***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: BACKGROUND Nearly two-thirds of elderly patients treated for depression fail to achieve symptomatic remission and functional recovery with first-line pharmacotherapy . In this study , we ask whether a mind-body exercise , Tai Chi Chih ( TCC ) , added to escitalopram will augment the treatment of geriatric depression design ed to achieve symptomatic remission and improvements in health functioning and cognitive performance . METHODS : One hundred twelve older adults with major depression age 60 years and older were recruited and treated with escitalopram for approximately 4 weeks . Seventy-three partial responders to escitalopram continued to receive escitalopram daily and were r and omly assigned to 10 weeks of adjunct use of either 1 ) TCC for 2 hours per week or 2 ) health education ( HE ) for 2 hours per week . All participants underwent evaluations of depression , anxiety , resilience , health-related quality of life , cognition , and inflammation at baseline and during 14-week follow-up . RESULTS Subjects in the escitalopram and TCC condition were more likely to show greater reduction of depressive symptoms and to achieve a depression remission as compared with those receiving escitalopram and HE . Subjects in the escitalopram and TCC condition also showed significantly greater improvements in 36-Item Short Form Health Survey physical functioning and cognitive tests and a decline in the inflammatory marker , C-reactive protein , compared with the control group . CONCLUSION : Complementary use of a mind-body exercise , such as TCC , may provide additional improvements of clinical outcomes in the pharmacologic treatment of geriatric depression Objective This study examined the feasibility , safety , and efficacy of using tai chi for treating major depressive disorder . Design Thirty-nine Chinese Americans with major depressive disorder were r and omized into a 12-wk tai chi intervention or a waitlisted control group in a 2:1 ratio . The key outcome measurement was the 17-item Hamilton Rating Scale for Depression . Positive response was defined as a decrease of 50 % or more on the 17-item Hamilton Rating Scale for Depression , and remission was defined as a score of 7 or lower on the 17-item Hamilton Rating Scale for Depression .  Results Of the participants ( n = 39 ) , 77 % were women , and mean ( SD ) age was 55 ( 10 ) years . There were 26 ( 67 % ) participants in the tai chi intervention group and 13 ( 33 % ) in the control group . Of the participants in the tai chi group , 73 % completed the intervention ; no adverse events were reported . We observed trends toward improvement in the tai chi intervention group , compared with the control group , in positive treatment-response rate ( 24 % vs. 0 % ) and remission rate ( 19 % vs. 0 % ) , although the differences in our small sample did not reach statistical significance . Conclusions A r and omized controlled trial of tai chi is feasible and safe in Chinese American patients with major depressive disorder . These promising pilot study results inform the design of a more definitive trial BACKGROUND There appears to be consensus that patients with only one or two prior depressive episodes do not benefit from treatment with mindfulness-based cognitive therapy ( MBCT ) . AIMS To investigate whether the effect of MBCT on residual depressive symptoms is contingent on the number of previous depressive episodes ( trial number NTR1084 ) . METHOD Currently non-depressed adults with residual depressive symptoms and a history of depression ( ≤2 prior episodes : n = 71 ; ≥3 episodes : n = 59 ) were r and omised to  MBCT ( n = 64 ) or a waiting list ( control : n = 66 ) in an open-label , r and omised controlled trial . The main outcome measured was the reduction in residual depressive symptoms ( Hamilton Rating Scale for Depression , HRSD-17 ) . RESULTS Mindfulness-based cognitive therapy was superior to the control condition across subgroups ( β = -0.56 , P<0.001 ) . The interaction between treatment and subgroup was not significant ( β = 0.45 , P = 0.16 ) . CONCLUSIONS Mindfulness-based cognitive therapy  reduces residual depressive symptoms irrespective of the number of previous episodes of major depression Mental health problems continue topresent a global challenge and contributesigniﬁcantly to the global burden ofhuman disease ( DALYs ) . Depression isthe most common psychiatric disorder and is thought to affect 121 million adultsworldwide , and as such was rated as thefourth leading cause of disease burden in2000 ( Moussavi et al. , 2007 ) , projected tobecome the highest cause of disease bur-den by 2020 . Antidepressant drugs are aneffective and commonly used treatmentfor depression in primary care ( Arrollet al. , 2009 ) , although almost half of thosetreated do not achieve full remission oftheir symptoms , and there remains a riskof residual symptoms , relapse/recurrence(Fava and Ruini , 2002 ) . In those patients who do demonstrate improvements indepressive symptoms with antidepres-sant therapies , a time-lag in the onset oftherapeutic effects is frequently reported . Antidepressant drugs are associated withadverse side effects ( Agency for Health Research and Quality ( AHRQ ) , 2012 ) and an increased risk of cardiovascu-lar disease , particularly in those withpre-existing cardiovascular conditions ormajor cardiovascular risk factors ( Waring,2012 ) . Furthermore , adherence to antide-pressant medications is often poor and patients often prematurely discontinuetheir antidepressant therapy ; it has beensuggested that approximately 50 % of psy-chiatric patients and 50 % of primary care patients are non-adherent when assessed6-months after the initiation of treatment(Sansone and Sansone , 2012).Psychological treatments for depres-sion have been recommended in theUK National Institute for Health and Clinical Excellence ( NICE ) guidelines ( NICE , 2009 ) and are becoming morecommonplace for helping to reducesymptoms in depressed adults ( Ambresinet al. , 2012 ; Brakemeier and Frase , 2012),with even brief psychosocial interven-tions showing promise for improvingadherence to depression medication treat-ment in primary care setting s ( Sirey et al.,2010).However , attendance atpsychologi-cal intervention sessions can be poor sincemany depressed adults who may beneﬁtfromsuch treatments choosenotto attendmental health clinics due to the perceivedstigma ofpsychological therapies . As such there has been an increasinginterest in the role of alternative inter-ventions for depression . Physical exercisehas been proposed as a complementarytreatment which may help to improveresidual symptoms of depression and pre-vent relapse ( Trivedi et al. , 2006 ) . Exercisehas been proposed by many as a poten-tial treatment for depression and meta- analysis has demonstrated that effect sizesin intervention studies range from -0.80to -1.1 ( Rethorst et al. , 2009 ) . However , the evidence is not always consistent;recent research has shown that that pro-vision of tailored advice and encourage-ment for physical activity did not improvedepression outcome or antidepressant usein depressed adults when compared withusual care ( Chalder et al. , 2012 ) . Other research ers have failed to ﬁnd an antide-pressant effect of exercise in patients with major depression but have foundshort term positive effects on physical outcomes , body composition and mem-ory ( Krogh et al. , 2012 ) . Others haveargued that the nature of exercise deliv-ery is an important factor , with exer-cise of preferred ( rather than prescribed)intensity shown to improve psychological , physiological and social outcomes , and exercise participation rates in depressedindividuals(Callaghanet al. , 2011 ) . Research ﬁndings have beensummarized by a recent Cochrane review whichreportedtheﬁndingsof32r and om-ized controlled trials in which exercisewas compared to st and ard treatment , no treatment or a placebo treatment inadults ( aged 18 and over ) with depression(Rimeretal.,2012).This review concludedthat exercise seems to improve depressivesymptoms in people with a diagnosis ofdepression when compared with no treat-ment or control intervention , althoughhighlighted that this should be interpretedwith caution since the positive effects ofexercise were smaller in method ologi-cally robust trials . Similarly , a systematic review found that physical exercise pro-grams obtain clinical ly relevant outcomes in the treatment of depressive symptomsin depressed older people Although cognitive-behavioural programmes for preventing depression have produced promising findings , their administration requires extensive training . Relaxation techniques are more straightforward psychological strategies , but they have not been investigated in the prevention of depression . This trial aim ed to compare the results of relaxation training ( RT ) with that of a cognitive-behavioural programme ( CBT ) for prevention of depression in university students with elevated depressive symptoms . The 133 participants ( mean age 23.3 years , 82 % women ) were r and omly assigned to CBT or RT . Both programmes were administered to groups of 5 or 6 participants in eight weekly 90-min sessions . Participants were evaluated by independent raters before , immediately after , and 3 and 6 months after taking part in the programmes . By itself , intervention type had no significant effect on either depression or anxiety scores . The scores were lower at the follow-up time points with respect to pre-intervention scores . Effect size was greatest between pre- and immediately post-intervention scores for CBT , d = 1.32 , 95 % CI [ 1.00 , 1.64 ] , and between pre- and 6-month post-intervention scores for RT , d = 0.75 , 95 % CI [ 0.47 , 1.03 ] . Anxiety symptoms were significantly improved by both interventions at 3-month follow-up , and by CBT at 6-month follow-up also . In the medium term ( 3 - 6 months ) , relaxation training produced similar reductions in depressive and anxiety symptoms as a more complex cognitive-behavioural programme CONTEXT Mindfulness-based cognitive therapy ( MBCT ) is a group-based psychosocial intervention design ed to enhance self-management of prodromal symptoms associated with depressive relapse . OBJECTIVE To compare rates of relapse in depressed patients in remission receiving MBCT against maintenance antidepressant pharmacotherapy  , the current st and ard of care . DESIGN Patients who met remission criteria after 8 months of algorithm-informed antidepressant treatment were r and omized to receive maintenance antidepressant medication , MBCT , or placebo and were followed up for 18 months . SETTING Outpatient clinics at the Centre for Addiction and Mental Health , Toronto , Ontario , Canada , and St Joseph 's Healthcare , Hamilton , Ontario . PARTICIPANTS One hundred sixty patients aged 18 to 65 years meeting DSM-IV criteria for major depressive disorder with a minimum of 2 past episodes . Of these , 84 achieved remission ( 52.5 % ) and were assigned to 1 of the 3 study conditions . INTERVENTIONS Patients in remission discontinued their antidepressants and attended 8 weekly group sessions of MBCT , continued taking their therapeutic dose of antidepressant medication , or discontinued active medication and were switched to placebo . MAIN OUTCOME MEASURE Relapse was defined as a return , for at least 2 weeks , of symptoms sufficient to meet the criteria for major depression on module A of the Structured Clinical Interview for DSM-IV . RESULTS Intention-to-treat analyses showed a significant interaction between the quality of acute-phase remission and subsequent prevention of relapse in r and omized patients ( P = .03 ) . Among unstable remitters ( 1 or more Hamilton Rating Scale for Depression score > 7 during remission ) , patients in both MBCT and maintenance treatment showed a 73 % decrease in hazard compared with placebo ( P = .03 ) , whereas for stable remitters ( all Hamilton Rating Scale for Depression scores ≤7 during remission ) there were no group differences in survival . CONCLUSIONS For depressed patients achieving stable or unstable clinical remission , MBCT offers protection against relapse/recurrence on a par with that of maintenance antidepressant pharmacotherapy . Our data also highlight the importance of maintaining at least 1 long-term active treatment in unstable remitters This study evaluated mindfulness-based cognitive therapy ( MBCT ) , a group intervention design ed to train recovered recurrently depressed patients to disengage from dysphoria-activated depressogenic thinking that may mediate relapse/recurrence . Recovered recurrently depressed patients ( n = 145 ) were r and omized to continue with treatment as usual or , in addition , to receive MBCT .  Relapse/recurrence to major depression was assessed over a 60-week study period . For patients with 3 or more previous episodes of depression ( 77 % of the sample ) , MBCT significantly reduced risk of relapse/recurrence . For patients with only 2 previous episodes , MBCT did not reduce relapse/recurrence .  MBCT offers a promising cost-efficient psychological approach to preventing relapse/recurrence in recovered recurrently depressed patients OBJECTIVE To document the short-term efficacy of omega-3 supplementation in reducing depressive symptoms in patients experiencing a major depressive episode ( MDE ) . METHOD Inclusive , double-blind , r and omized , controlled , 8-week , parallel-group trial , conducted October 17 , 2005 through January 30 , 2009 in 8 Canadian academic and 
    Output:
    
The strongest evidence currently exists for  mindfulness-based interventions and St. John ’s Wort ( SJW )  as monotherapies , and there is relatively strong evidence to support the use of omega-3 fatty acids and exercise as adjunct therapies .
However , there remains an overall lack of method ologically rigorous research to support the efficacy of many other IntM techniques .