SIGN 114: Non-pharmaceutical Management of Depression in Adults

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SIGN 114Non-pharmaceutical Management of
Depression in Adults

• Michelle Allan
• 16th February 2010

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Background

• 20 Scottish population experience depression _at_
  some point
• 500,000 GP consultations in Scotland 2006/7
  (depression affective disorders)
• gt1/2 with depression dont seek formal Rx
• Prescribed antidepressants most common
  intervention
• 3.65million items costing 43.7m 2006/7
• 8.8 population 15yrs use antidepressants daily
• 2/3 attempt self-chosen therapies
• e.g. St Johns wort, exercise, counselling

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Multi-factorial illness

• Biological
• Sleep disruption, appetite changes
• Psychological
• Impaired concentration/memory
• Increased negative thinking
• Social
• Loss of self confidence
• Withdrawal from social contact

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Recovery In One Domain May Be Reflected In
Concurrent Improvement In The Others

• Thus interventions covering biological
  psychosocial modes should be considered

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Psychological Therapies

• Delivered by those trained to approved levels of
  competency
• Behavioural activation, Interpersonal therapy
  Individual CBT recommended as Rx options A
• 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

• Structured exercise is a treatment option
• Local gym, pool, voluntary walking groups
• 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
• No difference in effectiveness in comparison with
  antidepressant medications CBT

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Self Help Lifestyle Modification

• General advice on healthy lifestyle. Address
• alcohol drug use
• diet eating behaviours
• maintenance of social networks personally
  meaningful activities
• sleep problems

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Self Help Lifestyle Modification

• Referral to self-help groups
• Guided self-help based on CBT or behavioural
  principles is recommended
• Computerised CBT recommended within this context
• e.g. http//bluepages.anu.edu.au
• http//moodgym.anu.edu.au

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St Johns Wort / Hypericum extract

• 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

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Insufficient evidence for

• Inositol
• Polyunsaturated fatty acids
• S-adenosyl L-methionine
• Chromium
• Ginseng
• Ginkgo biloba
• Glutamine
• Selenium
• Folate

• Acupuncture
• Animal assisted therapy
• Homeopathy
• Light therapy
• Massage therapy
• Yoga
• Reiki
• Tai chi
• Aromatherapy
• Reflexology
• Emotional freedom technique
• Thought field therapy

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Checklist for providing information

• Presentation
• Common, treatable, screening tools
• Management
• Information on treatments/-, risk of not
  responding, timescale
• Waiting times
• Other sources of support incl. library for books
• Healthy lifestyle behaviours

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Information

• 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