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NIHR Signal The most effective antidepressants for adults revealed in major review
Antidepressants are effective to treat moderate to severe depression in adults. Five antidepressants appear more effective and better tolerated than others. A major review of 522 antidepressant trials found that all of the 21 drugs studied performed better than placebo, in short-term trials measuring response to treatment. However, effectiveness varied widely. Researchers ranked drugs by effectiveness and acceptability after eight weeks of treatment. Several drugs were more effective and were ...
NIHR Signal Additional therapy helps social recovery from first episode psychosis
Social recovery therapy increases structured activity, such as work, education or sport, by eight hours per week for people with severe social withdrawal following a first episode of psychosis. This cognitive behavioural type of treatment was added to other early interventions and might be particularly useful for those lacking motivation or living with other conditions that prevent them engaging with mental health services. This NIHR-funded trial included 154 young adults with first episode of ...
NIHR Signal Doxycycline may be a safer first option for treating a blistering skin condition
Doxycycline (an established antibiotic) may be a safer first option than the standard steroid treatment for people with the autoimmune skin condition bullous pemphigoid. The condition causes severe, itchy blistering. This NIHR-funded study showed that people started on doxycycline were 19% less likely to have severe, life-threatening or fatal events during the next 12 months than those who started a steroid (prednisolone). Blister control was considered acceptable for both treatments (74% treat...
NIHR Signal Computerised interpretation of fetal heart rate during labour does not improve outcomes
Using a computerised decision-support system to interpret the outputs of continuous electronic fetal monitoring during labour does not show any advantages over clinicians interpreting the outputs themselves. This is the first trial to assess decision support of this kind. In this large NIHR-funded trial, rates of poor neonatal outcomes, caesarean sections and assisted deliveries were not affected by whether clinicians were alerted to potential problems by the decision-support system or by their...
NIHR Signal MRI scan before biopsy could detect more prostate cancer
In men with a raised prostate specific antigen (PSA) blood test, which can be a sign of prostate cancer, MRI scanning before standard biopsy could allow more targeted biopsies and increase diagnosis of medium and high-risk prostate cancer. In this NIHR-funded study, 576 men with suspected prostate cancer received a multi-parametric (MP)-MRI scan in addition to transrectal ultrasound-guided (TRUS) biopsy. They also had template mapping (TPM) biopsy of the entire prostate to reliably diagnose can...
NIHR Signal Mortality benefits from minimally invasive aneurysm repair aren’t sustained in the long term
Minimally invasive surgery to repair abdominal aortic aneurysm (AAA) was associated with fewer aneurysm-related deaths in the short-term, up to six months. From eight years onwards the open surgical procedures were associated with fewer aneurysm-related deaths, suggesting on-going monitoring is required. An AAA is a swelling due to weakness in the main blood vessel running through the centre of the abdomen. If the aneurysm bursts there is a high chance of death. Earlier trials suggested that th...
NIHR Signal Excision is probably better than stapling in the long-term for haemorrhoids
Recurrences of haemorrhoids (piles) are three times less likely if they are surgically removed rather than treated with a relatively new stapling procedure. There are now a wide range of techniques to tackle this common, distressing condition. Some, such as stapling, have become more popular despite a lack of evidence about improved long-term outcomes. This NIHR-funded trial compared both operations for moderate to severe haemorrhoids across multiple sites in the UK. Quality of life was simila...
NIHR Signal Treating low grade piles with a newer surgical technique leads to less recurrence than rubber band ligation
The new technique, called haemorrhoidal artery ligation requires an anaesthetic. In this trial it led to fewer episodes of recurrence than a single rubber band ligation of piles. The rubber band ligation, which can be done in the clinic, is less painful in the short-term and cheaper. This means that the decision over which treatment to offer or accept is a “trade-off”. Haemorrhoids affect a third of people in the UK, many of which can be managed using simple measures. For more serio...
NIHR Signal Simpler, cheaper therapy (behavioural activation) can be as good as CBT for treating depression
A simpler therapy called behavioural activation can be as effective at treating adults with depression as cognitive behavioural therapy (CBT). Also, it is delivered more cheaply, by trained junior mental health workers. CBT is commonly provided to adults with depression and it is recommended by NICE as first- line treatment. However, it is complex to deliver and therapists are highly skilled and expensive. Behavioural activation is a simpler type of talking therapy that encourages people to dev...
NIHR Signal Little or no benefit from progesterone to prevent preterm birth
In this trial, vaginal progesterone given to women at high risk of preterm delivery did not reduce the risk of premature birth compared to a placebo. The consequences for the baby in the first 28 days of life, and children at two years’ old, were also similar when looked at as a whole. Many different outcomes were looked at and this can provide a confusing picture. There appear slightly fewer deaths or brain injury around birth with progesterone. At two years childhood brain function was ...
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