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
Please check author names highlighted with each article.
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