Manejo del trastorno depresivo ¿Qué tratamiento elegir? / Management of depressive disorder. What treatment to choose?

Resumen A lo largo de la historia, el ser humano ha buscado mejorar y tratar las diferentes patologías mentales. Con los avances en investigación, actualmente hay una amplia variedad de opciones terapéuticas que pueden resultar un factor de confusión a la hora de escoger el tratamiento más adecuado para combatir el trastorno depresivo. Por tanto, en el presente trabajo se realiza una revisión de las principales opciones de tratamiento para la depresión con el fin de brindar pautas que mejoren la toma de decisiones al abordar esta patología.

Abstract Throughout history, the human being has sought to improve and treat different mental pathologies, with advances in research, currently there is a wide variety of therapeutic options that can be a confounding factor when choosing the most appropriate treatment. This paper reviews the main treatment options for depression in order to provide guidelines that improve decision-making when addressing this pathology.

Emotion regulation as the mediator of reductions in anxiety and depression in the Unified Protocol (UP) for transdiagnostic treatment of emotional disorders: double-blind randomized clinical trial / Regulação emocional como mediadora de reduções em ansiedade e depressão no Protocolo Unificado para o tratamento transdiagnóstico de transtornos psicológicos: ensaio clínico randomizado duplo-cego

Abstract Objective: An important subject in evaluation of the efficacy of treatments is to examine how the intervention is effective and to identify the consequences of that treatment. In this regard, the current study investigates the role of emotion regulation as the mediator of the treatment outcomes of therapy using the Unified Protocol (UP) for transdiagnostic treatment of emotional disorders. Method: This article describes a double-blind randomized clinical trial. A sample of 26 individuals was selected based on cut-off scores for the Beck Depression Inventory and Beck Anxiety Inventory and their final diagnoses were confirmed with the Anxiety Disorders Interview Schedule for DSM-IV (ADIS-IV). The sample was randomly divided into two groups: control and treatment (13 patients each). The treatment group received 20 one-hour UP sessions. The Beck Depression Inventory, the Beck Anxiety Inventory, and the Difficulties in Emotion Regulation Scale were administered at two stages, pre-treatment and post-treatment. Results: The UP reduced anxiety and depression in patients through improvement in emotion regulation. Furthermore, the results showed that the difficulty engaging in goal-directed behavior and non-acceptance of emotional response subscales were capable of predicting 62% of variance in anxiety scores. In turn, two subscales, difficulty engaging in goal-directed behavior and lack of emotional clarity, predicted 72% of variance in depression scores. Conclusion: Emotion regulation can be considered as a potential mediating factor and as predictive of outcomes of transdiagnostic treatment based on the UP. Clinical trial registration: Iranian Registry of Clinical Trials, IRCT2017072335245N1.

Resumo Objetivo: É importante, na avaliação da eficácia de tratamentos, examinar como a intervenção tem efeito e identificar suas consequências. O presente estudo investiga o papel da regulação emocional enquanto mediadora de desfechos do tratamento que emprega o Protocolo Unificado (PU) para o tratamento transdiagnóstico de transtornos psicológicos. Método: Este artigo descreve um ensaio clínico randomizado duplo-cego. Uma amostra de 26 indivíduos foi selecionada com base em escores pré-estabelecidos para o Inventário de Depressão de Beck e o Inventário de Ansiedade de Beck, e seus diagnósticos finais foram confirmados utilizando o instrumento Anxiety Disorders Interview Schedule for DSM-IV (ADIS-IV). A amostra foi dividida aleatoriamente em dois grupos: controle e tratamento (13 pacientes em cada). O grupo tratamento recebeu 20 sessões de PU de 1 hora cada. O Inventário de Depressão de Beck, Inventário de Ansiedade de Beck Beck e Escala de Dificuldades de Regulação Emocional foram administrados em duas etapas, antes e depois do tratamento. Resultados: O PU reduziu a ansiedade e a depressão em pacientes, ao melhorar a regulação emocional. Além disso, os resultados mostraram que as subescalas dificuldade de se engajar em comportamentos orientados por objetivos e não aceitação de resposta emocional responderam por 62% da variância nos escores de ansiedade. Nos escores de depressão, duas subescalas, dificuldade de se engajar em comportamentos orientados por objetivos e falta de claridade emocional, explicaram 72% da variância. Conclusão: A regulação emocional pode ser considerada o principal fator mediador e também preditora de desfechos do tratamento transdiagnóstico baseado no PU. Registro do ensaio clínico: Iranian Registry of Clinical Trials, IRCT2017072335245N1.

A newly designed intensive caregiver education program reduces cognitive impairment, anxiety, and depression in patients with acute ischemic stroke

This study aimed to evaluate the effect of a newly designed intensive caregiver education program (ICEP) on reducing cognitive impairment, anxiety, and depression in acute ischemic stroke (AIS) patients. One hundred and ninety-six AIS patients were divided into ICEP group and Control group in a 1:1 ratio using blocked randomization method. In the ICEP group, the caregivers received ICEP, while in the Control group caregivers received usual education and guidance. All patients received conventional rehabilitation treatment. Cognitive impairment (assessed by Mini Mental State Examination (MMSE) score and Montreal Cognitive Assessment (MoCA) score), anxiety (assessed by Hospital Anxiety and Depression Scale (HADS)-A score and Self-rating Anxiety Scale (SAS) score), and depression (assessed by HADS-D score and Self-rating Depression Scale (SDS) score) were assessed at baseline (M0), 3 months (M3), 6 months (M6), and 12 months (M12). Cognitive impairment score at M12 and cognitive impairment score change (M12-M0) were increased, while cognitive impairment rate at M12 was reduced in the ICEP group compared with the Control group. Anxiety score change (M12-M0), anxiety score at M12, and anxiety rate at M12 were decreased in the ICEP group compared with the Control group. Depression score change (M12-M0), depression score at M12, and depression rate at M12 were lower in the ICEP group compared with the Control group. Further subgroup analysis based on baseline features also provided similar results. In conclusion, ICEP effectively reduced cognitive impairment, anxiety, and depression in AIS patients.

Exposição ao aleitamento materno e transtornos mentais comuns na adolescência / Exposure to breastfeeding and common mental disorders in adolescence / Exposición a la lactancia materna y trastornos mentales comunes en la adolescencia

Resumo: O objetivo foi avaliar o efeito da exposição e do tempo de exposição ao aleitamento materno na ocorrência de transtornos mentais comuns (TMC) entre adolescentes escolares brasileiros. Este trabalho analisou dados do Estudo de Riscos Cardiovasculares em Adolescentes (ERICA), avaliando aqueles que tiveram o questionário referente ao aleitamento materno respondido pelos pais ou responsáveis. A presença de TMC foi identificada pelo General Health Questionnaire, versão 12 itens (GHQ-12), considerando-se dois pontos de corte (escores ≥ 3 e ≥ 5). As associações foram testadas em análises bivariadas e por meio de modelos de regressão logística múltipla, com ajustes por variáveis potenciais de confusão. Dentre os 41.723 adolescentes avaliados, a maioria foi composta por estudantes do sexo feminino (54,6%), que tinham idades entre 12 e 15 anos (71%), estudavam em escolas públicas (83,1%), residiam na Região Sudeste (51,9%) e eram das classes econômicas B (53,8%) e C (34,1%). Cerca de metade das mães dos adolescentes não tinha o ensino médio completo (51,7%). O grupo de adolescentes com mais de seis meses de aleitamento materno (51,8%) apresentou uma menor prevalência de TMC para os dois pontos de corte do GHQ-12 avaliados, quando comparado com o grupo que não recebeu aleitamento materno ou que o recebeu por período ≤ 1 mês (RI = 0,82; IC95%:0,69-0,97 e RI = 0,74; IC95%: 0,59-0,91 para 3 e 5 pontos, respectivamente). O aleitamento materno prolongado parece desempenhar um papel protetor para a ocorrência de TMC na adolescência.

Abstract: This article sought to evaluate the effect of exposure, and exposure time, to breastfeeding on the occurrence of common mental disorders (CMD) among Brazilian adolescents enrolled in school. This study analyzed data from the Study of Cardiovascular Risk in Adolescents (ERICA), evaluating those whose questionnaire regarding breastfeeding had been filled out by parents or guardians. The presence of CMD was identified using the General Health Questionnaire, version 12 items (GHQ-12), and we considered two cutoff points (scores ≥ 3 and ≥ 5). We tested the associations in bivariate analyses and through multiple logistical regression models, adjusting for potential confounding variables. Of the 41,723 adolescents we evaluated, most were students of the female sex (54.6%), aged between 12 and 15 years (71%), attended public schools (83.1%), resided in the Southeastern region (51.9%) and belonged to the economic classes B (53.8%) and C (34.1%). Around half of the adolescents' mothers had not completed their secondary education (51.7%). The group of adolescents who were breastfed for more than six months (51.8%) had a lower CMD prevalence for both GHQ-12 cutoff points, when compared with the group who were not breastfed or who were breastfed for ≤ 1 month (IR = 0.82; 95%CI: 0.69-0.97 and IR = 0.74; 95%CI: 0.59-0.91 for 3 and 5 points, respectively). Prolonged breastfeeding seems to play a protective role on the occurrence of CMD in adolescence.

Resumen: El objetivo fue evaluar el efecto de la exposición y del tiempo de exposición a la lactancia materna en la ocurrencia de trastornos mentales comunes (TMC) entre adolescentes escolares brasileñas. Este trabajo analizó datos del Estudio de Riesgos Cardiovasculares en Adolescentes (ERICA), evaluando aquellos, cuyo cuestionario -referente a la lactancia materna- había sido respondido por los padres o responsables legales. La presencia de TMC fue identificada por el General Health Questionnaire, versión 12 ítems (GHQ-12), considerándose dos puntos de corte (puntuaciones ≥ 3 y ≥ 5). Las asociaciones fueron probadas en análisis bivariados, y a través de modelos de regresión logística múltiple, con ajustes por variables potenciales de confusión. Entre los 41.723 adolescentes evaluados, la mayoría estuvo compuesta por estudiantes que eran del sexo femenino (54,6%), que tenían una edad entre 12 y 15 años (71%), estudiaban en escuelas públicas (83,1%), residían en la región Sudeste (51,9%) y eran de las clases económicas B (53,8%) y C (34,1%). Cerca de la mitad de las madres de los adolescentes no contaba con la enseñanza media completa (51,7%). El grupo de adolescentes con más de seis meses de lactancia materna (51,8%) presentó una menor prevalencia de TMC para los dos puntos de corte del GHQ-12 evaluados, cuando se comparan con el grupo que no recibió lactancia materna o que la recibió durante un período ≤ 1 mes (RI = 0,82; IC95%: 0,69-0,97 y RI = 0,74 y IC95%: 0,59-0,91 para 3 y 5 puntos, respectivamente). La lactancia materna prolongada parece desempeñar un papel protector para la ocurrencia de TMC en la adolescencia.

Protocolo del Sistema Nacional de Vigilancia Epidemiológica: enfermedades no transmitibles (ENT) diabetes, cardiovasculares y cáncer. No. 11 / Protocolo del Sistema Nacional de Vigilancia Epidemiológica: enfermedades no transmitibles (ENT) diabetes, cardiovasculares y cáncer. No. 11

Estos protocolos están dirigido a personal médico, paramédico y otros profesionales que realizan acciones gerenciales y operativas de vigilancia epidemiológica en los servicios de salud del país, y están divididos en varios tomos para dar a conocer y actualizar la identificación y medidas de control para diversos padecimientos a fin de continuar con el mejoramiento de las capacidades técnicas de los trabajadores de salud, que permita planificar la prestación de servicios con decisiones partiendo de un enfoque epidemiológico comprobado, para responder a los cambios de tendencias epidemiológicas y con ello contribuir al fortalecimiento de prácticas asertivas de la salud pública de nuestro país.

Sintomatología depresiva materna en México: prevalencia nacional, atención y perfiles poblacionales de riesgo / Maternal depressive symptomatology in México: National prevalence, care, and population risk profiles

Objetivo. Estimar la prevalencia de sintomatología depresiva (SD) en madres de menores de cinco años, tasas de detección y atención y probabilidades de presentar SD de acuerdo con perfiles de riesgo específicos. Material y métodos. Muestra de 7 187 mujeres con hijos menores de cinco años, proveniente de la Encuesta Nacional de Salud y Nutrición (Ensanut) 2012. Resultados. La prevalencia de SD es de 19.91%, lo que implica que 4.6 millones de menores viven con madres que podrán sufrir depresión moderada o grave. Hay bajas tasas de detección (17.06%) y atención (15.19%) de depresión. La SD se asocia con violencia (OR=2.34; IC95% 1.06-5.15), tener más de cuatro hijos, sexo femenino del menor, mayor edad del último hijo, bajo peso al nacer, inseguridad alimentaria y haber iniciado vida sexual antes de los 15 años (p<0.01). La probabilidad acumulada de SD, si se consideran todos los factores de riesgo, es de 69.76%; se podría reducir a 13.21% con medidas preventivas enfocadas en eliminar la violencia, la inseguridad alimentaria, las valoraciones inequitativas de género y el bajo peso al nacer. Conclusiones. La SD es un problema relevante de salud pública en México; está asociada con un conjunto bien determinado de factores de riesgo que ameritan prevención, así como detección y atención oportuna en los distintos niveles de atención.

Objective. This study estimates the prevalence of depressive symptomatology (DS) in women with children younger than five years of age, examines detection and care rates and probabilities of developing DS based on specific risk profiles. Materials and methods. The sample consists of 7 187 women with children younger than five drawn from the Ensanut 2012. Results. DS prevalence is 19.91%, which means at least 4.6 million children live with mothers who experience depressive symptoms indicative of moderate to severe depression. Rates of detection (17.06%) and care (15.19%) for depression are low. DS is associated with violence (OR=2.34; IC95% 1.06-5.15), having ≥4 children, having a female baby, older age of the last child, low birth weight, food insecurity, and sexual debut <15 years old (p<0.01). Accumulated probability of DS, taking into consideration all risk factors measured, is 69.76%. It could be reduced to 13.21% through prevention efforts focused on eliminating violence, food insecurity, bias against having a female baby, and low birth weight. Conclusions. DS is a compelling public health problem in Mexico associated with a well-defined set of risk factors that warrant attention and timely detection at various levels of care.

Blended Infant MassageeParenting Enhancement Program on Recovering Substance-Abusing Mothers' Parenting Stress, Self-Esteem, Depression, Maternal Attachment, and Mother-Infant Interaction

PURPOSE: This study aimed to determine whether a blended Infant MassageeParenting Enhancement Program (IMPEP) improved maternal psychosocial health outcomes (parenting stress, depressive symptoms, self-esteem, maternal attachment) and maternal-infant interaction among substanceaddicted mothers (SAMs) actively engaged in outpatient rehabilitation. METHODS: Designed as a randomized, three-group controlled trial testing two levels of psychoeducational intervention (IMPEP vs. PEP) and a control group (standard care parenting resources), the studywas conducted in two substance abuse centers in southeast Florida on a convenience sample of 138 recovering SAM-infant pairs. IMPEP or PEP classes were held weekly onWeeks 2e5, with data collected at baseline (Week 1),Week 6, andWeek 12 via structured interviews, observation (Observation Checklist onMaternal-Infant Interaction), and self-administered questionnaires (Abidin Parenting Stress Index, Beck Depression Inventory, Rosenberg Self-Esteem Scale, Muller's Maternal Attachment Inventory), analyzed descriptively and inferentially using Kruskall-Wallis analysis of variance and post hoc Wilcoxon rank sum and Mann-Whitney U tests. RESULTS: Both IMPEP and PEP groups had significantly increased Parenting Stress Index scores (decreased parenting stress) and decreased Beck Depression Inventory scores (decreased depressive symptoms) compared to controls at Week 12, whereas there were no clinically meaningful differences among study groups in Rosenberg Self-Esteem Scale, Muller's Maternal Attachment Inventory, or Observation Checklist on Maternal-Infant Interaction scores. Only the IMPEP group showed significant improvements in both psychological and physical (waist-hip ratio) measures of parenting stress over time. CONCLUSIONS: The findings suggest that infant massage blended into a structured parenting program has value-added effects in decreasing parenting stress and maternal depressive symptoms, but not on SAM's self-esteem, attachment, or maternal-infant interaction.

A depressão feminina no discurso de mulheres / Depression in Women through women's discourse

A depressão em mulheres tornou-se um grave problema de saúde pública e importante causa de incapacitação tanto em países em desenvolvimento como nos desenvolvidos. De acordo com a literatura psiquiátrica, a mulher apresentaria maior vulnerabilidade à depressão devido à influência do ciclo reprodutivo feminino e às diferentes fases e oscilações hormonais pelas quais as mulheres passariam durante suas vidas, entre outros fatores que aumentam sua vulnerabilidade. Configura-se como de fundamental importância, portanto, a contribuição das ciências sociais para a compreensão e discussão da questão da depressão feminina, bem como da própria definição do fenômeno. O presente trabalho tem como objetivos: caracterizar o perfil sociodemográfico e trajetórias de vida das mulheres com diagnóstico de depressão, sujeitos da pesquisa; identificar motivos que levaram as mulheres a buscar assistência em saúde por ocasião do diagnóstico de depressão; desvelar sentidos atribuídos pelas mulheres à experiência do diagnóstico de depressão; caracterizar processos de elaboração da vivência com a depressão pelas próprias mulheres; analisar as narrativas das mulheres, a partir da leitura biomédica e de gênero, na perspectiva das ciências sociais. A pesquisa, de natureza qualitativa, utilizou a técnica dos depoimentos pessoais para a coleta de dados a partir de roteiro temático. As narrativas foram interpretadas com base na análise do discurso à luz das ciências sociais.

Depression in women has become a serious public health problem and major cause of disability in both developed and developing countries. According to psychiatric literature, women present higher vulnerability to depression due to the influence of the female reproductive cycle and different phases and hormonal fluctuations they would face during their lifetime, among other factors. The contribution of social sciences is, therefore, of paramount importance for understanding and discussing the issue of female depression, as well as the very definition of the phenomenon. This study aims at characterizing the sociodemographic profile and life trajectories of women diagnosed with depression, subjects of the present research; identifying reasons why women seek health care at the time of the diagnosis of depression; uncovering the meanings attributed by such women to the experience of such diagnosis; characterizing processes of elaboration of the experience of living with depression by women themselves and analyzing the narratives of women as from biomedical and gender readings from the perspective of social sciences. The research is qualitative, having used the technique of personal accounts to collect data from the viewpoint of a thematic guide. The narratives were interpreted through discourse analysis from the viewpoint of the social sciences.

Evaluación de la eficacia de un programa preventivo para la depresión en adolescentes de sexo femenino / Evaluation of the efficacy of a prevention program for depression in female adolescents

Se evalúa el efecto de un programa preventivo de depresión aplicado a adolescentes de sexo femenino que cursaban primero medio. Este programa fue implementado en dos modalidades: 1) Indicada, aplicado a participantes con sintomatología depresiva subumbral (grupo experimental n=101; grupo control n=108), y 2) Universal, aplicado a cursos completos sólo de niñas (grupo experimental=119 participantes; grupo control n=118). El programa tuvo 11 sesiones, de 1,5 hora de duración, con 15 a 23 participantes por grupo. Se evaluó el efecto del programa en depresión, en ansiedad, conductas de autodaño y conductas externalizadas. El programa no mostró efectos en ninguna de sus dos modalidades de implementación. La modalidad indicada fue más satisfactoria para las participantes. Se comentan las limitaciones del estudio y sus proyecciones para el desarrollo de programas preventivos.

This study assesses the impact of a preventive program of depression in female adolescents from first grade of secondary school. The program was implemented in two ways: 1) Indicated: Applied to patients with subthreshold depressive symptoms (experimental group N=101; control group N=108) 2) Universal applied to a class comprised only by girls (experimental group=119; control group N=118). The program had 11 sessions, that lasted 1,5 hours each, with 15 to 23 participants per group. The impact of the program was measured in terms of anxiety, self-damage behavior, and externalized behavior. The program did not show effects in any of the two modalities. The Indicated modality obtained more satisfaction in the group of participants. The limitations of the study and implications for preventive programs in mental health are discussed.

Relación entre los trastornos depresivos y los factores psicosociales en adultos mayores del club de autoayuda en Chimboco / Relationship between depressive disorders and psychosocial factors in older adults self-help club Chimboco

La depresión en el adulto mayor constituye un problema de salud importante a nivel social, afectando en la calidad de vida y aumentando la morbimortalidad del adulto mayor.El presente estudio es cuantitativo, descriptivo de corte transversal en el periodo comprendido en el mes de septiembre del año 2010, aplicando la escala abreviada de depresión de Yesavage y un cuestionario en el cual se encuentran preguntas de aspectos psicosociales.Correspondiendo el 70.6% al sexo femenino y 29.4% al masculino. Depresión moderada un 47.1% y grave 20.6%. El 73.9% de las mujeres y el 26.1% de los varones presentaron depresión moderada a grave.Las situaciones psicosociales como: aspectos sociodemográficos, la situación familiar actual y los factores laborales influyen de manera importante sobre la salud del adulto mayor, siendo estos cambios en su vida factores desencadenantes de estrés que llevan a trastornos depresivos, disminuyendo la calidad de vida del adulto mayor.La prevención, detección y tratamiento oportuno de trastornos depresivos aumentan la esperanza de vida, mejorando la calidad y brindando al adulto mayor un envejecimiento activo

Physical activity in the prevention of the most frequent chronic diseases: an analysis of the recent evidence.

BACKGROUND: Physical activity is widely recognized as a means for the primary prevention of chronic diseases as well as in patients' treatment and rehabilitation. Moreover, activity has beneficial effects on an individual's health and well-being. Despite the benefits of regular physical activity, the percentage of physically inactive adults in the world is high. Environmental and policy approaches aimed to increase physical activity require continual stress of the epidemiological evidence from studies investigating disease mechanisms as well as controlled clinical trials. PURPOSE: To update the evidence that physical activity/exercise is important for reducing the chronic diseases (cardiovascular and heart, diabetes, cancer, obesity, osteoporosis, and fall-related injuries, depression and emotional stress) and for mechanisms that may operate in the relation between physical activity and a disease risk. METHODS: Research studies published from 2004 through to March 2007 were identified through a review of the literature available on the NLM PubMed, Medline, Current Contents, and Elsevier-Science Direct databases. RESULTS: Recent evidence on physical activity/exercise and reduction of chronic major diseases incidence and rehabilitation of patients replicates previous findings. The strongest evidence exists for colon cancer, breast cancer, and cardiovascular diseases. The maximal magnitudes of the risk reduction reported were: 75% for breast cancer, 49% for cardiovascular and heart diseases, 35% for diabetes, 22% for colorectal cancer. Increased physical activity also prevented the weight gain associated with aging at least 2-times greater in individuals who were more active compared with those who were inactive. Limited new findings has been reported for the beneficial role of physical activity in fall-related injures, depression and emotional distress. CONCLUSION: Recent evidence confirms previous findings that engaging in moderate physical activity is very important for the primary prevention of chronic diseases, decreasing all causes of mortality and that exercise is one of the determinants for physical and psychological well-being. The current evidence provides further support that physical activity can suppress concentrations of 17 alpha-estradiol in women.

Effects of a Drug Misuse and Abuse Prevention Program on Knowledge, Attitude, and Preventive Behaviors Related to Drug Misuse and Abuse, and Depression in Low-income Elderly Women / 간호학회지

PURPOSE: This study was conducted to determine the effects of a drug misuse and abuse prevention programon knowledge, attitude, and preventive behaviorsrelated to drug misuse and abuse, and depression in low-income elderly women in the urban area. METHOD: The design of this study was a nonequivalent control group pretest-posttest design. The subjects consisted of 26 in the experimental group and 23 in the control group. The program was performed for about 1hour, once a week for 5 weeks. Data was analyzed by the SAS(ver.8.02) computer program, and it included descriptive statistics, Fisher's exact test, Mann-Whitney U test, Wilcoxon signed ranks test, and ANCOVA. RESULT: There were statistically significant differences in knowledge, attitude, and preventive behaviors related to drug misuse and abuse, and depression between the experimental group and the control group. CONCLUSION: This study showed that this prevention program of drug misuse and abuse is appropriate for low-income elderly women, Therefore this program is recommended as a nursing intervention strategy for the elderly.

Revisão sobre o uso da terapia cognitiva-comportamental na prevenção de recaídas e recorrências depressivas / Cognitive-behavioral therapy in prevention of depression relapses and recurrences: a review

OBJETIVO: Fazer um levantamento das teorias e revisar as evidências existentes sobre o papel da terapia cognitiva-comportamental (TCC) na prevenção de recaídas e recorrências de episódios depressivos. MÉTODO: Revisão dos ensaios clínicos randomizados e controlados que investigam a eficácia da TCC na prevenção de recaídas e/ou recorrências depressivas. As bases de dados consultadas foram o Medline, Lilacs, Cochrane, Biosis e a Embase. Foram verificadas as referências bibliográficas dos artigos selecionados, de artigos de revisão e de livros sobre o tema. RESULTADOS: Foram encontrados 15 estudos de desenhos heterogêneos e vários deles com problemas metodológicos. A maioria comparou o uso de TCC e antidepressivos apenas na fase aguda. Em 12 deles a TCC diminuiu a taxa de recorrência/recaídas de modo estatisticamente significativo. As publicações mais recentes apontam para a utilidade da TCC nos sintomas depressivos residuais como estratégia preventiva de recorrências. CONCLUSÕES: A TCC mostrou-se eficaz na redução de recaídas depressivas, mas ainda precisam ser mais bem investigadas sua eficácia em relação ao uso de antidepressivos e qual estratégia de TCC (seu uso apenas na fase aguda, na fase aguda e manutenção, na manutenção após antidepressivo na fase aguda ou o enfoque nos sintomas residuais após antidepressivo na fase aguda) é mais eficaz para cada tipo de paciente

Psicoterapia del niño y adolescente con depresión / Psychotherapy of the child and adolescent with depression

This article is a revision of the literature on psychotherapy for children and adolescents suffering depression. Based on the findings, psychotherapy, particularly cognitive-behavioral interventions are recommended over pharmaceutical treatments. Etiological factors seem to indicate that family systems therapy to be appropriate for depression in children. Included are recommendations for prevention

Consequências da deficiência estrogênica nos anos da perimenopausa / Consequences os estrogen deficiency in the perimenopausal years

A perimenopausa tem sido reconhecida cada vez mais como uma entidade separada no processo da menopausa precoce ou tardio. A menopausa näo deve ser vista necessariamente como um declínio, mas sim pode ser uma experiência pessoal positiva e o começo de uma vida de transiçäo satisfatória. Esperar pela parada das menstruaçöes antes de iniciar tratamento näo tem uma base fisiológica.