Depression: Experts Outline Innovative Approaches

Date: Oct-01-2012Depression can be a stubborn problem - at least one in three patients fail to respond to proven
therapies - and experts in the field have put their heads together to outline practical treatment
approaches for general practitioners in an MJA Open supplement on "difficult-to-treat depression".

"While GPs have many skills in the assessment and treatment of depression, they are often faced
with people with depression who simply do not get better, despite the use of proven therapies, be
they psychological or pharmacological", wrote Professor David Castle, Chair of Psychiatry at St
Vincent's Health and the University of Melbourne, and coauthors.

They wrote that they hoped the approaches outlined in the supplement could assist clinicians -
and GPs in particular - to improve the outcomes of patients with difficult-to-treat depression.

In an article on pharmacological approaches to the problem, Dr Herng-Nieng Chan and Professor
Philip Mitchell, psychiatrists with the University of New South Wales and the Black Dog Institute,
and coauthors outlined the latest evidence-based drug treatment strategies for people with
difficult-to-treat depression, based on studies including a US trial of almost 3000 patients.

The US study found that 30% of patients failed to achieve remission of their depression after using
up to four different antidepressants. "This finding reflects the reality of clinical practice and
highlights the need to employ the best available evidence in the management of people with
complex depression", they wrote.

Professor Paul Fitzgerald, a psychiatrist from Monash Alfred Psychiatry Research Centre, wrote
that electroconvulsive therapy remained the most widely used and effective biological non-drug
treatment for difficult-to-treat depression.

However, he also detailed innovative new forms of brain stimulation, including magnetic seizure
therapy and vagus nerve stimulation, which showed promise. "Ongoing work is required to define
which treatments are likely to be most useful, and in which patient groups", he wrote.

Dr Melissa Casey, director of psychology at Southern Health, and coauthors wrote that evidence-
based psychological approaches including cognitive behaviour therapy, interpersonal
psychotherapy and family-based therapy could improve outcomes in difficult-to-treat depression.

As thought patterns and behaviour played a large role in determining outcomes of treatment for
people with depression, they wrote, they were "prime candidates for intervention through a
psychosocial treatment regimen".

Courtesy: Medical News Today Note: Any medical information available in this news section is not intended as a substitute for informed medical advice and you should not take any action before consulting with a health care professional.