8 New Developments in Depression

Outpatient treatment sees modest growth. The prevalence of treated depression increased over the past few decades, though less than expected, and an increasing proportion of patients were covered by insurance, particularly Medicaid. An analysis showed rates of outpatient treatment climbing from 2.36 per 100 population in 1998 to 3.47 per 100 population in 2015. The proportion of patients treated with psychotherapy decreased from 53.7% in 1998 to 43.2% in 2007 and increased to 50.4% in 2015; the proportion receiving pharmacotherapy remained steady at about 80%. National outpatient expenditures have experienced a slowing growth.

Outcome expectancy varies with treatment type and time. In a study of outcome expectancy with MDD treatment, expectancy improved during pharmacotherapy and psychotherapy. With pharmacotherapy, greater treatment response was predicted by both higher optimistic and lower pessimistic expectancy at mid-treatment. With cognitive behavioral therapy, greater response was predicted by higher optimistic expectancy at pre-treatment and lower pessimistic expectancy at mid-treatment. Strategies to enhance optimism may enhance clinical outcomes.

“Next steps” proposed for depression remission. In a study of potential “next-step” treatments for patients with MDD, remission was more likely for those who were employed, had less severe and chronic depression, were less anxious, and had no complicated grief symptoms. Next-step treatment selections were suggested by age ≥65 years (augmentation with aripiprazole better than a switch to bupropion) and severe mixed hypomanic symptoms (augmentation with aripiprazole and combination with bupropion better than a switch to bupropion).

Unwanted sexting triggers distress. Receiving or sending unwanted but consensual sexts resulted in more depression, anxiety, and stress and lower self-esteem in young adults, with a stronger relationship for males than for females. Receiving unwanted sexts and sending sexts under coercion were independent predictors of poorer mental health and had an additive effect. No association was found for receiving or sending sexts overall. The findings may help explain why sexting may be seen as a normative sexual behavior or as a potential risk behavior.

Counseling interventions guide perinatal depression prevention. In a systematic review of interventions for preventing perinatal depression, counseling interventions reduced the likelihood of onset by 39%. Specific counseling approaches targeted high-risk women and included a substantial proportion of Black and Latina participants. The “Mothers and Babies” course is based on cognitive behavioral therapy, and “Reach Out, Stand Strong, Essentials for new mothers” (ROSE) is an interpersonal therapy–based approach.

Food for thought: probiotics for depression and anxiety. Investigators conducted a random-effects meta-analysis of controlled clinical trials to evaluate the effects of prebiotics and probiotics on depression and anxiety. Prebiotics did not differ from placebo, but probiotics yielded small but significant effects. The probiotic effects were larger for clinical than community samples-the effect increased to medium-to-large in a preliminary analysis restricted to psychiatric samples. There is general support for antidepressant and anxiolytic effects of probiotics.

Physical activity and sleep offer an educated approach to depression. Rigorous physical activity and quality sleep may help college students who have depressive symptoms reduce and regulate them, but the effects may vary by sex. In a study of university students in China, vigorous physical activity and sleep variables significantly predicted depression levels for the overall sample. Vigorous and moderate physical activity variables significantly predicted depression for males. No level of physical activity had a significant relationship with depression for females.

Unhealthy eating depresses mental health. Moderate and serious psychological distress were independently associated with unhealthy diet in a large population-based survey. Both were linked with lower intake of healthy foods (eg, vegetables, fruits, and water) and higher intake of unhealthy foods (eg, soda, French fries, and fast food). The authors suggested increasing efforts to improve diet quality in clinical practice and targeting interventions at young adults, persons with less than a high school education, and obese persons.