While the focus of treatment for depression is often on pharmacotherapy, the usefulness of nonpharmacologic treatment should not be forgotten.
Stimulation therapy: New therapies, such as vagal nerve stimulation and transcranial magnetic stimulation, are being developed. Both techniques are indicated by the FDA for use in depression. The magnitude of effect has varied from study to study. With further research, both forms of stimulation therapy show promise as future treatments for depression, especially in difficult-to-treat cases.91,92
Exercise: No matter which treatment plan for depression you choose, encouraging exercise in healthy patients is a must given the benefits it will provide both mentally and physically. Exercise is simple, noninvasive, inexpensive, and effective in reducing symptoms of depression and has a low risk of side effects. However, exercise is almost always overlooked—sometimes by both the clinician and the patient. Exercise, which can be structured or home-based, has comparable effects to pharmacotherapy in reducing depression.93 Ernst investigated the theory that depression results from lack of synthesis of new neurons in the hippocampus.94 Studies in rats showed that exercise results in the synthesis of new neurons in the brain, much like that which is seen in the use of antidepressant therapy. Ernst concluded that exercise reduces depressive symptoms at a rate comparable to antidepressant therapy. The effects of exercise may not manifest as quickly as pharmacotherapy, but by 16 weeks, the groups had equivalent therapeutic benefit.95 Patients who continue with a regular exercise routine show lower rates of relapse compared with those who exercise only during a depressive episode.96
Psychotherapy: This treatment approach is potentially as effective as pharmacotherapy. Psychotherapy tends to yield better results in patients with mild-to-moderate depression than in those with severe depression.97 Several barriers to the usefulness of psychotherapy exist, including cost, convenience, and availability. Additionally, results vary significantly from person to person. Good candidates for psychotherapy include those who are experiencing their first episode of depression or whose depression is linked to a stressful life event. Additionally, persons who are interested in psychotherapy tend to have good results. Psychotherapy is effective monotherapy to reduce rates of relapse when used as continuation therapy.98
In choosing a treatment plan for depression, consideration of the unique features of your patient’s case is crucial. Individualizing treatment can lead to quicker recovery and improved quality of life, overall health, and well-being. A summary of treatments by symptom, subtype, and comorbidity appears in Table 2. Efficient management of depression will significantly reduce the morbidity and mortality associated with this widespread chronic illness.
Ms. Berns is a physician assistant at Family Medicine Specialists, P.C., in Cedar Rapids, Iowa. Special thanks to Don St. John, PA-C, department of psychiatry, University of Iowa Health Care, Iowa City, for his assistance on this article. The author has no relationships to disclose relating to the content of this article.
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