33,34
A recent selleck kinase inhibitor meta-analysis of studies on prevention of PPD did not find clear evidence that preventive interventions during pregnancy may reduce the incidence of postpartum depression.27 This meta-analysis did not, however, focus on studies in which women who met diagnostic criteria for a depressive disorder were excluded at pretest, and in which the incidence of depression in treatment and control groups were established according to diagnostic criteria. In the earlier described meta-analysis, Inhibitors,research,lifescience,medical seven randomized controlled in which diagnostic instruments were used, could be included. These resulted in an incidence rate ratio of 0.65 (95% CI: 0.41~1.05; P<0.1). Another group of studies has focused on the prevention of depression in general medical disorders. Several groups of general medical patients have been examined in prevention studies, including adolescents with newly diagnosed epilepsy and subthreshold Inhibitors,research,lifescience,medical depression (but no major depressive disorder),35 older patients with neovascular macular degeneration,36 and stroke patients.37 Three studies have examined
the possibility of preventing depressive disorders in primary care.16,38,39 Most studies in this field used cognitive behavior therapy16,35,38 or problem-solving therapy as intervention.36,37 One of the studies Inhibitors,research,lifescience,medical in primary care used a stepped-care intervention.
Such stepped-care interventions Inhibitors,research,lifescience,medical are interesting because they seem to have larger effects than single interventions (with a reduction of the incidence of 50%),39 and because they devote most intervention time to those who need it most. In such a stepped-care approach, the first step is watchful waiting. This means that no specific intervention is conducted for 6 to 8 weeks, because many subclinical depressive symptoms recover Inhibitors,research,lifescience,medical spontaneously without intervention. In the second step, a guided self-help intervention is provided to patients. Guided self-help has been proven to be Carfilzomib effective in the reduction of depressive symptoms,40 and may be sufficient for some patients. If the guided self-help is not sufficient and patients continue to have depressive symptoms, a brief psychological intervention is provided, such as problem-solving therapy, or a brief cognitivebehavioral intervention. When this is not enough, patients are referred to specialized mental health care where they receive intensive treatment with antidepressant medication. Prevention of other mental disorders Although most research has examined the effect of prevention on the incidence of depressive disorders, a growing number of studies has examined the possibilities of preventing the onset of anxiety disorders and psychotic disorders in high-risk populations.