***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*** 
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    Input: OBJECTIVE The authors examined which , if any , research design features and patient characteristics would significantly differ between successful and unsuccessful antidepressant trials . METHOD Clinical trial data were review ed for nine antidepressants approved by the Food and Drug Administration between 1985 and 2000 . From the antidepressant research programs on these medications , 52 clinical trials were included in the study . The authors evaluated trial design features , patient characteristics , and difference in response between placebo and antidepressant . RESULTS Nine trial design features and patient characteristics were present in the research programs for all nine of the antidepressants . The severity of depressive symptoms before patient r and omization , the dosing schedule ( flexible versus fixed ) , the number of treatment arms , and the percentage of female patients  were significantly associated with the difference in response to antidepressant and placebo . The duration of the antidepressant trial , number of patients per treatment arm , number of sites , and mean age of the patients were similar in successful trials ( with a greater antidepressant-placebo difference ) and less successful trials ( with a smaller antidepressant-placebo difference ) . CONCLUSIONS These findings may help in the design of future antidepressant trials Pharmacotherapy and psychotherapy are generally effective treatments for major depressive disorder ( MDD ) ; however , research suggests that patient preferences may influence outcomes . We examined the effects of treatment preference on attrition , therapeutic alliance , and change in depressive severity in a longitudinal r and omized clinical trial comparing pharmacotherapy and psychotherapy . Prior to r and omization , 106 individuals with MDD reported whether they preferred psychotherapy , antidepressant medication , or had no preference .  A mismatch between preferred and actual treatment was associated with greater likelihood of attrition , fewer expected visits attended , and a less positive working alliance at session 2 . There was a significant indirect effect of preference match on depression outcomes , primarily via effects of attendance . These findings highlight the importance of addressing patient preferences , particularly in regard to patient engagement , in the treatment of MDD OBJECTIVE The authors examined the association of treatment preferences with treatment initiation , adherence , and clinical outcome among nonsenior adult and senior primary care patients with depression . METHODS Sixty primary care participants meeting DSM-IV criteria for major depression were r and omly assigned to receive treatment congruent or incongruent with their primary stated preference . Participants received either 20 weeks of escitalopram , with monitoring by a care manager , or 12 weekly sessions of interpersonal psychotherapy followed by two monthly booster sessions .  Adherence to treatment and depression severity were reassessed at weeks 4 , 8 , 12 , and 24 . RESULTS Participants expressed stronger preferences for psychotherapy  than for  antidepressant medication . Preference strength was a more sensitive measure of outcome than was congruence versus incongruence of preference with the assigned treatment . Across age groups , preference strength was significantly associated with treatment initiation and 12-week adherence rate but not with depression severity or remission . CONCLUSIONS A continuous measure of preference strength may be a more useful measure in clinical practice than preferences per se . Future research should focus on whether and how greater facilitation of the treatment decision-making process between patient and clinician influences clinical outcome Rejection of catheters is generally thought to be due to patients pulling out their catheters , but we found circumstantial evidence for this in only one third of cases . Some catheters with smaller balloons drop out spontaneously , perhaps owing to laxity of the pelvic floor or urethral dilatation caused by repeated catheterisation , and others are expelled forcibly , presumably owing to uninhibited contractions of the bladder . Urinary catheters may therefore drop out , be pushed out , or be pulled out . The life expectancy of catheters in this group of patients suggests the type of catheter that should be used . We recommend cheaper latex catheters and think that expensive " long life " silicon catheters are inappropriate in most long stay patients . Rejection of catheters is common in poorly mobile old people with cognitive impairment . It is associated with urethral trauma and may result in septicaemia . Long term catheterisation should therefore be considered only when other methods to promote continence and provide comfort have failed.3 Further work is needed to determine why some patients pull out their catheters and whether bladder stabilising drugs might reduce episodes of spontaneous rejection of catheters Background : Clinicians and research ers have question ed whether participants in r and omized control trials ( RCTs ) are representative of patients in the broader clinical population . Method : We compared the demographic , clinical , and personality characteristics of patients ( N=256 ) with major depressive disorder ( MDD ) receiving antidepressant medication or interpersonal therapy as part of an RCT investigation ( n=105 ) versus in a clinic ( n=151 ) . The RCT and clinic protocol s were identical with the exception of recruitment procedures ( advertisement versus physician referral ) and assignment to treatment ( r and omized versus nonr and omized ) . Results : No significant differences emerged between the RCT participants and clinic patients for sex , age , marital status , and education . Overall , clinic patients were no more severely depressed compared to RCT participants ; there was , however , a significant interaction effect . Response rates were significantly higher for RCT participants versus clinic patients . Those participating in the RCT scored significantly higher on a personality scale assessing preference for novel experiences compared to those in the clinic . Conclusions : Differences in clinical and personality variables between those receiving treatment for MDD as part of an RCT versus in a clinic exist ; however , the clinical significance of these differences remains in question , as these variables were unrelated to treatment outcome . Depression and Anxiety , 2009 . © 2009 Wiley‐Liss , A new wave of meta-analyses suggests that antidepressants are no better than placebo for major depressive disorder ( MDD ) , and therefore , antidepressants not only do n't work , but even worse , they harm patients because of the risk of adverse effects . The authors analyzed data from all antidepressant studies su bmi tted to the Food and Drug Administration for registration ( including failed studies with inordinately high placebo reponses ) , or used a met analysis filter and selected those few studies that meet those criteria . In aggregate , the data , at best , show a clinical ly trivial advantage of the antidepressants over placebo in acute r and omized trials . However , their conclusions range from antidepressants do n't work at all to the antidepressants should be reserved only for the most seriously depressed patients . Kirsch is capitalizing on this trend with his recently published book . I view this debate through my perspective of over 25 years of clinical experience , serving as a rater for clinical trials , planning and conducting National Institute of Mental Health and industry efficacy and effectiveness clinical trials , and consulting to the pharmaceutical industry . The real story , I believe , is a bit more complicated . Give everyone with fever  penicillin and many will improve . Compare penicillin to placebo and on average , you would find no difference . Why ? Most people with fever have viral infections or non-penicillin sensitive bacterial infections that are time limited ( eg , common upper respiratory infections ) . One could reasonably conclude that penicillin does n't work and we should all take chicken soup instead . Give everyone with MDD an antidepressant and many will improve . Compare any given antidepressant to placebo and on average , you should find no difference . Yet , a difference does exist and even if the trials have an overall small effect size in favor of antidepressants , it is not quite accurate to state that antidepressants are equal to placebo . Why ? If that were true , then in a third of the trials placebo would beat antidepressants , in a third of the trials antidepressants would beat placebo , and the remaining third of the trials it would be a tie . MDD is analogous to fever . It is a heterogeneous , nonspecific syndrome that is the final common pathway of multiple dysregulated psychological and brain processes . Genetic epidemiological studies strongly suggest that stress is a causal factor and that the persistence or The assumption that depressed patients who are assigned to placebo in antidepressant clinical trials are exposed to substantial morbidity and mortality has not been based on research data . Because of worldwide concern about placebo use and the implication s of our earlier findings of no increased suicide risk in  placebo-treated  patients , we conducted a replication study in a new patient sample . We assessed suicide risk and symptom reduction among  placebo-treated patients participating in antidepressant clinical trials for two recently approved antidepressants  , venlafaxine ER and citalopram , which were unavailable during our previous study . Among 23,201 participant patients , 32 committed suicide and 172 attempted suicide . Rates of suicide and attempted suicide did not differ significantly among the placebo- and drug-treated groups . Based on patient exposure years , annual rates of suicide and attempted suicide were 0.5 and 6.7 % with placebo , 0.9 % with active comparator ( rates for attempted suicide are unavailable ) , and 0.6 and 6.3 % with investigational antidepressants . Symptom reduction was 47.9 % with investigational drugs ( n = 1172 ) , 47.5 % with active comparators ( n = 161 ) , and 35.5 % with placebo ( n = 606 ) . These data may inform discussion s about the use of placebo in antidepressant clinical trials 
    Output:
    
Differences were not seen with psychotherapy compared to antidepressants , alternative therapies or active intervention controls .
CONCLUSIONS In conclusion , the combination of psychotherapy and antidepressants for depression may provide a slight advantage whereas antidepressants alone and psychotherapy alone are not significantly different from alternative therapies or active intervention controls .
These data suggest that type of treatment offered is less important than getting depressed patients involved in an active therapeutic program .