***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: This study represents a 2.25-year follow-up to a treatment study reported earlier ( McLean & Hakstian , 1979 ) in which 121 unipolar depressed out patients were treated by either ( a ) nondirective psychotherapy , ( b ) behavior therapy , ( c ) pharmacotherapy , or ( d ) relaxation therapy . A nondepressed , normal control group was evaluated on the same 28 measures and 6 intervals for contrast purpose s. Behavior therapy patients alone were significantly improved in the areas of mood , personal productivity , and social activity , relative to treatment control patients over the follow-up period . Also , twice as many behavior therapy patients ( i.e. , 64 % ) fell within one st and ard deviation of the normal , nondepressed control group distribution on depressed mood , compared with non-directive psychotherapy and pharmacotherapy patients , when scores were aggregated across the 6 assessment points Eighty-four depressed pregnant women were recruited during the second trimester of pregnancy and r and omly assigned to a massage therapy group , a progressive muscle relaxation group or a control group that received st and ard prenatal care alone . These groups were compared to each other and to a non-depressed group at the end of pregnancy . The massage therapy group participants received two 20 min therapy sessions by their significant others each week for 16 weeks of pregnancy , starting during the second trimester . The relaxation group provided themselves with progressive muscle relaxation sessions on the same time schedule . Immediately after the massage therapy sessions on the first and last days of the 16-week period the women reported lower levels of anxiety and depressed mood and less leg and back pain . By the end of the study the massage group had higher dopamine and serotonin levels and lower levels of cortisol and norepinephrine . These changes may have contributed to the reduced fetal activity and the better neonatal outcome for the massage group ( i.e. lesser incidence of prematurity and low birthweight ) , as well as their better performance on the Brazelton Neonatal Behavior Assessment . The data suggest that depressed pregnant women and their offspring can benefit from massage therapy Les auteurs ont trouve une efficacite semblable pour la therapie cognitivo-comportementale et pour la relaxation , dans le traitement de la depression chez Outcomes of seven treatment trials comparing cognitive behavioral therapy to treatment with tricyclic antidepressant medication in major depressive disorder have been quite similar to one another . This led us to question whether treatment outcome in time-limited studies reflected a unique effect of cognitive behavioral therapy . To test the uniqueness hypothesis , relaxation training , a nonpharmacologic , noncognitive treatment , was chosen as a comparison for cognitive behavioral therapy as well as drug therapy . Treatment duration was 16 weeks . The sample of 37 patients treated for major depressive disorder was less depressed than those previously studied . For both cognitive behavioral therapy and relaxation training , outcome of depression was superior to that of tricyclic antidepressant medication by endpoint analysis . The posttreatment scores on the Beck Depression Inventory of 82 % of the group receiving cognitive behavioral therapy improved to a Beck Depression Inventory score ≤9 which was not significantly greater than that for the group receiving relaxation training.(73 % ) , so a unique effect was not demonstrated for cognitive behavioral therapy . The outcome for tricyclic antidepressant medication  ( 29 % improved to criteria ) was significantly worse than that for cognitive behavioral therapy . The patient 's pretreatment initial expectancy was not predictive BACKGROUND Season-related subsyndromal depressive symptoms during winter are common among population s at high latitudes . Both physical exercise and exposure to bright light can relieve the fatigue and downturn of mood associated with the shortening length of day . Serum cholesterol level may be related to changes in mood , but the evidence is contradictory . Our objective was to compare the effect of aerobic exercise with or without bright-light exposure on health-related quality of life , mood , and serum lipids in a sample of relatively healthy adult subjects . METHOD A r and omized controlled trial was conducted with subjects allocated to group aerobics training in a gym with bright light ( 2500 - 4000 lux ) ( N = 40 ) or normal illumination ( N = 42 ) or to relaxation/stretching sessions in bright light as a control group ( N = 42 ) twice a week for a period of 8 weeks . Changes in mood were recorded using question naires at the beginning of the study , at weeks 4 and 8 . and at follow-up 4 months after the study . A blood sample was drawn before and after the 8-week intervention to measure the concentrations of serum lipids . RESULTS Ninety-eight subjects completed the 8-week study . Both exercise and bright light effectively relieved depressive symptoms .  Bright light reduced atypical depressive symptoms more than exercise ( p = .03 ) , based on the atypical symptoms subscore of the Structured Interview Guide for the Hamilton Depression Rating Scale-Seasonal Affective Disorders Version Self-Rating Format . There were no significant differences between the study groups in the changes in serum lipid levels . CONCLUSION Bright light administered twice a week , alone or combined with physical exercise , seems to be a useful intervention for relieving seasonal mood slumps Fifty-three child and adolescent psychiatric patients with depressive disorders were r and omly allocated to brief cognitive-behaviour therapy ( CBT ) or to a control treatment , relaxation training .  Forty-eight patients completed the treatment phase of the trial , which comprised 5 - 8 treatment sessions . Post-treatment assessment s showed a clear advantage of CBT over relaxation on measures of both depression and overall outcome . However , there were no significant differences between the treatments on comorbid anxiety and conduct symptoms . At follow-up , the differences between the groups were reduced , partly because of a high relapse rate in the DTP group and partly because subjects in the relaxation group continued to recover Recent studies have found that positive affect is associated with greater relative left frontal EEG activation and negative affect is associated with greater relative right frontal EEG activation . Further , chronically depressed adults typically display stable right frontal EEG activation . The present study investigated the effects of music on mood state and right frontal EEG activation associated with chronic depression . Fourteen chronically depressed female adolescents  listened to rock music for a 23-minute session . These adolescents were compared with a control sample of chronically depressed female adolescents who were simply asked to sit and relax their minds and their muscles for the same time period .  EEG was recorded during baseline , music , and postmusic for three minutes each , and  saliva sample s were collected before and after the session to determine the effects of the music on stress hormone ( cortisol ) levels . No group differences or changes were noted for observed or reported mood state . However , cortisol levels decreased and relative right frontal activation was significantly attenuated during and after the music procedure . It was concluded that music had positive effects on the physiological and biochemical measures even though observed and self-reported mood did not change Background Combining bright light exposure and physical exercise may be an effective way of relieving  depressive symptoms . However , relatively little is known about individual factors predicting either a good response or treatment failure . We explored background variables possibly explaining the individual variation in treatment response or failure in a r and omised trial . Methods Participants were volunteers of working-age , free from prior mental disorders and recruited via occupational health centres . The intervention was a r and omised 8-week trial with three groups : aerobics in bright light , aerobics in normal room lighting , and relaxation/stretching in bright light . Good response was defined as a 50 % decrease in the symptom score on either the Hamilton Depression Rating Scale ( HDRS ) or 8-item scale of atypical symptoms . Background variables for the analysis included sex , age , body-mass index , general health habits , seasonal pattern , and sleep disturbances . Results Complete data were received from 98 subjects ( 11 men , 87 women ) . Of them , 42 ( 5 men , 37 women ) were classified as responders on the HDRS . Overall , light had a significant effect on the number of responders , as assessed with the HDRS ( X2 = .02 ) . The number needed to treat ( NNT ) for light was 3.8 . Conclusions We investigated the effect of bright light and exercise on depressive symptoms . Problems with sleep , especially initial insomnia , may predict a good response to treatment using combined light and exercise . Bright light exposure and physical exercise , even in combination , seem to be well tolerated and effective on depressive symptoms BACKGROUND So-called atypical depressive symptoms ( carbohydrate craving , prolonged sleep , weight gain , increased appetite ) frequently emerge in association with low illumination to which people are ordinarily exposed indoors , or even outdoors at extreme latitudes in wintertime . Our objective was to analyse the effect of physical exercise alone or combined with bright light on mood and the health-related quality of life during winter . METHODS We carried out a r and omized controlled trial on 120 indoor employees in southern Finl and between November and January . The subjects were allocated to supervised fitness training under bright ( 2500 - 4000 lx ) or ordinary ( 400 - 600 lx ) light conditions in a gym 2 - 3 times weekly for 8 weeks , or supervised relaxation training once a week over the same period as active placebo . We collected question naire data on the changes in mood and health-related quality of life after 4 and 8 weeks of training , and after 4 months follow-up . RESULTS Fitness training in bright light result ed in greater relief from atypical depressive symptoms and more vitality than in ordinary room light . Compared with relaxation alone , the former regime improved general mental health and social functioning in addition to the improvement in depressive symptoms and vitality , whereas the latter only increased vitality . CONCLUSIONS Supervised physical exercise combined with exposure to bright light appears to be an effective intervention for improving mood and certain aspects of the health-related quality of life in wintertime . This effect appears unrelated to the history of season-dependent symptoms , being noticeable among healthy individuals The National Institute of Mental Health ( NIMH ) Treatment of Depression Collaborative Research Program ( Elkin et al. , Archives of General Psychiatry , 46 , 971 - 982 ; 1989 ) reported treatment-by-severity interactions favouring pharmacotherapy for more depressed out patients , on a minority of relevant comparisons . The present study reports secondary analyses from a similar , preexisting data set in which treatment-by-severity interactions are systematic ally investigated with depressed out patients treated either with nondirective psychotherapy , behaviour therapy , pharmacotherapy , or relaxation/placebo . Despite multiple severity measures and variable severity cut scores , no treatment was differentially effective in improving more severely depressed patients . Also , there was little difference across symptom severity levels in the proportions of recovered patients between treatment groups . Finally , dynamic cluster analysis demonstrated that the proportion of pharmacotherapy nonresponders ( 20 % ) did not differ from the proportion of nonresponders in behaviour therapy or placebo groups . It is concluded that this failure to replicate the NIMH trial findings can not be attributed to treatment differences , population s or statistical power . The suggestion that pharmacotherapy be the treatment of choice for more severely depressed out patients appears to be unjustified on the basis of available evidence Thirty-two depressed adolescent mothers received ten 30-minute sessions of massage therapy or relaxation therapy over a five-week period . Subjects were r and omly assigned to each group . Although both groups reported lower anxiety following their first and last therapy sessions , only the massage therapy group showed behavioral and stress hormone changes including a decrease in anxious behavior , pulse , and salivary cortisol levels . A decrease in urine cortisol levels suggested lower stress following the five-week period for the massage therapy group Objective : To evaluate the short-term effects of exercise in patients with major depression . Design : Prospect i ve , r and omised , controlled study . Setting : A university hospital . Patients : A consecutive series of 38 in patients with a major depression episode undergoing st and ard clinical antidepressant drug treatment . Interventions : Patients were r and omly assigned to an exercise ( walking , n = 20 ) or placebo ( low-intensity stretching and relaxation exercises , n = 18 ) group . Training was carried out for 10 days . Main outcome measurements : Severity of depression assessed with the Bech-Rafaelsen Melancholy Scale ( BRMS ) and the Center for Epidemiologic Studies Depression scale ( CES-D ) . Results : After 10 days , reduction of depression scores in the exercise group was significantly larger than in the placebo group ( BRMS : 36 % v 18 % ; CES-D : 41 % v 21 % ; p for both = 0.01 ) ; the proportion of patients with a clinical response ( reduction in the BRMS scores by more than six points ) was also larger for the exercise group ( 65 % v 22 % , p<0.01 ) . Conclusions : Endurance exercise may help to achieve substantial improvement in the mood of selected patients with major depression in a short time Treatment efficacy is typically evaluated by examining group means and pre-post change scores . Although informative , such analyses may obscure individual or subgroup differences in response ( outcome profiles ) . The present study used two different methods to define treatment outcome profiles -- rationally-derived criteria ( Frank et al. , Archives of General Psychiatry 48 , 851 - 855 , 1991 ) and dynamic clustering -- to evaluate four treatments of unipolar depression : behaviour therapy , amitriptyline , psychodynamic psychotherapy and relaxation training ( attention placebo ) . The profiling methods yielded similar results . Regardless of treatment , the majority of patients displayed either a recovery or nonremission outcome profile , with relatively few instances of remission followed by a recurrence of depression . These findings challenge the view that any of the treatments are associated with a strong tendency to relapse , at least over 
    Output:
    
Three trials showed no significant difference between  relaxation  and psychological treatment  on clinician-rated depression at post intervention ( SMD 0.29 ( 95 % CI -0.18 to 0.75)).Inconsistent effects were found when comparing relaxation training to medication and there were few data available comparing relaxation with complementary and lifestyle treatments .
Relaxation techniques were more effective at reducing self-rated depressive symptoms than no or minimal treatment .
However , they were not as effective as psychological treatment .