SIGN 114: Non-pharmaceutical Management of Depression in Adults

1. SIGN 114:Non-pharmaceutical Management of Depression in Adults Michelle Allan 16th February 2010

2. Background… • 20% Scottish population experience depression @ some point • 500,000 GP consultations in Scotland 2006/7 (depression & affective disorders) • >1/2 with depression don’t 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

3. Multi-factorial illness… • Biological • Sleep disruption, appetite changes • Psychological • Impaired concentration/memory • Increased negative thinking • Social • Loss of self confidence • Withdrawal from social contact

4. Recovery In One Domain May Be Reflected In Concurrent Improvement In The Others • Thus interventions covering biological & psychosocial modes should be considered

5. 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

6. 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

9. 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

10. 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

11. St John’s 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

12. 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 T’ai chi Aromatherapy Reflexology Emotional freedom technique Thought field therapy Insufficient evidence for…

13. ‘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

15. 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