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  • Sertraline versus other antidepressive agents for depression.

    28 January 2018

    BACKGROUND: The National Institute for Health and Clinical Excellence clinical practice guideline on the treatment of depressive disorder recommended that selective serotonin reuptake inhibitors should be the first-line option when drug therapy is indicated for a depressive episode. Preliminary evidence suggested that sertraline might be slightly superior in terms of effectiveness. OBJECTIVES: To assess the evidence for the efficacy, acceptability and tolerability of sertraline in comparison with tricyclics (TCAs), heterocyclics, other SSRIs and newer agents in the acute-phase treatment of major depression. SEARCH STRATEGY: MEDLINE (1966 to 2008), EMBASE (1974 to 2008), the Cochrane Collaboration Depression, Anxiety and Neurosis Controlled Trials Register and the Cochrane Central Register of Controlled Trials up to July 2008. No language restriction was applied. Reference lists of relevant papers and previous systematic reviews were hand-searched. Pharmaceutical companies and experts in this field were contacted for supplemental data. SELECTION CRITERIA: Randomised controlled trials allocating patients with major depression to sertraline versus any other antidepressive agent. DATA COLLECTION AND ANALYSIS: Two review authors independently extracted data. Discrepancies were resolved with another member of the team. A double-entry procedure was employed by two reviewers. Information extracted included study characteristics, participant characteristics, intervention details and outcome measures in terms of efficacy (the number of patients who responded or remitted), acceptability (the number of patients who failed to complete the study) and tolerability (side-effects). MAIN RESULTS: A total of 59 studies, mostly of low quality, were included in the review, involving multiple treatment comparisons between sertraline and other antidepressant agents. Evidence favouring sertraline over some other antidepressants for the acute phase treatment of major depression was found, either in terms of efficacy (fluoxetine) or acceptability/tolerability (amitriptyline, imipramine, paroxetine and mirtazapine). However, some differences favouring newer antidepressants in terms of efficacy (mirtazapine) and acceptability (bupropion) were also found. In terms of individual side effects, sertraline was generally associated with a higher rate of participants experiencing diarrhoea. AUTHORS' CONCLUSIONS: This systematic review and meta-analysis highlighted a trend in favour of sertraline over other antidepressive agents both in terms of efficacy and acceptability, using 95% confidence intervals and a conservative approach, with a random effects analysis. However, the included studies did not report on all the outcomes that were pre-specified in the protocol of this review. Outcomes of clear relevance to patients and clinicians were not reported in any of the included studies.

  • The cardiovascular effect of incretin-based therapies among type 2 diabetes: a systematic review and network meta-analysis.

    13 March 2018

    OBJECTIVE: To evaluate the comparative cardiovascular safety of incretin-based therapies in patients with type 2 diabetes mellitus (T2DM). METHODS: Medline, Embase, the Cochrane Library and were searched for randomized controlled trials (RCTs) with duration≥12 weeks. Network meta-analysis was performed, followed by subgroup analysis and meta-regression. The Grading of Recommendations Assessment, Development and Evaluation system was used to assess the quality of evidence. The outcome of interest was a composite of cardiovascular death, myocardial infarction, stroke and heart failure. Odds ratio (OR) with 95% confidence interval (CI) was calculated as the measure of effect size. RESULTS: 281 RCTs (76.9% double-blinded) with 180,000 patients were included, comparing incretin-based therapies with other six classes of anti-diabetic drugs or placebo. A statistically significant reduction in the risk of cardiovascular events was found in favour of GLP-1RAs when compared with placebo (OR 0.89, 95%CI: 0.80-0.99) and sulfonylurea (OR 0.76, 95%CI: 0.59-0.99), whereas DPP-4 inhibitors showed a neutral effect compared with placebo (OR 0.92, 95%CI: 0.83-1.01). CONCLUSIONS: Incretin-based therapies show similar cardiovascular risk in comparison with metformin, insulin, thiazolidinediones, alpha-glucosidase inhibitor and sodium-glucose co-transporter 2. GLP-1RA could decrease the risk compared with sulfonylurea or placebo, while DPP-4I appears to have neutral effect on cardiovascular risk.

  • Comparative efficacy and tolerability of new-generation antidepressants for major depressive disorder in children and adolescents: protocol of an individual patient data meta-analysis.

    12 March 2018

    INTRODUCTION: Although previous conventional meta-analyses and network meta-analyses have provided some important findings about pharmacological treatments for children and adolescents with depressive disorders in the past decades, several questions still remain unsolved by the aggregate data from those meta-analyses. Individual participant data meta-analysis (IPD-MA) enables exploration of the impacts of individual characteristics on treatment effects, allowing matching of treatments to specific subgroups of patients. We will perform an IPD-MA to assess the efficacy and tolerability of new-generation antidepressants for major depressive disorder in children and adolescents. METHODS AND ANALYSIS: We will systematically search for all double-blind randomised controlled trials (RCTs) that have compared any new-generation antidepressant with placebo for the acute treatment of major depressive disorder in children and adolescents, in the following databases: PubMed, EMBASE, the Cochrane Library, PsycINFO, Web of Science, CINAHL, LILACS and ProQuest Dissertations. We will contact all corresponding authors of included RCTs and ask for their cooperation in this project by providing individual participant data from the original trials. The primary outcomes will include efficacy, measured as the mean change of depression symptoms by Children's Depression Rating Scale Revised (CDRS-R), and tolerability, measured as the proportion of patients who withdrew from the trials early due to adverse effects. The secondary outcomes will include response rates, remission rates, deterioration rate, all-cause discontinuation, suicidal-related outcomes and global functioning outcome. Using the raw de-identified study data, we will use mixed-effects logistic and linear regression models to perform the IPD-MAs. The risk of bias of included studies will be assessed using the Cochrane risk of bias tool. We will also detect the publication bias and effects of non-participation of eligible studies. DISSEMINATION: Ethical approval is not required given that informed consent has already been obtained from the patients by the trial investigators before the included trials were conducted. This study may have considerable implications for practice and help improve patient care. PROSPERO REGISTRATION NUMBER: CRD42016051657.

  • Psychopathology as adaptive development along distinctive pathways.

    6 December 2017

    Contrary to the standard assumption that psychopathology stems from developmental immaturity (retardation, fixation, regression), people diagnosed with psychopathology typically develop along distinctive pathways in which they build complex, advanced skills. These pathways are based on adaptation to trauma, such as maltreatment, or to problems in affective-cognitive regulation, such as those in autism. They do not fit normative developmental frameworks. Research has characterized several types of distinctive pathways, especially those arising from maltreatment; they are marked by normal developmental complexity but distinctive affective-cognitive organization. In one study sexually abused depressed adolescent girls admitted for treatment in a mental hospital described themselves-in-relationships with age-appropriate, complex developmental levels equal to those of both nonabused depressed girls and other adolescents. At the same time, they showed a powerful negativity bias contrasting with the positivity biases of other girls. Many of them produced dramatic switches in affective-cognitive organization across assessments contrasting with the similar organization showed by other girls. In another study toddlers from maltreating families showed a consistent negativity bias in play and representations of interactions. We show how to portray these distinctive developmental pathways through the example of Hidden Family Violence, in which people dissociate their private violent world from their public, good-citizen world.

  • Prize for best scientific publication awarded to Prof. Alan Stein

    10 December 2013

    At the recent conference of the International Network for the Demographic Evaluation of Populations and Their Health (INDEPTH) my co-authors and I were awarded the prize for the best scientific publication over the past two years for our paper “Young children’s risk of dying before and after their mother’s death, a rural Southern African population - based surveillance study” (published in PLOS Medicine). This was a collaboration with the University of Witwatrsrand ( South Africa) and the University of Washington (USA).

  • The Gosling Fellowship

    27 February 2015

    Due to a generous gift from the Gosling Estate, the Royal College of Psychiatrists would like to award the sum of £5000 each to two Psychiatry trainees specifically for the purpose of enabling them to complete a research project in the area of Neuropsychiatry as part of their psychiatry training programme. The award can be used for anything that is directly needed for the research project, as justified in the application.

  • Depression linked to violent crime, study finds

    27 February 2015

    Wellcome Trust Senior Research Fellow Prof Seena Fazel said: "We wanted to determine whether there was an increased risk of violence in individuals with clinical depression, and without other factors which are known to contribute to this risk. "One important finding was that the vast majority of depressed persons were not convicted of violent crimes, and that the rates reported are below those for schizophrenia and bipolar disorder, and considerably lower than for alcohol or drug abuse. "There is considerable concern about self-harm and suicide in depression," he added. "We demonstrate that the rates of violent crime are at least as high, but they don't receive the same level of attention in clinical guidelines or mainstream clinical practice."

  • John Radcliffe Hospital’s Psychological Medicine Team awarded gold in the Trust's 'Team of the Year' category

    10 December 2014

    Trust lead for psychological medicine Michael Sharpe, who nominated the team, said it deserved recognition after transforming the care of patients over the past year.

  • Dementias Platform UK launches unparalleled resource for research

    20 October 2015

    The Data Portal is a secure research environment, using the latest privacy preserving methods to provide researchers with high quality information and tools to facilitate collaborative research.

  • Seena Fazel comments on German Wings crash

    30 March 2015

    "It's not so much a mental illness problem – it's young men who feel socially excluded, angry and disaffected," he said, although he noted that he couldn't say whether this was true in the case of the Germanwings co-pilot.

  • Mindfulness meditation adapted for South Asian city life

    10 June 2013

    Professor Mark Williams, director of the Oxford Mindfulness Centre at Oxford University, is among the growing number of academics and scientists who have dedicated their careers to unlocking the potential of mindfulness meditation, a Western, non-sectarian form of meditation based on Buddhist practices.

  • BMA Margaret Temple Award 2013 for Dr Anthony James and colleagues

    21 May 2013

    Research to look at olfactory stem cells and induced pluripotential stem cells from skin fibroblasts of patients with adolescent-onset schizophrenia and matched healthy controls