressed outpatients: meta-analysis of four randomized comparisons.
Treatment of major depression with psychotherapy or psychotherapy-pharmacotherapy combinations. Six-year outcome for cognitive behavioral treatment of residual symptoms in major depression. Systematic review of efficacy of cognitive behaviour therapies in childhood and adolescent depressive disorder. Several studies9-11 have shown that cognitive therapy is superior to no treatment or to placebo. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference.

Studies have shown that cognitive therapy is an effective treatment for depression and is comparable in effectiveness to antidepressants and interpersonal or psychodynamic therapy.
Although it is unclear who benefits most from cognitive therapy, motivated patients who have an internal locus of control and the capacity for introspection likely would benefit most.During cognitive therapy, the therapist helps the patient work through several steps. Two comprehensive meta-analyses11,13 showed that cognitive therapy is as effective as interpersonal or brief psychodynamic therapy in managing depression.
The combination of cognitive therapy and antidepressants has been shown to effectively manage severe or chronic depression.
CBT should be strongly considered as initial therapy for patients with severe or chronic depression or for adolescents. A meta-analysis12 of four studies, which included 169 patients with major depression, showed similar results for tricyclic antidepressants and CBT. Good evidence has shown that cognitive therapy reduces relapse rates in patients with depression, and some evidence has shown that cognitive therapy is effective for adolescents with depression. An important part of CBT for depression is scheduling pleasurable activities, especially with others, that usually give positive reinforcement. The evidence suggests that cognitive therapy is a valid alternative to antidepressants for patients with mild to moderate depression and possibly for patients with more severe depression.

Later evidence suggests that this combination may be more effective than either therapy alone for some patients. A meta-analysis17 that included six studies and 595 patients showed that patients with severe depression benefited from the combination of psychotherapy and pharmacotherapy.
However, only two trials studied CBT, and patients with less severe depression gained little from the combination.17 A more recent study18 of 681 patients with chronic major depression compared nefazodone (Serzone), CBT, and combination therapy. Two small studies20,21 of 40 patients with unipolar major depression and residual symptoms following antidepressant therapy showed that patients treated with CBT initially had fewer residual symptoms and fewer depressive episodes after six years compared with those treated with clinical therapy.A more recent, larger study19 randomized 158 patients who did not respond to adequate antidepressant therapy to receive cognitive therapy with clinical management or clinical management alone. A meta-analysis22 of six studies with 191 patients showed that CBT was significantly more effective than placebo or inactive interventions in managing adolescent depressive disorder (36 versus 62 percent, NNT = 4).

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