***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 
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    ***EXAMPLES*** 
    Input: This pilot study investigated the effectiveness of Mindfulness-Based Cognitive Therapy ( MBCT ) , a treatment combining mindfulness meditation and interventions taken from cognitive therapy , in patients suffering from chronic-recurrent depression . Currently symptomatic patients with at least three previous episodes of depression and a history of suicidal ideation were r and omly allocated to receive either MBCT delivered in addition to treatment-as-usual ( TAU ; N = 14 completers ) or TAU alone ( N = 14 completers ) . Depressive symptoms and diagnostic status were assessed before and after treatment phase . Self-reported symptoms of depression decreased from severe to mild levels in the MBCT group while there was no significant change in the TAU group . Similarly , numbers of patients meeting full criteria for depression decreased significantly more in the MBCT group than in the TAU group . Results are consistent with previous uncontrolled studies . Although based on a small sample and , therefore , limited in their generalizability , they provide further preliminary evidence that MBCT can be used to successfully reduce current symptoms in patients suffering from a protracted course of the disorder Dysthymia is one of the most prevalent problems in primary care , especially in the elderly . In this study , we evaluated the demographic and clinical predictors of nonresponse to treatment in primary care patients with dysthymia . The study sample consisted of 338 primary care patients meeting DSMIII-R criteria for dysthymia from 4 diverse geographic sites in a r and omized controlled 11-week trial of paroxetine , problem-solving therapy or placebo .  Patients who attended at least 4 treatment sessions were used in the analysis . A score of less than 7 on the Hamilton was defined as a positive response to treatment . By Week 11 , 52.2 % of patients had a positive response to treatment . Patients with lower levels of education ( odds ratio 0.44 , 95 % CI 0.23 , 0.86 ) , higher scores on the personality dimension of neuroticism ( odds ratio 0.58 , 95 % CI 0.36 , 0.92 ) and those with more severe medical illness ( odds ratio 0.97 , 95 % CI 0.95 , 0.99 ) were less likely to recover with either active or placebo treatments . Elderly women ( > 60 years of age ; odds ratio 0.19 , 95 % CI 0.05 , 0.66 ) were also less likely to respond to all treatments ; however , females had a significantly higher response to placebo treatment compared to males . The factors associated with lack of response to treatment included lower-levels of education , high neuroticism , more severe medical illness and being an older female . This analysis is based on patients agreeing to participate in a r and omized controlled trial , limiting representativeness of the sample , however , the demographic and clinical characteristics are common in elderly depressed primary care patients , and may signal the need for increased mental health specialty consultation A total of 117 depressed clients , stratified for severity , completed 8 or 16 sessions of manualized treatment , either cognitive-behavioral psychotherapy ( CB ) or psychodynamic-interpersonal psychotherapy ( PI ) . Each of 5 clinician-investigators treated clients in all 4 treatment conditions . On most measures , CB and PI were equally effective , irrespective of the severity of depression or the duration of treatment . However , there was evidence of some advantage to CB on the Beck Depression Inventory ( Beck , Ward , Mendelson , Mock , & Erbaugh , 1961 ) . There was no evidence that CB 's effects were more rapid than those of PI , nor did the effects of each treatment method vary according to the severity of depression . There was no overall advantage to 16-session treatment over 8-session treatment . However , those presenting with relatively severe depression improved substantially more after 16 than after 8 sessions 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 Abstract Objectives : To determine whether problem solving treatment combined with antidepressant medication is more effective than either treatment alone in the management of  major depression in primary care . To assess the effectiveness of problem solving treatment when given by practice nurses compared with general practitioners when both have been trained in the technique . Design : R and omised controlled trial with four treatment groups . Setting : Primary care in Oxfordshire . Participants : Patients aged 18 - 65 years with major depression on the research diagnostic criteria —a score of 13 or more on the 17 item Hamilton rating scale for depression and a minimum duration of illness of four weeks . Interventions : Problem solving treatment by research general practitioner or research practice nurse or antidepressant medication or a combination of problem solving treatment and antidepressant medication . Main outcome measures : Hamilton rating scale for depression , Beck depression inventory , clinical interview schedule ( revised ) , and the modified social adjustment schedule assessed at 6 , 12 , and 52 weeks . Results : Patients in all groups showed a clear improvement over 12 weeks . The combination of problem solving treatment and antidepressant medication was no more effective than either treatment alone . There was no difference in outcome irrespective of who delivered the problem solving treatment . Conclusions : Problem solving treatment is an effective treatment for depressive disorders in primary care . The treatment can be delivered by suitably trained practice nurses or general practitioners . The combination of this treatment with antidepressant medication is no more effective than either treatment alone . Key messages Problem solving treatment is an effective treatment for depressive disorders in primary care Problem solving treatment can be delivered by suitably trained practice nurses as effectively as by general practitioners The combination of problem solving treatment and antidepressant medication is no more effective than either treatment alone Problem solving treatment is most likely to benefit patients who have a depressive disorder of moderate severity and who wish to participate in an active psychological Abstract Objective : To compare the clinical effectiveness of general practitioner care and two general practice based psychological therapies for depressed patients . Design : Prospect i ve , controlled trial with r and omised and patient preference allocation arms . Setting : General practice s in London and greater Manchester . Participants : 464 of 627 patients presenting with depression or mixed anxiety and depression were suitable for inclusion . Interventions : Usual general practitioner care or up to 12 sessions of non-directive counselling or cognitive-behaviour therapy provided by therapists . Main outcome measures : Beck depression inventory scores , other psychiatric symptoms , social functioning , and satisfaction with treatment measured at baseline and at 4 and 12 months . Results : 197 patients were r and omly assigned to treatment , 137 chose their treatment , and 130 were r and omised only between the two psychological therapies . All groups improved significantly over time . At four months , patients r and omised to non-directive counselling or cognitive-behaviour therapy improved more in terms of the Beck depression inventory ( mean ( SD ) scores 12.9 ( 9.3 ) and 14.3 ( 10.8 ) respectively ) than those r and omised to usual general practitioner care ( 18.3 ( 12.4 ) ) . However , there was no significant difference between the two therapies . There were no significant differences between the three treatment groups at 12 months ( Beck depression scores 11.8 ( 9.6 ) , 11.4 ( 10.8 ) , and 12.1 ( 10.3 ) for non-directive counselling , cognitive-behaviour therapy , and general practitioner care ) . Conclusions : Psychological therapy was a more effective treatment for depression than usual general practitioner care in the short term , but after one year there was no difference in outcome CONTEXT Insufficient evidence exists for recommendation of specific effective treatments for older primary care patients with minor depression or dysthymia . OBJECTIVE To compare the effectiveness of pharmacotherapy and psychotherapy in primary care setting s among older persons with minor depression or dysthymia . DESIGN R and omized , placebo-controlled trial ( November 1995-August 1998 ) . SETTING Four geographically and clinical ly diverse primary care practice s. PARTICIPANTS A total of 415 primary care patients ( mean age , 71 years ) with minor depression ( n = 204 ) or dysthymia ( n = 211 ) and a Hamilton Depression Rating Scale ( HDRS ) score of at least 10 were r and omized ; 311 ( 74.9 % ) completed all study visits . INTERVENTIONS Patients were r and omly assigned to receive paroxetine ( n = 137 ) or placebo ( n = 140 ) , starting at 10 mg/d and titrated to a maximum of 40 mg/d , or problem-solving treatment- primary care ( PST-PC ; n = 138 ) . For the paroxetine and placebo groups , the 6 visits over 11 weeks included general support and symptom and adverse effects monitoring ; for the PST-PC group , visits were for psychotherapy . MAIN OUTCOME MEASURES Depressive symptoms , by the 20-item Hopkins Symptom Checklist Depression Scale ( HSCL-D-20 ) and the HDRS ; and functional status , by the Medical Outcomes Study Short-Form 36 ( SF-36 ) physical and mental components . RESULTS Paroxetine patients showed greater ( difference in mean [ SE ] 11-week change in HSCL-D-20 scores , 0.21 [ 0 . 07 ] ; P = .004 ) symptom resolution than placebo patients . Patients treated with PST-PC did not show more improvement than placebo ( difference in mean [ SE ] change in HSCL-D-20 scores , 0.11 [ 0.13 ] ; P = .13 ) , but their symptoms improved more rapidly than those of placebo patients during the latter treatment weeks ( P = .01 ) . For dysthymia , paroxetine improved mental health functioning vs placebo among patients whose baseline functioning was high ( difference in mean [ SE ] change in SF-36 mental component scores , 5.8 [ 2.02 ] ; P = . 01 ) or intermediate ( difference in mean [ SE ] change in SF-36 mental component scores , 4.4 [ 1.74 ] ; P = .03 ) . Mental health functioning in dysthymia patients was not significantly improved by PST-PC compared with placebo ( P>/=.12 for low- , intermediate- , and high-functioning groups ) . For minor depression , both paroxetine and PST-PC improved mental health functioning in patients in the lowest tertile of baseline functioning ( difference vs placebo in mean [ SE ] change in SF-36 mental component scores , 4.7 [ 2.03 ] for those taking paroxetine ; 4.7 [ 1.96 ] for the PST-PC treatment ; P = .02 vs placebo ) . CONCLUSIONS Paroxetine showed moderate benefit for depressive symptoms and mental health function in elderly patients with dysthymia and more severely impaired elderly patients with minor depression . The benefits of PST-PC were smaller , had slower onset , and were more subject to site differences than those of paroxetine OBJECTIVE The research ers evaluated the effectiveness of paroxetine and Problem-Solving Treatment for Primary Care ( PST-PC ) for patients with minor depression or dysthymia . STUDY DESIGN This was an 11-week r and omized placebo-controlled trial conducted in primary care practice s in 2 communities ( Lebanon , NH , and Seattle , Wash ) .  Paroxetine ( n=80 ) or placebo ( n=81 ) therapy was started at 10 mg per day and increased to a maximum 40 mg per day , or PST-PC was provided ( n=80 ) . There were 6 scheduled visits for all treatment conditions . POPULATION A total of 241 primary care patients with minor depression ( n=114 ) or dysthymia ( n=127 ) were included . Of these , 191 patients ( 79.3 % ) completed all treatment visits . OUTCOMES Depressive symptoms were measured using the 20-item Hopkins Depression Scale ( HSCL-D-20 ) . Remission was scored on the Hamilton Depression Rating Scale ( HDRS ) as less than or equal to 6 at 11 weeks . Functional status was measured with the physical health component ( PHC ) and mental health component ( MHC ) of the 36-item Medical Outcomes Study Short Form . RESULTS All treatment conditions showed a significant decline in depressive symptoms over the 11-week period . There were no significant differences between the interventions or by diagnosis . For dysthymia the remission rate for paroxetine ( 80 % ) and PST-PC ( 5 
    Output:
    
Conclusions : Depression can be efficaciously treated with six to eight sessions of psychotherapy , particularly cognitive behavioral therapy and problem-solving therapy .
Access to non-pharmacologic treatments for depression could be improved by training healthcare providers to deliver brief psychotherapies