***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 Depression is one of the most disabling diseases , and causes a significant burden both to the individual and to society . WHO data suggests that depression causes 6 % of the burden of all diseases in Europe in terms of disability adjusted life years ( DALYs ) . Yet , the knowledge of the economic impact of depression has been relatively little research ed in Europe . AIMS OF THE STUDY The present study aims at estimating the total cost of depression  in Europe based on published epidemiologic and economic evidence . METHODS A model was developed to combine epidemiological and economic data on depression in Europe to estimate the cost . The model was populated with data collected from extensive literature review s of the epidemiology and economic burden of depression in Europe . The cost data was calculated as annual cost per patient , and epidemiologic data was reported as 12-month prevalence estimates . National and international statistics for the model were retrieved from the OECD and Eurostat data bases . The aggregated annual cost estimates were presented in Euro for 2004 . RESULTS In 28 countries with a population of 466 million , at least 21 million were affected by depression . The total annual cost of depression in Europe was estimated at Euro 118 billion in 2004 , which corresponds to a cost of Euro 253 per inhabitant . Direct costs alone totalled dollar 42 billion , comprised of outpatient care ( Euro 22 billion ) , drug cost ( Euro 9 billion ) and hospitalization ( Euro 10 billion ) . Indirect costs due to morbidity and mortality were estimated at Euro 76 billion . This makes depression the most costly brain disorder in Europe , accounting for 33 % of the total cost . The cost of depression corresponds to 1 % of the total economy of Europe ( GDP ) . DISCUSSION Our cost results are in good agreement with previous research findings . The cost estimates in the present study are based on model simulations for countries where no data was available . The predictability of our model is limited to the accuracy of the input data employed . As there is no earlier cost-of-illness study conducted on depression in Europe , it is , however , difficult to evaluate the validity of our results for individual countries and thus further research is needed . CONCLUSION The cost of depression poses a significant economic burden to European society . The simulation model employed shows good predictability of the cost of depression in Europe and is a novel approach to estimate the cost-of-illness in Europe . IMPLICATION S FOR HEALTH CARE PROVISION AND POLICIES : Health and social care policy and commissioning must be evidence -based . The empirical results from this study confirm previous findings , that depression is a major concern to the economic welfare in Europe which has consequences to both healthcare providers and policy makers . One important way to stop this explosion in cost is through increased research efforts in the field . Moreover , better detection , prevention , treatment and patient management are imperatives to reduce the burden of depression and its costs . Mental healthcare policies and better access to healthcare for mentally ill are other challenges to improve for Europe . IMPLICATION S FOR FURTHER RESEARCH This study has identified several research gaps which are of interest for future research . In order to better underst and the impact of depression to European society long-term prospect i ve epidemiology and cost-of-illness studies are needed . In particular data is lacking for Central European countries . On the basis of our findings , further economic evaluations of treatments for depression are necessary in order to ensure a cost-effective use of European healthcare budgets BACKGROUND Health-related quality of life ( HRQoL ) data in depression are limited . We studied the impact of antidepressant ( AD ) treatment on HRQoL outcomes in depressed patients and investigated factors associated with these outcomes in routine practice setting s. METHODS The Factors Influencing Depression Endpoints Research ( FINDER ) study was a 6-month , European , prospect i ve , observational study , design ed to estimate HRQoL in 3468 adult patients with a clinical ly diagnosed episode of depression at baseline and at 3 and 6-months after commencing AD treatment .  HRQoL was assessed by the Medical Outcome Short-Form ( 36 ) Health Survey ( SF-36 ) and European Quality of Life-5 Dimensions ( EQ-5D ) . Regression analysis identified baseline and treatment variables independently and significantly associated with HRQoL outcomes . RESULTS Most HRQoL improvement occurred within 3 months of starting treatment . Better HRQoL outcomes were strongly associated with fewer somatic symptoms at baseline , AD treatment taken and not switching within AD groups . Education and occupational status were also important . Depression variables ( number of previous depressions and current episode duration ) were consistently associated with worse HRQoL outcomes . Self-rated depression severity was associated with poorer outcomes on the SF-36 mental component only . LIMITATIONS As this was an observational study , the important finding that between and within AD group switching impacted HRQoL will need to be investigated in more controlled setting s. CONCLUSIONS Receiving an AD treatment was associated with large improvements in HRQoL , but switching within AD groups was consistently associated with poorer outcomes . Somatic symptoms , including painful symptoms , are often present in depressed patients and appear to negatively impact HRQoL outcomes OBJECTIVE To assess the efficacy of duloxetine 60 - 120 mg once daily in the prevention of depressive recurrence in out patients with recurrent major depressive disorder ( MDD ) . METHOD Eligible patients with at least 3 episodes of MDD ( DSM-IV diagnosis ) in the past 5 years received open-label duloxetine 60 - 120 mg/day for up to 34 weeks . Patients meeting response criteria were then r and omly assigned to either duloxetine or placebo for up to 52 weeks of double-blind maintenance treatment . The primary outcome measure was time to recurrence of a major depressive episode . Safety and tolerability were assessed via analysis of treatment-emergent adverse events ( TEAEs ) , vital signs , weight , and laboratory measures .  Patients were recruited from 43 study centers in 5 European countries ( France , Germany , Italy , Russia , and Sweden ) and the United States . The study was conducted from March 2005 to January 2008 . RESULTS A total of 288 patients were r and omly assigned to duloxetine or placebo .  Time to a depressive recurrence was significantly longer in duloxetine-treated patients compared with placebo-treated patients ( p < .001 ) . During the double-blind maintenance phase , 33.1 % of placebo-treated patients experienced a depressive recurrence compared with 14.4 % of duloxetine-treated patients ( p < .001 ) . There were no significant differences between treatment groups in TEAEs , discontinuations due to adverse events , vital signs , or weight . CONCLUSIONS Treatment with duloxetine was associated with a longer time to depressive recurrence and a significantly lower recurrence rate compared with placebo . TRIALS REGISTRATION ( Clinical Trials.gov ) Identifier : NCT00105989 Background . The main aim of this study is to investigate the role that social , environmental and personal factors play in explaining change in function in patients with major depressive disorder ( MDD ) . Method . The sample of the current study comes from a naturalistic and prospect i ve cohort study of patients starting antidepressant treatment in one distinct health area of Madrid . A total of 97 adults ( 18 years or older ) with MDD have been followed up three points in time and evaluated with the  WHO_DAS II  and instruments that assessed socio-demographic characteristics , clinical and context ual factors . Data were analysed using multilevel modelling statistical approach to repeated measures data . Results . Change of severity of depression symptoms was the main explanatory factor for change in patient 's functioning , accounting for 32 % of the variance of functioning over time . Context ual factors ( environmental and personal variables ) , including gender , work status , societal attitudes , health satisfaction and quality of life accounted for 20 % of the functioning variance after controlling for the effect of health condition variables . Conclusions . Social , environmental and personal factors seem to play a significant role in explaining depressed patients ' functioning after controlling for health condition/medical factors OBJECTIVES This study provides an empirical evaluation of Cognitive Behaviour Therapy ( CBT ) alone vs Treatment as usual ( TAU ) alone ( generally pharmacotherapy ) for late life depression in a UK primary care setting . METHOD General Practitioners in Fife and Glasgow referred 114 Participants to the study with 44 meeting inclusion criteria and 40 participants providing data that permitted analysis . All participants had a diagnosis of mild to moderate Major Depressive Episode . Participants were r and omly allocated to receive either TAU alone or CBT alone . RESULTS Participants in both treatment conditions benefited from treatment with reduced scores on primary measures of mood at end of treatment and at 6 months follow-up from the end of treatment . When adjusting for differences in baseline scores , gender and living arrangements , CBT may be beneficial in levels of hopelessness at 6 months follow-up . When evaluating outcome in terms of numbers of participants meeting Research Diagnostic Criteria for depression , there were significant differences favouring the CBT condition at the end of treatment and at 3 months follow-up after treatment . CONCLUSIONS CBT alone and TAU alone produced significant reductions in depressive symptoms at the end of treatment and at 6 months follow-up . CBT on its own is shown to be an effective treatment procedure for mild to moderate late life depression and has utility as a treatment alternative for older people who can not or will not tolerate physical treatment approaches for depression Objective : In this study , we tested the efficacy of bright light therapy as an adjunct to antidepressant treatment ( sertraline ) in patients with non‐seasonal major depression OBJECTIVE Patients ( 30 - 50 % ) with non-psychotic major depression will not respond despite an adequate trial of antidepressant medication . This study evaluated risperidone as an augmenting agent for patients who failed or only partially responded to an adequate trial of an antidepressant medication . METHOD Ninety-seven patients with unipolar non-psychotic major depression who were not responsive to antidepressant monotherapy were r and omized to risperidone ( 0.5 - 3mg/day ) or placebo augmentation in a four-week , double-blind , placebo controlled treatment trial . The primary outcome measure was remission defined by a score of < or = 10 on the Montgomery-Asberg Depression Rating Scale ( MADRS ) . Secondary outcomes measures were the Hamilton Rating Scale for Depression , the Clinician Global Impression of Severity scale and the overall satisfaction item of the Quality of Life and Enjoyment Question naire . RESULTS Subjects in both treatment groups improved significantly over time . The odds of remitting were significantly better for patients in the risperidone vs. placebo arm ( OR=3.33 , p=.011 ) . At the end of 4 weeks of treatment 52 % of the risperidone augmentation group remitted ( MADRS < or = 10 ) compared to 24 % of the placebo augmentation group ( CMH(1)=6.48 , p=.011 ) , but the two groups were converging . Patients in the risperidone group also reported significantly more improvement in quality -of-life than patients in the placebo group . There were no between-group differences in the number of adverse events reported , however , weight gain was significantly higher in the group receiving risperidone . CONCLUSION Augmentation of an antidepressant with risperidone for patients with difficult-to-treat depression leads to more rapid response and a higher remission rate and better quality -of-life Background Depressive disorders are common , cause considerable disability , and do not always respond to st and ard therapy ( psychotherapy , antidepressants ) . Anthroposophic treatment for depression differs from ordinary treatment in the use of artistic and physical therapies and special medication . We studied clinical outcomes of anthroposophic therapy for depression . Methods 97 out patients from 42 medical practice s in Germany participated in a prospect i ve cohort study . Patients were aged 20–69 years and were referred to anthroposophic therapies ( art , eurythmy movement exercises , or rhythmical massage ) or started physician-provided anthroposophic therapy ( counselling , medication ) for depression : depressed mood , at least two of six further depressive symptoms , minimum duration six months , Center for Epidemiological Studies Depression Scale , German version ( CES-D , range 0–60 points ) of at least 24 points . Outcomes were CES-D ( primary outcome ) and SF-36 after 3 , 6 , 12 , 18 , 24 , and 48 months . Data were collected from July 1998 to March 2005 . Results Median number of art/eurythmy/massage sessions was 14 ( interquartile range 12–22 ) , median therapy duration was 137 ( 91–212 ) days . All outcomes improved significantly between baseline and all subsequent follow-ups . Improvements from baseline to 12 months were : CES-D from mean ( st and ard deviation ) 34.77 ( 8.21 ) to 19.55 ( 13.12 ) ( p < 0.001 ) , SF-36 Mental Component Summary from 26.11 ( 7.98 ) to 39.15 ( 12.08 ) ( p < 0.001 ) , and SF-36 Physical Component Summary from 43.78 ( 9.46 ) to 48.79 ( 9.00 ) ( p < 0.001 ) . All these improvements were maintained until last follow-up . At 12-month follow-up and later , 52%–56 % of evaluable patients ( 35%–42 % of all patients ) were improved by at least 50 % of baseline CES-D 
    Output:
    
Medication played a dual role as determinant of onset and change in some psychosocial areas , e.g. in pain , sleep , and energy and drive .
The present systematic review provides information on the psychosocial difficulties that depressive patients face in their daily lives .