Before we get into next lessons discussion about psychotherapy I thought it would be helpful to provide an overview of the nonpharmacologic treatment options for depression. These options include stand-alone treatments as well as augmentation to medications depending on the severity of depression. Let's jump right in.
Today's Content Level: Beginner
•Psychotherapy = "talk therapy"
•Psychotherapy involves communication between patients and mental health professionals with the intent to modify ways of negative thinking or behavior, find relief from emotional distress, receive education about their symptoms, and seek solutions in their lives.
•Therapy can be provided by a number of different mental health professionals including psychiatrists, psychologists, social workers, psych nurse practitioners, licensed professional counselors, psych nurses, and more.
•There are numerous "types" of psychotherapies that vary based on their theoretical and practical approach.
•There are a number of psychotherapies with at least some evidence for the treatment of depressive disorders. These include:
Cognitive-behavioral therapy (CBT)
Interpersonal psychotherapy (IPT)
Dialectical behavioral therapy (DBT)
•Multiple meta-analyses show psychological therapies (CBT, IPT, supportive therapy, psychodynamic therapy) equally efficacious in acute tx of depression. 1
•CBT has been shown to be as effective as antidepressant medications for mild-moderate severity of depression. 2
•May be used alone or in conjunction with pharmacotherapy.
•Psychotherapy will be discussed in more detail during a later session where we will understand the underlying theory and and important principles regarding these therapies.
We will discuss these techniques in detail during a dedicated article but here is a brief overview.
Electroconvulsive Therapy (ECT)
ECT was formerly known as shock therapy.
Involves a brief electrical stimulation (generalized seizure) of the brain while the patient is under general anesthesia.
Most effective and rapid treatment in severe depression, psychotic depression, depression with catatonia, and treatment refractory depression.
Transcranial Magnetic Stimulation (TMS)
Machine that produces weak repetitive electric currents in the brain tissue by rapidly changing magnetic fields.
Numerous small-scale studies have demonstrated efficacy in the treatment of major depression; however, studies show less efficacy than for ECT.
Deep Brain Stimulation (DBS)
Surgical treatment involving the implantation of a medical device that sends electrical impulses to specific parts of the brain.
Originally used in treatment refractory neurologic conditions such as Parkinson's disease, disabling dystonia, chronic pain, and tremors.
Has now been used in treatment refractory major depression.
Due to highly invasive nature of this modality it has potential for serious complications and side effects.
•Light therapy = phototherapy.
•Exposure to daylight or to lamps that emit specific wavelengths of light (lasers, diodes, fluorescent or dichroic lamps) or full spectrum light. Typically prescribed for a certain amount of time and, in some cases, at a specific time of day.
•Light therapy is used to treat major depression with a seasonal pattern (seasonal affective disorder), with some support for its use with nonseasonal psychiatric disorders including MDD.
•Side effects are uncommon but include headache, eye strain, blurred vision, insomnia, and even mania (rare). 3
•Here is one example of a popular lamp used for this purpose.
LIFESTYLE: EXERCISE & NUTRITION & MEDITATION
Physical activity and exercise have been shown in multiple studies to improve symptoms of depression and other mental health concerns.
Comprehensive meta-analyses have shown that exercise have beneficial effects on depression symptoms that are comparable to those of antidepressant treatments. 4 It is also a viable adjunct treatment in combination with antidepressants.
All forms of exercise have been studied and most show improvement in mood including aerobic exercises, strength training, yoga, and more.
A well-rounded healthy diet is important to improve mood and optimize treatment. 5 Nutritional science is a difficult discipline, however there are studies that show certain dietary choices improving mood. Of note, the mediterranean diet has received significant press for its ability to lead to less depression over time. 6
Mindfulness activities, including meditation and journaling, have shown modest improvements in depressed mood. 7
Other modalities can be considered in some patients as a form of supportive therapy or argument with more traditional therapies. Some options include art therapy, recreational therapy, equine therapy, nature therapy, and additional creative interventions.
I hope this was a helpful introduction to nonpharmacologic options for depressive disorders. Tomorrow we will discuss psychotherapy in more detail. At a later date we will discuss interventional treatments (ECT, TMS, DBS) in more detail as well.
Resources today include the articles linked in the body of the article, Pocket Psychiatry, Kaplan & Sadock's Synopsis of Psychiatry, First Aid for the Psychiatry Clerkship, and Ninja's PRITE study guide.
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