No benefit of antidepressants in inpatient treatment of depression. A longitudinal, quasi-experimental field study.

RATIONALE: Antidepressants (AD) are mostly considered indispensable for the treatment of major depression. The vast majority of depressive inpatients are treated with AD. However, there is a growing body of studies indicating that the effectiveness of AD is greatly overestimated due to methodological issues with the AD efficacy studies (e.g., publication bias, unintentional unblinding, confusion between withdrawal symptoms and relapse). OBJECTIVES: The benefit of the additional use of AD in the inpatient treatment of depression with intensive cognitive-behavioral therapy (CBT) has been investigated in a naturalistic design. METHODS: Depressiveness was assessed using the Beck Depression Inventory (BDI-II) during a preliminary interview (T0), at admission (T1), at discharge (T2), and at a 6-month follow-up (T3). Two study phases were compared: During Phase A, AD were recommended in accordance with the German guideline. In Phase B, AD were no longer recommended, and they were only prescribed upon explicit request from patients. In phase A (N = 574), 60.3% of all patients were taking AD at discharge. In Phase B (N = 424), 27.9% of patients were on AD at discharge. Apart from the difference in AD usage, the two treatment conditions were similar, and the samples did not significantly differ in terms of age, sex, diagnoses, history of suicide attempts, comorbid anxiety disorders, and unemployment. RESULTS: In both study phases, BDI-II scores were strongly decreased at T2 and T3, respectively, compared with T1. The BDI-II scores of the two phases did not differ at any of the measurement time points. Depression changes were similar in both phases. In sequential multiple regression analyses with the total sample, AD were no significant predictors for the reduction of depression at either T2 or T3. CONCLUSIONS: The inpatient CBT was effective in depression. The effectiveness of CBT is not improved by the additional use of AD. The current prescribing practices of AD should be questioned.

Inpatient treatment decreases depression but antidepressants may not contribute. A prospective quasi-experimental study.

OBJECTIVE: The aim of the study is the evaluation of psychiatric-psychotherapeutic inpatient treatment utilizing a naturalistic design. METHODS: In a sample of 574 consecutively admitted patients, depression (64.5%), personality disorders (19.5%), schizophrenia (4.2%), bipolar disorder (3.3%), obsessive-compulsive disorder (2.3%) or other mental disorders (6.4%) were diagnosed. All patients were treated with psychotherapy, most with antidepressants. Depression was measured using the Beck Depression Inventory-II (BDI-II). 180 patients formed a waiting list control group. The regularly discharged patients (N = 489) were asked to participate in a six-month follow-up, with 62.6% taking part. RESULTS: From the time of admission to discharge, there was a strong decline in depression (31.5 vs. 13.2 points on the BDI-II), as well as from admission to follow-up (31.2 vs. 18.3 points). In the control group, there was a weak symptom decline (34.6 vs. 32.1 points) until admission, which was independent of the waiting period duration. For the success of treatment, it did not matter whether the patients received antidepressants. In the follow-up, 81.0% of patients retrospectively considered psychotherapy to be important for treatment outcome, only 2.3% considered medications to be important. CONCLUSIONS: Psychiatric inpatient treatment reduces depression significantly at discharge and follow-up; the decrease in depression is rather due to psychotherapy than to antidepressants.

Establishment of a colonic adenoma cell line (GEKI-2): spectral karyotype analysis and functional characterization.

BACKGROUND AND AIMS: On the genetic level colonic carcinogenesis is best described by the adenoma-carcinoma sequence, but it may be modulated by exogenous factors, particularly by dietary factors and chemopreventive agents. The protective effects of exogenous factors are thought to be exerted rather in the early stages of the adenoma-carcinoma sequence. Thus, an in vitro model consisting of cells stemming from an colon adenoma would be desirable. However, establishing such a cell line has proven difficult. MATERIALS AND METHODS: We report the establishment of a colon adenoma cell line. The cells were generated from a colon adenoma and propagated as a stable cell line for more than 40 passages. The cells are microsatellite stable and confirmed to be of epithelial origin by cytokeratin staining. RESULTS: In contrast to commercially available colon cancer cell lines, cytogenetic analysis with spectral karyotype analysis revealed no chromosomal alterations in this adenoma cell line. Incubation with butyrate resulted in a time- and dose-dependent inhibition of proliferation and in an significant increase in cellular differentiation. The cdk inhibitor p21/waf which plays a pivotal role in growth inhibition and differentiation is expressed consecutively in GEKI-2 cells. The expression of cdk1 and cdk2, important regulatory elements in the cell cycle, is downregulated following treatment with butyrate. CONCLUSION: The presented colon adenoma cell line GEKI-2 may prove a versatile tool for further exploring the underlying mechanisms of protective and promoting factors in early colon cancerogenesis.