***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: The authors evaluated a six-session interactive computer cognitive-behavioral treatment program given to volunteer patients who met Research Diagnostic Criteria ( RDC ) for major or minor depressive disorder . Patients were r and omly assigned to computer-administered cognitive-behavioral treatment , to therapist-administered cognitive-behavioral treatment , or to a waiting-list control condition . After treatment and at 2-month follow-up , both treatment groups had improved significantly more than control subjects in their scores on the Beck Depression Inventory , SCL-90-R depression and global scales , Hamilton Rating Scale for Depression , and Automatic Thoughts Question naire . The treatment groups did not differ from each other at either time OBJECTIVE To design a treatment manual and adherence measure for attachment-based family therapy ( ABFT ) for adolescent depression and to collect pilot data on the treatment 's efficacy . METHOD Over a period of 2 years , 32 adolescents meeting criteria for major depressive disorder ( MDD ) were r and omly assigned to 12 weeks of ABFT or a 6-week , minimal-contact , waitlist control group . The sample was 78 % female and 69 % African American ; 69 % were from low-income , inner-city communities . RESULTS At post-treatment , 81 % of the patients treated with ABFT no longer met criteria for MDD , in contrast with 47 % of patients in the waitlist group . Mixed factorial analyses of variance revealed that , compared with the waitlist group , patients treated with ABFT showed a significantly greater reduction in both depressive and anxiety symptoms and family conflict . Of the 15 treated cases assessed at the follow-up , 13 patients ( 87 % ) continued to not meet criteria for MDD 6 months after treatment ended . CONCLUSIONS ABFT appears to be a promising treatment and worthy of further development Les auteurs ont trouve une efficacite semblable pour la therapie cognitivo-comportementale et pour la relaxation , dans le traitement de la depression chez In this study , the authors examined prospect ively the 24-month natural course of remission from major depressive disorder ( MDD ) as a function of personality disorder ( PD ) comorbidity . In 302 participants ( 196 women , 106 men ) , psychiatric and PDs were assessed  at baseline with diagnostic interviews , and the course of MDD was assessed with the Longitudinal Interval Follow-Up Evaluation at 6- , 12- , and 24-month follow-ups .  Survival analyses revealed an overall 24-month remission rate of 73.5 % for MDD that differed little by gender . Participants with MDD who had certain forms of coexisting PD psychopathology ( schizotypal , borderline , or avoidant ) as their primary PD diagnoses had a significantly longer time to remission from MDD than did patients with MDD without any PD . These PDs emerged as robust predictors of slowed remission from MDD even when controlling for other negative prognostic predictors OBJECTIVE The purpose of this study was to assess the differences between early ( EDs ) , late drop-outs ( LDs ) and completers in the continuation phase of a clinical trial . METHODS The authors studied 119 out patients who were treatment responders in an 8-week open trial with fluoxetine 20 mg/day , and who were then enrolled in a 26-week clinical trial comparing the efficacy of fluoxetine versus fluoxetine and cognitive behavior therapy ( CBT ) .  Patients were assessed using the Structured Clinical Interview for DSM-III-R-Axis I ( SCID-Patient Edition ) , Hamilton Depression Rating Scale ( HAMD-17 ) and the following self-rated scales : Beck Depression Inventory ( BDI ) , Beck Hopelessness Scale ( BHS ) , Anxiety Sensitivity Index ( ASI ) and the Symptom Question naire ( SQ ) prior to starting the 26-week continuation phase . We defined ' EDs ' as patients who dropped out either at or prior to Visit 2 ( which was at 2 months into the 6-month continuation phase ) ; those dropping out at Visit 3 or later were defined as ' LDs ' ( ED < or = 2 months and LD > 2 months ) . The Kruskal-Wallis and the Mann-Whitney U tests were used for data analysis . RESULTS Of the 119 out patients , 83 were completers ( mean age : 42.1 + /- 9.0 years , 46 [ 55 % ] women , age of onset of major depressive disorder [ MDD ] = 24.3 + /- 12.5 years ) , 11 were EDs ( mean age : 38.1 + /- 13.0 years , 4 [ 36 % ] women , age of onset of MDD = 22.0 + /- 11.1 years ) and 25 were LDs ( mean age : 35.2 + /- 10.4 years , 12 [ 48 % ] women , age of onset of MDD = 24.6 + /- 11.6 years ) . LDs were significantly younger than completers ( P<.01 ) . There was no significant difference in age between EDs and LDs , nor between EDs and completers . EDs and completers were depressed for a longer period of time compared to LDs ( P<.05 ) . EDs also had significantly greater overall impairment in social adjustment compared to completers ( P<.05 ) . CONCLUSIONS Our data suggest that LDs are significantly younger than completers , although age is not a predictor between EDs and LDs . Further , EDs and completers are depressed for a longer duration than LDs , and EDs have significantly greater social impairment compared to completers . Our study identified some patient characteristics significantly associated with dropping out of a long-term clinical trial OBJECTIVE This paper presents retrospective and prospect i ve data regarding time course parameters of major depressive disorder ( MDD ) in community adolescents ( 14 to 18 years old ) : time to onset and recovery and , among those who recovered , time to recurrence . METHOD Diagnostic interviews were conducted with 1,508 r and omly selected high school students . Three hundred sixty-two had experienced at least one past or current episode of MDD . RESULTS Mean age at onset of first episode was 14.9 ( SD = 2.8 ) . Early MDD onset was associated with female gender and suicidal ideation . MDD episode duration ranged from 2 to 520 weeks , with a mean of 26.4 weeks ( SE = 3.3 ) and a median of 8.0 weeks . Longer episodes were observed in those whose depression occurred early ( at or before age 15 ) , whose depression had been accompanied by suicidal ideation , and for whom treatment was sought . Of the adolescents who recovered , 5 % relapsed within 6 months , 12 % within 1 year , and approximately 33 % within 4 years . Shorter time to recurrence was associated with prior suicidal ideation and attempt and with later first onset . CONCLUSIONS Risk of MDD is low in childhood , increasing substantially with adolescence . The majority of episodes in community adolescents are relatively brief , although the risk of recurrence is substantial . Suicidal behaviors are important mediators of episode duration and of recurrence The objectives of the present report were : a ) to determine the spontaneous remission rate in depressed out patients who do not receive antidepressant medication ; b ) to develop a novel method for obtaining a control group that can be used to gauge the effectiveness of antidepressant medication in clinical practice ; and c ) to compare response rates from the present sample with outcomes of depressed patients in our practice who were treated with antidepressant medications .  By using a naturalistic design , prospect i ve assessment s were made on all depressed out patients . Twenty-five patients who met full criteria for a major depressive episode ended up not taking antidepressant medication for a variety of reasons . " Response " rates to a no-treatment trial were determined with st and ard outcome criteria using the Clinical Global Impression-Improvement scale . Eight patients ( 32.0 % ) had a positive response , 5 patients ( 20.0 % ) had a partial response , and 12 patients ( 48.0 % ) were nonresponders to a no-treatment trial . These response rates were higher than expected , but significantly lower than what we had found in a cohort of depressed patients who underwent an antidepressant trial ( p = .02 ) . Likewise , treatment-resistant patients fared better on  pharmacotherapy  , though this difference was not statistically significant . These results suggest that the occurrence of spontaneous remissions may be common in clinical practice , and therefore the specific short-term benefits of antidepressant medication in clinical practice may frequently be overestimated . Despite the high rate of spontaneous remission in our sample , the present study allowed us to confirm the effectiveness of antidepressant medication in clinical practice using a novel method for obtaining a control comparison group Compared the effects of 2 psychotherapies based on divergent conceptualizations of depression in later life . Seventy-five older adults diagnosed with major depressive disorder were assigned r and omly to problem-solving therapy ( PST ) , reminiscence therapy ( RT ) , or a waiting-list control ( WLC ) condition . Participants in PST and RT were provided with 12 weekly sessions of group treatment . Dependent measures , taken at baseline , posttreatment , and 3-month follow-up , included self-report and observer-based assessment s of depressive symptomatology . At posttreatment , both the PST and the RT conditions produced significant reductions in depressive symptoms , compared with the WLC group , and PST participants experienced significantly less depression than RT subjects . Moreover , a significantly greater proportion of participants in PST versus RT demonstrated sufficient positive change to warrant classification of their depression as improved or in remission at the posttreatment and follow-up evaluations Elementary school children with mild-to-moderate depressive symptoms were r and omly assigned to a control group or an 8-session Primary and Secondary Control Enhancement Training program . The program focused on ( a ) primary control ( changing objective conditions to fit one 's wishes ; e.g. , through activity selection and goal attainment ) and ( b ) secondary control ( changing oneself to buffer the impact of objective conditions ; e.g. , altering depressogenic thinking , practicing mood-enhancing cognitions ) . At immediate posttreatment and 9-month follow-up , the treatment group showed greater reductions than the control group in depressive symptomatology on the Children 's Depression Inventory and the Revised Children 's Depression Rating Scale , and treated children , more than controls , shifted from above to within the normal range on both measures . Future research is needed to test treatment effects with severely depressed youths BACKGROUND We evaluated the long-term outcome of  depression and anxiety and associated disability among primary -care attenders with common psychiatric disorders and symptoms ( n = 201 ) using binary and multicategorical , interview-based outcome measures of psychiatric illness and disability . METHODS A two-stage design was used . In the first stage , 1994 consecutive attenders of 25 general practitioners were screened on psychiatric illness with the General Health Question naire and by their physicians . A stratified r and om sample ( n = 292 ) with differing probabilities was selected for second-stage interview ( Present State Examination and Groningen Disability Schedule ) . Patients with psychiatric symptoms ( n = 201 ) were reassessed 1 ( n = 182 ) and 3 1/2 ( n = 154 ) years later . RESULTS At 1- and 3 1/2-year follow-ups , many cases no longer met the criteria of their baseline diagnosis and disability levels had substantially dropped . However , partial remission , not full recovery , was the rule , and was associated with residual disability . Depression had better outcomes than anxiety and mixed anxiety-depression . CONCLUSIONS We concluded that a multicategorical , rather than a binary , outcome measure better reflects patient outcomes , since it highlights partial remission , mild symptoms , and residual disability , and as such , stresses the need to supplement short-term treatment . A multicategorical caseness model may be advantageous for research and clinical practice . We suggest a dynamic-equilibrium model to account for residual symptoms and disability . This study is a follow-up to two earlier reports on the recognition , treatment , and 1-year course of common psychiatric illnesses in general practice The goal of the study was to describe the naturalistic course of unipolar major depression in subjects not receiving somatic therapy for their depressive illness . Affectively ill individuals were recruited into the Collaborative Depression Study and followed prospect ively for up to 15 years . One hundred thirty subjects who recovered from their intake episode of major depression subsequently experienced a recurrence that went untreated for at least 4 weeks following onset of the recurrence . The duration of the recurrent episode was examined using survival analytic techniques . Of the 130 subjects , 46 obtained somatic therapy at some time during the course of their depressive illness , while 84 subjects received no somatic therapy throughout their entire depressive episode . Survival analysis , which accounts for these 46 individuals by censoring their episodes at the time treatment was obtained , yielded a median time to recovery of 23 weeks . In the sub sample of 84 subjects whose depressive illness went untreated from its inception through its resolution , the median time to recovery was 13 weeks . These results suggest that there is a high rate of recovery in individuals not receiving somatic treatment of their depressive illness , particularly in the first 3 months of an episode . Because treatment-seeking behavior is known to be associated with a worse prognosis , 23 weeks probably represents a lower-limit approximation of the median duration of an untreated depressive episode OBJECTIVE This trial examined the effects of both acute and maintenance cognitive-behavioral therapy ( CBT ) for depressed adolescents 
    Output:
    
It is undesirable to expect 100 % treatment coverage for depression , given many will remit before access to services is feasible .
Considering reported rates of spontaneous remission , a short untreated period seems defensible for this sub population , where judged appropriate by the clinician .
Conclusions may not apply to individuals with more severe depression