Continued research is needed to position exercise training as an evidence-based therapy. High study heterogeneity and lack of sound investigations of exercise must be considered. Conclusions Findings provide preliminary yet cautionary support for the clinical use of exercise training for adult depression. ![]() ![]() With individual comparisons of EX, BA, and CBT to NDST, we found small to moderate effect sizes (0.09 to 0.46), suggesting EX, BA, and CBT may equally outperform NDST. Effect size estimates between BA and CBT (SMD = -0.09, 95% CI = -0.50 to 0.31), BA and EX (-0.22, -0.68 to 0.24), and CBT and EX (-0.12, -0.42 to 0.17) were very small, suggesting comparable treatment effects of BA, CBT, and EX. According to surface under the cumulative ranking (SUCRA) probabilities, BA was mostly likely to have the highest efficacy (1.6), followed by CBT (1.9), EX (2.8), and NDST (3.8). All treatment arms significantly outperformed TAU (standard mean difference range, -0.49 to -0.95) and WL (SMD range, -0.80 to -1.26) controls. Results From 28,716 studies, 133 trials with 14,493 patients (mean age of 45.8 years 71.9% female) were included. Included trials assessed depression using a validated psychometric tool. Methods Our search was performed in seven relevant databases (inception to March 10, 2020) and targeted randomized trialsomparing psychological interventions head-to-head and/or to a treatment as usual (TAU) or waitlist (WL) control for the treatment of adults (18 years or older) with depression. Therefore, we conducted a network meta-analysis to compare the efficacy of exercise training (EX), behavioral activation therapy (BA), cognitive-behavioral therapy (CBT), and non-directive supportive therapy (NDST). Evidence supports the efficacy of exercise training (EX) for depression however, its comparative efficacy to conventional, evidence-supported psychotherapies remains understudied. Objective An estimated 3.8% of the global population experiences depression, according to the WHO report. Complementariamente, el descubrimiento de numerosos efectos no deseados asociados al consumo de los ISRS (Cascade, Kalali y Kennedy, 2009 Gartlehner et al., 2016 Soler,, Simón y Safont, 2008), incluyendo disfunciones sexuales, ganancia de peso, trastornos gastrointestinales y trastornos del sueño (Fournier et al., 2010 Gartlehner, Gaynes, Amick et al., 2016 NICE, 2010 Organización Mundial de la Salud, 2017b), y efectos no deseados de carácter paradójico como el aumento transitorio de las ideaciones y de las conductas suicidas (Andrews et al., 2012 Ferguson, 2001 Khawam, Lorencic y Malone, 2006 Organización Mundial de la Salud, 2017b) sugieren la necesidad de revisar las patrones de prescripción actuales. Varios estudios de revisión han indicado que los ISRS solamente resultan clínicamente superiores al placebo en casos graves, pero no en depresiones leves y moderadas (Andrews, Anderson, Amstadter y Neale, 2012 Fournier et al., 2010 Jakobsen, Katakam, Schou et al., 2017 Kirsch, Deacon, Huedo-Medina et al., 2008). An interactive version of this work can be found at. Regarding other pharmacologic and procedural options, e.g., transcranial magnetic stimulation, cannabinoids, ketamine, psychedelics, and stellate ganglion block, evidence does not yet support inclusion in the algorithm. Anti-adrenergic agents should be considered for general PTSD symptoms if not already tried, though evidence for daytime use lags that available for sleep. ![]() Second generation antipsychotics (SGAs) can be considered, particularly for SSRI augmentation when PTSD-associated psychotic symptoms are present, with the caveat that positive evidence is limited and side effects considerable. If significant non-sleep PTSD symptoms remain, an SSRI should be tried, followed by a second SSRI or venlafaxine as third step. ![]() First choices for difficulty initiating sleep include hydroxyzine and trazodone. Nightmares and non-nightmare disturbed awakenings are best addressed with the anti-adrenergic agent prazosin, with doxazosin and clonidine as alternatives. Following consideration of variations required by special patient populations, addressing of sleep impairments remains as the first recommended step. New studies and review articles from January 2011 to November 2021 were identified via PubMed and analyzed for evidence supporting changes. Developments since then warrant revision. Algorithms for posttraumatic stress disorder were published by this team in 19.
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