Depression and anxiety: Medication management using antidepressants versus cognitive behavioral therapy

Depression And Anxiety: Medication Management Using Antidepressants Versus Cognitive Behavioral Therapy Author’s Name The Institutional Affiliation Course Number and Name Instructor Name Assignment Due Date PICOT Question In adults diagnosed with both depression and anxiety disorders (P), how does the use of cognitive behavioral therapy (I) compare to antidepressant medication (C) in reducing symptoms of both conditions (O) over six months (T)? Introduction Depression and anxiety management by antidepressants, compared with cognitive behavior therapy (CBT), is a significant area in nursing practice. This research discusses several approaches to treatment and their effectiveness and outcomes. Based on the evaluated themes in an annotated bibliography, CBT is comparatively an effective mode of therapy for adult depression and anxiety as compared to antidepressants in pediatric populations and treatment-resistant cases. Understanding the effect of these therapies is vital to developing more comprehensive, evidence-based treatment strategies in nursing. Annotated Bibliography Article 1 Uphoff, E., Ekers, D., Robertson, L., Dawson, S., Sanger, E., South, E., Samaan, Z., Richards, D., Meader, N., & Churchill, R. (2020). Behavioural activation therapy for depression in adults. Cochrane Database of Systematic Reviews, 7(7). https://doi.org/10.1002/14651858.cd013305.pub2 Main Findings and Purpose This paper evaluates the effectiveness and acceptability of behavioral activation (BA) as a treatment for adults with depression when compared to other psychological therapies, medications, or standard controls such as treatment as usual, waiting lists, or no treatment. Behavioral activation, a brief psychotherapeutic approach, alters how people engage with their environment and is considered inexpensive and easy to execute. We included 53 randomized controlled trials of 5,495 participants with comparisons among different treatment modalities. The main findings indicate that behavioral activation is more effective than humanistic therapy or medication and is similarly effective to cognitive behavioral therapy (CBT) and other psychological interventions in the short term. However, reviews found moderate to very low certainty where the evidence quality varied between outcomes. The results lacked precision and certainty; no significant difference was found between behavioral activation and most comparison groups regarding treatment acceptability, as measured by dropout rates. The findings indicate that behavioral activation has promise as a treatment for depression but that higher levels of evidence are needed to strengthen the basis of evidence and better understand its efficacy and acceptability compared to other treatments. Study’s Methodology, Validity, and Reliability The study methodology is applied well since it is a comprehensive search strategy that does not restrict dates, language, or publication status, thus increasing the comprehensiveness of the literature review. Including published and unpublished or ongoing trials avoids publication bias as both types of studies are included. However, the reliability of this study is somewhat compromised by variability in both study size and the number of RCTs comparing BA with other treatments. Moreover, parallel-group RCT and cluster RCT, respectively, can introduce methodological heterogeneity that might affect the comparability of results and the validity of the review. Strengths and Weaknesses The study’s strengths were the extensive search of its database and the systematic method of extracting data and assessing the risk of bias by two review authors. The resulting aspects improve the credibility and reliability of the findings. However, the study is limited by the lack of evidence for some comparisons and very low certainty of evidence for some outcomes, particularly for the acceptability of treatment. In addition, findings are limited to a shorter inference period due to the reliance on short-term results with insufficient long-term follow-up. Relevance with Research Topic These findings are of direct relevance to broader investigating the effects of managing depression and anxiety with medication versus psychotherapy, with CBT specifically. These results show the importance of nurses using various approaches in therapeutic practice, as BA can be as effective as CBT and more than some kinds of medication. It is relevant for mental health nurses, who need to consider BA as a treatment option that can be justified, especially where cost-effectiveness and ease of implementation are the prioritized factors. Additionally, the study’s implications recommend that nurses should advocate for talking about the availability of various treatment options, particularly patient-centered ones, and regarding the indications of the patient and the patient’s desire. Article 2 Hendriks, G.-J., Janssen, N., Robertson, L., van Balkom, A. J., van Zelst, W. H., Wolfe, S., Oude Voshaar, R. C., & Uphoff, E. (2024). Cognitive behavioral therapy and third-wave approaches for anxiety and related disorders in older people. Cochrane Database of Systematic Reviews, 2024(7). https://doi.org/10.1002/14651858.cd007674.pub3 Main Findings and Purpose This study aims to consider the efficacy of CBT in older adults (65 and over) in reducing symptoms of anxiety versus minimal management and other psychological therapies. Data from 21 randomized controlled trials of 1234 participants were studied, primarily relating to generalized anxiety disorder and other clinical diagnoses. CBT is found to decrease small-to-moderate levels of anxiety immediately post-treatment with a standardized mean difference (SMD) of -0.51. However, this benefit blurs as time progresses, and even CBT and minimal management do not differ significantly at three to six months of follow-up. CBT appears to reduce comorbid depression symptoms post-treatment with a similar low-certainty evidence level. Uniquely, when compared to other psychological therapies, insufficient evidence yet supports any superiority of CBT specifically for the treatment of post-traumatic stress disorder, with no significant differences found in terms of anxiety severity, depression symptoms, or dropout rates. Study’s Methodology, Validity, and Reliability This study employs a systematic methodology to sift RCTs from various databases and international registries and compile them in a robust data collection process. The Cochrane tool was used to assess systematically the risk of bias in the study, thus lessening its validity. Nevertheless, the conclusions are somewhat undermined by the low certainty of evidence and difficulties in patient and personnel blinding in psychological therapy trials. Moreover, despite the focus on immediate post-treatment outcomes and slim attention on longer-term outcomes, the applicability of the findings in the long term should be debated. Strengths and Weaknesses The strength of this study is that it focuses its criteria on older adults, which fills a significant gap in existing research about the effectiveness of CBT in this demographic. The findings are credible because of the rigorous selection, assessment, and review processes. However, a weakness of the study is its lack of comparison with non-CBTS therapi...