Depression: Treatment Beyond Medication (The Dana Foundation):
“Major depressive disorder affects nearly 7 percent of people in the US aged 18 and up, according to the Depression and Bipolar Support Alliance. Those who seek treatment will most likely be prescribed a second-generation antidepressant medication such as a selective serotonin reuptake inhibitor (SSRI), tricyclic antidepressant (TCA), or a monoamine oxidase inhibitor (MAOI). Some recent studies, though, suggest that these types of medications are not quite as effective as previously believed…There are alternative treatments to antidepressant medication, and in February 2016, the American College of Physicians issued a new clinical practice guideline suggesting that one—cognitive behavioral therapy (CBT)—is an equally viable choice to treat adults with depression…“We’re learning that what we call depression today may actually be 10, 12, maybe even 15 different diseases,” he says. “So where we hope to go is to find biomarkers so we can identify for groups of patients, or individual patients, for whom one treatment or another treatment is better. Some patients may actually need more than one treatment to get better. It’s possible. But we don’t know yet. We still have a lot of work to do. But until we do that work, it’s good that we have some different options we can try.”
Study: Nonpharmacologic Versus Pharmacologic Treatment of Adult Patients With Major Depressive Disorder: A Clinical Practice Guideline From the American College of Physicians (Annals of Internal Medicine). From the abstract:
- Description: The American College of Physicians (ACP) developed this guideline to present the evidence and provide clinical recommendations on the comparative effectiveness of treatment with second-generation antidepressants versus nonpharmacologic treatments for major depressive disorder in adults.
- Methods: This guideline is based on a systematic review of published, English-language, randomized, controlled trials from 1990 through September 2015 identified using several databases and through hand searches of references of relevant studies. Interventions evaluated include psychotherapies, complementary and alternative medicines (including acupuncture, ?-3 fatty acids, S‑adenosyl-l-methionine, St. John’s wort [Hypericum perforatum]), exercise, and second-generation antidepressants. Evaluated outcomes included response, remission, functional capacity, quality of life, reduction of suicidality or hospitalizations, and harms…
- Recommendation: ACP recommends that clinicians select between either cognitive behavioral therapy or second-generation antidepressants to treat patients with major depressive disorder after discussing treatment effects, adverse effect profiles, cost, accessibility, and preferences with the patient (Grade: strong recommendation, moderate-quality evidence).
- Summary for patients Here…“The authors looked at research that compared different treatment options for adults with MDD. The authors found that both talk therapy and antidepressant medicines were equally effective in treating MDD. St. John’s wort may be as effective as antidepressants and talk therapy. However, because St. John’s wort is not regulated in the United States, talk to your doctor before taking it. Other alternative treatments may not be as effective as antidepressant medicines or talk therapy.”
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