Wednesday, June 20, 2007

What Works For Depression

In a recent report Mind (the National Association of Mental Health) revealed that 93 per cent of GPs in the UK have prescribed antidepressants because of a lack of alternative treatment options. There are many alternatives for depression that work well in addition to or in place of anti-depressants. What were they thinking?

It usually takes a combination of treatments to stay well. A person who is prescribed antidepressants will still need to pursue a healthy lifestyle - things like exercise, adequate sleep, healthy food and minimal negative stress.

A small proportion of people with depression have what is termed melancholic or biological depression. This includes people with bipolar disorder. For them medicine is almost always required to reach or remain in good health, while non-medical treatments are considered to be supplementary. For non-melancholic depression, treatments that use strategies other than medication are common.

Back to the merits of different treatments.

The Centre for Mental Health Research did a survey of the scientific literature available, and ranked treatments according to the depth and quality of evidence supporting them. (The Medicine Net medical dictionary is a good resource if you need to look up one of the terms below.)

Medical treatments:
Antidepressants and electro-convulsive therapy are both ranked highly with strong scientific evidence for their effectiveness.

Psychological treatments:
Cognitive behavioral therapy ranks highest with strong evidence as being very effective. Interpersonal psychotherapy, psychodynamic psychotherapy and bibliotherapy are all on the next tier. They are supported by scientific evidence as being effective, but the evidence is not as strong.

Lifestyle & Alternative Therapies:
Exercise, light therapy and St John's Wort are ranked on the second tier as useful treatments, with good evidence but not as strong as for, say, antidepressants. On the third tier there is a large group of other promising treatments with less evidence in support. It includes acupuncture, alcohol avoidance, massage therapy, relaxation therapy, vitamins and yoga.

The Black Dog Institute took a different approach, surveying what patients rated as the most helpful treatments. The leader of the study Professor Gordon Parker said that patients "do not necessarily share the views of professionals about effective therapies for depression". Yes, patients can be fairly incisive about what is or isn't working!

2,692 individuals took part in the survey. Leaving aside medicines and "talk therapies", people with depression rated exercise as being the most helpful. They considered yoga, meditation, relaxation and massage to be the next most beneficial, while acupuncture and homeopathy followed with moderate ranking scores. The various herbal and Omega 3 preparations were ranked lowest.

So there you have it. The experience of many is that it takes more than drugs to get well. The more aggressively you pursue the things that may work, the more likely you are to maintain good health. Putting it into practice is the hard part!

Center for Mental Health Research
Black Dog Institute (news release dated 18/2/07)

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