talk-to-doctor-about-depressionThe influential American College of Physicians (ACP) has recommended that doctors should choose cognitive behavioural therapy (CBT) to treat adults with major depressive disorder.

Their guideline follows an exhaustive review of 25 years-worth of trials conducted between 1990 and 2015 into the treatment of a disorder which cost an estimated $US83.1 billion worldwide in 2000 and which will affect one in six New Zealanders during their lifetime.

Depression has a serious impact on everyday life and involves a loss of pleasure or interest in things which were previously enjoyed, a change in weight or appetite, sleep issues, fatigue, issues surrounding concentration, feelings of worthlessness and indecision, and recurrent thoughts of death or suicide.

The study measured similar effectiveness of CBT and second-generation antidepressants (SGAs) in treating depression – but that antidepressants had serious side-effects and higher rates of relapse.

“Patients are frequently treated for depression by primary care physicians, who often initially prescribe SGAs,” said ACP President Wayne J. Riley, MD, MPH, MBA, MACP. “However, CBT is a reasonable approach for initial treatment and should be strongly considered as an alternative treatment to SGAs where available, and after discussing treatment effects, adverse effect profiles, costs, accessibility, and preferences with patients.”

The study reviewed four approaches to depression treatment including psychotherapy; alternative medicine such as yoga, St John’s wort, acupuncture, omega 3s and meditation; SGAs and exercise. The available evidence showed there was no difference in response between SGAs, psychotherapy, exercise and some of the alternative treatments including St John’s wort, acupuncture and yoga.

But their recommendation, published in the Annals of Internal Medicine, told doctors to “select between either cognitive behavioural therapy or second-generation antidepressants to treat patients with major depressive disorder” while including adverse effects associated with SGAs such as constipation, diarrhea, dizziness, headache, insomnia, nausea, sexual adverse events and drowsiness.

Because St John’s wort isn’t regulated by the US Food and Drug Administration, the ACP warned patients in the US might not be able to “get quality-controlled St John’s wort or reliably obtain preparations with similar effectiveness as those used in the included studies”.

Robert Street Clinic has a wide range of psychotherapists, psychiatrists and psychologists skilled in CBT and we can answer all your questions regarding how therapy and antidepressants can work for you. For more information, call us on 09 973 5950, email us at info@robertstclinico.nz or message us via the website