By Dr. Minal Mistry, Psychiatrist
Following on from my December 2016 blog “Depression: medication is not working? Try exercise and the internet!”, people have been asking me about other treatments for depression that do not involve antidepressants. I get the sense that professionals and the public are becoming more skeptical of medication and, with the rise of popularity of treatments that do not involve swallowing a “happy pill”, it is time for me to start this new year with a blog on other approaches…using the latest evidence of course!
New evidence for “non-pharmacological” treatments for depression.
My previous December 2016 blog coincided with research published in Evidence-Based Medicine – owned by the British Medical Journal (BMJ) – regarding treatments for depression without the use of medication (“non-pharmacological”). The study was aptly named “Non-pharmacological treatment of depression” and demonstrated the effectiveness of such treatments … we will return to the results later, but what are these other treatments that do not involve conventional medication?
What treatments do not involve conventional medication?
The list of treatments that do not involve conventional antidepressant treatment is extensive. In addition to other “medication” such as naturopathic medicine (e.g. herbals, acupuncture) and “biological interventions” (e.g. electroconvulsive therapy, transcranial magnetic stimulation) the research evaluated:
Non-pharmacological approaches and evidence.
This above list of non-pharmacological treatments to improving one’s mental health is not exhaustive. Moreover, there is nothing “new” about them because non-medication approaches have been around for a long time. For instance, I have received training in an approach called “Adaptation Practice”, which has existed as long as I have been alive, since 1974, and now has research supporting its effectiveness.
There are countless other approaches to improving mental well-being that have existed for so long, but only recently are we seeing evidence for their effectiveness. I often question the merits of “waiting” for research to “prove” a treatment works, but that is the way the scientific community works…so let’s move onto the new research!
The new research.
In the December 2016 edition of Evidence-Based Medicine, Wigdan H. Farah and colleagues (mostly affiliated with the famous Mayo Clinic in Minnesota) published: “Non-pharmacological Treatment of Depression: a systematic review and evidence map”. This research was comprehensive because it was an “umbrella systematic review”. Systematic reviews are regarded as the strongest form of medical evidence. However, this new research was a “systematic review of systematic reviews” which included an incredible 367 Randomised Controlled Trials (RCTs - the most reliable type of evidence) with outcomes about non-pharmacological treatments.
Although it is unclear about the effectiveness of non-pharmacological treatments relative to each other, this study found three interesting results in comparing such treatments with antidepressants:
The authors of this study are not necessarily dismissing the role of antidepressants. They do say that since non-medication methods are also effective in depression, “shared decision-making” (which engages patients and carers, and is based on the person’s values and preferences) is needed.
For years, I have been implementing the advice from this research in my own psychiatric practice by:
My open-minded approach allows the person with depression to make an informed decision about their treatment…it is all about one’s human right to make one’s own choices based on accurate, up-to-date and unbiased information. Hopefully this latest research from the United States will now allow a person with depression to explore non-medication options with greater confidence – leading to better choices and improved mental health.
Wigdan H Farah, Mouaz Alsawas, Maria Mainou, Fares Alahdab, Magdoleen H Farah, Ahmed T Ahmed, Essa A Mohamed, Jehad Almasri, Michael R Gionfriddo, Ana Castaneda-Guarderas, Khaled Mohammed, Zhen Wang, Noor Asi, Craig N Sawchuk, Mark D Williams, Larry J Prokop, M Hassan Murad, Annie LeBlanc. Non-pharmacological treatment of depression: a systematic review and evidence map. Evid Based Med 2016; 21: 214-221.
Cite this article as:
Minal Mistry (2017) Treating depression without antidepressants. The Beautiful Space-A journal of Mind, Art and Poetry. January 2017: TBSB110
By Dr Hena Jawaid, Psychiatrist
The world, today is a strange place to live where people are migrating from a downtrodden, war-ridden, perished country to the one, which is more established, progressive and developed. The differences in social, cultural, ethnical and religious backgrounds affect the psychological well-being of any migrant. Inability to adjust in a new social role manifests in different forms. It influences an individual's attitude towards the life, purpose, identity and motivation. It changes the struggle of a person to find his place in a world. All these elements breed a new identity for an immigrant and drive him to adopt an extreme form of devotion to fighting for himself and his related group.
Time has changed the globe into more distant and polarised mindsets, which have been developed as a result of identity differences and allegiance to one's origin.
A study published in British Journal of Psychiatry (1) has caught my attention recently although it has its own limitations. But the study overall has touched the sensitive pulses of politics, international adversities, war-prone factors and mindsets on the basis of religious adherence. It mainly deals with the extremism, religion, and psychiatric comorbidity.
The study mainly pinpoints the phenomenon of radicalization (2), which starts from the larger proportion of a population who maintains neutrality towards ‘anti-’ and ‘pro-’ groups; amongst them the vulnerable or abused one climbs the next ladder as being sympathetic towards radicals. Factors like persistent alienation, ‘identity confusion’ and security threats in a new place change their reactions towards the radicals, and they become supportive to the extremists’ cause. The opportunities then ultimately turn them into radicals.
This Cross-sectional study has been done in Great Britain amongst 3679 participants; their age ranges were 18–34 years, The attitudes, psychiatric morbidity, ethnicity, and religion were not only explored, but associations were also critically analysed. It has been done in a mixed cohort of White, the UK born, and non-UK born, from rich and deprived areas and on different ethnicities. The two main cohorts were named as “pro-British” and ‘anti-British’ to reveal the polarised attitudes of the population.
The main findings showed that the extremist mindsets of both sides lack higher education and are associated with poor social and economic status. The ‘anti-British’ radical group moves to acquire the extremist conviction to protect itself from the disillusionment of a new social identity and also to ensure the adherence with one's religious/cultural origins.
The most interesting finding lies where one with the extreme version of faith (anti or pro) is protected from depression. The need to belong to one's society (religious, ethical and cultural aspects) is essential to know one's existence and life’s purpose when such needs are not fulfilled properly then it can cause depression. The depression is more common at a baseline layer of a population who maintains neutrality to both sides of extremism. The religious practices protect an individual from the substance use and dependence. The strong religious adherence was also linearly associated with the extremist behaviour and motivation to fight for one's identity conflict. The process of the sectarian grouping and Jihadization was also explored.
The investigation of the four-stage model of Al-Qaeda-influenced radicalization (3) reveals its seven sub-stages. The pre-radicalization stage starts from the justification of a radicals’ approach to deal with basic identity conflicts. This further takes one to the Salafi (literalism) form of Islam (without contextual links), which further moves one away from the old identity/position. The association with a similar set of mentality helps one in adopting a new belief and eventually progressive acceptance of jihadi-Salafism. This ultimately leads one to jihadization against the system, nation or ideology.
This is the era where people are migrating in collective masses and suffering from the local and global trauma of refuge, displacement, and homelessness. This movement has its own short-term and long-term consequences. This phase of an identity crisis, confusion, distrust and stereotypical beliefs is generating the wave of anger, frustration, and alienation in a migrating group for a new social setup. The recruited groups, their variables, and confounding factors were not explored. The readiness of expressed priority (in the assessments/questionnaires of study) of pro and anti groups cannot be practically established.
Cite this article as:
Hena Jawaid (2017) Anger, resentment and reactions amongst immigrants. The Beautiful Space- A Journal of Mind, Art and Poetry. January 2017: TBSB109
Please check author names highlighted with each article.
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