Transcript SIGN 114: Non-pharmaceutical Management of Depression in

SIGN 114:
Non-pharmaceutical Management of
Depression in Adults
Michelle Allan
16th February 2010
Background…
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20% Scottish population experience depression @ some point
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500,000 GP consultations in Scotland 2006/7 (depression & affective
disorders)
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>1/2 with depression don’t seek formal Rx
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Prescribed antidepressants = most common intervention
– 3.65million items costing £43.7m 2006/7
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8.8% population ≥15yrs use antidepressants daily
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2/3 attempt self-chosen therapies
– e.g. St Johns wort, exercise, counselling
Multi-factorial illness…
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Biological
– Sleep disruption, appetite changes
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Psychological
– Impaired concentration/memory
– Increased negative thinking
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Social
– Loss of self confidence
– Withdrawal from social contact
Recovery In One Domain May Be
Reflected In Concurrent
Improvement In The Others
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Thus interventions covering biological
& psychosocial modes should be
considered
Psychological Therapies
Delivered by those trained to approved levels of
competency
 Behavioural activation, Interpersonal therapy &
Individual CBT recommended as Rx options [A]
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– Couple focused approach should be considered
Problem solving therapy & short term
psychodynamic therapy may be considered [B]
 Consider mindfulness based cognitive therapy in
group setting to reduce relapse in those with ≥3
episodes of depression
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Exercise
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Structured exercise is a treatment option
– Local gym, pool, voluntary walking groups
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Make patients aware of factors which improve &
help maintain motivation
– Set realistic goals: allows individual to monitor
progress
– Exercising with others
– Exercise class or buddy system: increase enjoyment
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No difference in effectiveness in comparison with
antidepressant medications & CBT
Self Help & Lifestyle Modification
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General advice on healthy lifestyle.
Address:
– alcohol & drug use
– diet & eating behaviours
– maintenance of social networks & personally
meaningful activities
– sleep problems
Self Help & Lifestyle Modification
Referral to self-help groups
 Guided self-help based on CBT or
behavioural principles is recommended
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– Computerised CBT recommended within this
context
e.g.
http://bluepages.anu.edu.au
http://moodgym.anu.edu.au
St John’s Wort / Hypericum extract
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Cumulative evidence suggests Hypericum extract
has a modest effect over placebo in Rx
mild/moderate depression
– GPs should not advise use of hypericum due to lack of
standardisation of dose & risk of interactions with
several common meds inc. OCP
– GPs should facilitate full consideration of potential
drug interactions in patients using hypericum
– OD: confusion, autonomic instability, renal & muscle
damage
Insufficient evidence for…
Inositol
 Polyunsaturated fatty
acids
 S-adenosyl L-methionine
 Chromium
 Ginseng
 Ginkgo biloba
 Glutamine
 Selenium
 Folate
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Acupuncture
Animal assisted therapy
Homeopathy
Light therapy
Massage therapy
Yoga
Reiki
T’ai chi
Aromatherapy
Reflexology
Emotional freedom technique
Thought field therapy
‘Checklist’ for providing information
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Presentation
– Common, treatable, screening tools
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Management
– Information on treatments:+/-, risk of not
responding, timescale
– Waiting times
– Other sources of support incl. library for
books
– Healthy lifestyle behaviours
Information
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Patient/carer info leaflet
– http://www.sign.ac.uk/pdf/pat114.pdf
www.livinglifetothefull.com
 www.moodjuice.scot.nhs.uk
 Breathing space
 Samaritans
 SAMH
 SANEline
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