Major depression and medications for treatment in Canadian Pharmacy Mall
Major depression is one of the most prevalent mental disorders worldwide. Lifetime prevalence rate estimates for major depression range from 10% to 15%. On the basis of a cross-national epidemiologic study, the 12-month prevalence of major depression is 6.5% and the lifetime prevalence is 14.6% in the ten highest income countries. In Japan, the estimated 12-month prevalence of major depression is 2.2% and the lifetime prevalence is 6.6%. This condition incurs a great socioeconomic burden and is associated with serious consequences such as suicide.
In Japan, 30,651 people committed suicide in 2011. Suicide is the most frequent cause of death in the age range from 20 to 39 years and the second most frequent in the 40 to 49 age range. For the age ranges of 10 to 14 and 50 to 54, suicide is the third most frequent cause of death. It has been noted that depressive disorders are the most prevalent disorders in suicide victims.
It therefore follows that treat- ment of depression is a particularly important aspect of suicide prevention. In addition, the estimated economic burden associated with depression is approximately $11 billion in Japan, with $1,570 million relating to direct medical costs, $2,542 million to depression-related suicide costs, and $6,912 million to workplace costs. Effective treatment of depression should work to alleviate this economic burden.
Cognitive behavioural therapy is a popular intervention shown to be effective for depression. The UK National Institute for Health and Clinical Excellence (NICE) guidelines recommend cognitive behavioural therapy for the treatment of mild to moderate depression.
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Group cognitive behavioural therapy is as effective as individual cognitive behavioural therapy for the treatment of depression. In addition, conducting group therapy is economical in terms of time spent and cost savings per patient. Therapists can treat a greater number of people and reducing patient wait times. Group cognitive behavioural therapy can be effectively conducted by clinical psychologists in Japan, although there is a shortage of trained cognitive behavioural therapists in Japan.
To deliver cognitive behavioural therapy cost effectively and in a fashion that maximizes access for all, it is important to conduct group cognitive behavioural therapy in community settings. In Japan, Mental Health and Welfare Centers are located in each government-decreed city and prefecture. These centres are intended to help maintain and promote the mental health of the populations they serve.
Increased access to cognitive behavioural therapy at these centres could have a substantial positive impact on depression and suicide rates in the community. However, most studies of group cognitive behavioural therapy have been conducted in medical or research settings, such that the effectiveness and feasibility of this intervention in community settings remains to be determined. The present pilot study estimated the effect size of a group cognitive behavioural therapy program for depression in a community setting as an alternative to conducting a randomized controlled trial.
Study Design
The study was conducted at the Chiba city Center of Mental Health from September to December 2013. This endeavour was part of the Chiba prefecture project for suicide prevention. All procedures were performed in accordance with the Helsinki Declaration. Required ethical approval was obtained from the Ethics Committee of Chiba University. This study is reported according to the TREND statement.
Participants
Participants were recruited through leaflets placed at medical institutions in Chiba City and through web-based advertisements. As all participants continued to be treated by their physicians, the participants were required to obtain permission from their general practitioner prior to study enrolment.
The eligibility criteria for this study were a primary diagnosis of major depressive disorder according to DSM-IV criteria and age between 20 and 55 years. Comorbid diagnoses were permitted if clearly secondary to the depression, to better reflect the realities of routine clinical practice.
The exclusion criteria for potential participants were presence of psychosis, personality disorders, bipolar disorder, high risk of suicide, substance abuse or dependence in the past 6 months, unstable medical condition, pregnancy, or lactation.
All patients were asked to bring a referral form from their psychiatrist together with confirmation of their treatment history. All participants were then evaluated by a psychiatrist at the Mental and Emotional Health Centre for eligibility before the assessment of outcome.
Six patients initially enrolled in this study. One patient was excluded because of a primary diagnosis that was not major depression. The remaining five patients participated and finished the program without dropping out.