Background: There are a couple of independent studies examining the effectiveness of telephone based therapy for the treatment of depression. However, up-to-date systematic reviews are lacking.

Objective: To evaluate the effectiveness of telephone-based therapy in the management of patients suffering from depression compared with the usual care.

Methods: A systematic review and meta-analysis of randomized controlled trials was conducted that compared telephone-based therapy with usual care for depression. We searched MEDLINE, EMBASE, PsycINFO, CINAHL, and CENTRAL (up to August 28, 2012) to identify eligible studies. The primary outcome was depression level at the end of the intervention. We pooled the mean depression level data from the studies using standardized mean difference using the random-effects model.

Results: A total of 11 studies met the inclusion criteria. Nine of these studies was considered for the pooled analysis. Comparison of depression levels in the immediate post-intervention period from the seven studies included in the pooled analysis was in favour of telephone-based therapy (standardized mean difference = -0.43; 95% CI: -0.74-0.12). In the remaining two studies, telephone-based therapy resulted in a statistically significant improvement in clinical outcomes and patient satisfaction. A longer duration of intervention and the presence of known medical comorbidity was positively associated with the effectiveness of telephone-based therapy. The overall effect was stable when studies with extreme characteristics were excluded. Intervention results were found to be sustained throughout the follow-up period.

Conclusion: Telephone-based therapy could be more effective than face-to face therapy in reducing the symptoms of depression. However, further research is required to establish the applicability and costeffectiveness of telephone-based therapy for routine depression management in health systems.

Study background: Tricyclic antidepressants are widely prescribed in the treatment of depression, although the mechanism of their therapeutic effects is poorly understood. Novel hypotheses suggest that antidepressants might act on synaptic plasticity and cytoskeletal remodeling. The aim of the present study was to evaluate in animals exposed to acute and chronic behavioural despair paradigms of depression, the treatment with amitriptyline, a widely used tricyclic antidepressant, on axon Growth-Associated Protein 43 (GAP43), a synaptic protein, in the mouse hippocampus.

Methods: The effect produced by peripheral administration of amitriptyline on hippocampal GAP43 expression was investigated by immunoblotting and immunofluorescence experiments.

Results: Animals exposed to the Tail Suspension Test (TST), a highly predictive model of antidepressant activity following acute treatment, did not show any variation in the GAP43 contents 6 and 24 h after testing. Acute administration of amitriptyline (10 mg/kg i.p.) increased hippocampal levels of GAP43. Conversely to TST, animals exposed to Unpredictable Chronic Mild Stress (UCMS), an animal model of depression, showed diminished GAP43 immunostaining in the hippocampal CA3 region. Chronic administration of amitriptyline not only counteracted the immobility induced by exposure to UCMS paradigm evaluated by the TST, but also reversed the decrease of the synaptic protein.

Conclusion: These findings suggest that depressive states might be associated to a reduction of synaptic protein expression. These synaptic changes might be involved in the mechanism of tricyclic antidepressant drugs and may contribute to their psychotherapeutic actions.

A promising area of research on depression is its interactions with the immune system, taking place within the field of psychoneuroimmunology. Indications of brain-immune system interactions exist at different levels of organizations: in animal studies, stressful events can disorganize the immune response and increase susceptibility or even mortality to experimentally induced tumours.

The impact of a “24-7” schedule in our general physiology, as well as our cognitive capacities, is a growing social concern. A disrupted circadian rhythm is inherent to many occupations in today’s society, namely airline pilots and crew-members, military and law enforcement personnel, medical staff or any rotating shift worker. This makes it a socially pervasive phenomenon, taking a toll on mental and general health. The comprehension of these mechanisms has been delayed by the difficulty to dissociate the effect of sleep abnormalities from circadian clock dysfunction and the lack of indisputable biological markers to define and diagnose a circadian disorder.

Employers may purchase evidence-based depression care management products to improve work outcomes of their depressed employees. Because employers have imperfect information about mental health products, they may rely on peers to evaluate benefits and costs of the products. We examined the impact of peer influence on employer appraisal of depression care products in a randomized controlled trial of marketing intervention for a high quality depression care product. Using a general form of the autocorrelation model in social network analysis, findings showed significant peer influences on how employers changed their appraisal of a depression care product.