Non-pharmacological treatment

Prescribing beyond the pills

National Institute for Health and Clinical Excellence (NICE) Clinical Guidance (CG90) 
"For people with persistent subthreshold depressive symptoms or mild to moderate depression, consider offering one or more of the following interventions, guided by the person’s preference:1 

  • Individualised guided self-help based on the principles of cognitive behavioural therapy (CBT)

  • Computerised cognitive behavioural therapy (CCBT)

  • A structured group physical activity programme

Treatment for major depressive disorder is as diverse as the condition itself.

"For people with moderate or severe depression, provide a combination of antidepressant medication and a high-intensity psychological intervention (CBT or IPT)1"

Treatment for major depressive disorder is as diverse as the condition itself.2

For patients presenting with mild to moderate depression, psychotherapy is one of the treatment options recommended by NICE. For more severe cases, psychotherapy remains an important aspect of treatment, administered alongside pharmacotherapy.3

A range of psychological interventions are available for patients with depression, but the most common therapies used in practice are described below:

Cognitive behavioural therapy (CBT)
CBT is based on the propositions that cognitive functioning affects behaviour, can be monitored and changed and that desired behaviour change can be achieved through cognitive change.3 CBT has demonstrated limited efficacy in reducing depressive symptoms.4

Interpersonal therapy (IPT)
The goal of IPT is to address interpersonal issues within important relationships including family and peers.5 IPT is an effective treatment for depression both alone and in combination with pharmacotherapy.6

Mindfulness-based cognitive therapy (MBCT)
MBCT is a psychotherapy that has been shown to successfully reduce relapse in depression by up to 34%.7 It combines psychological and educational aspects of CBT with meditation components of mindfulness-based stress reduction.8

For more information on the role that psychological therapies can play in the treatment of depression, read the clinical guidance from NICE here 

Psychodynamic therapy (PDT)
PDT involves guided self-help to manage unconscious behavioural patterns. Some evidence suggests that PDT may be effective in depression and could be provided online.7,8 Efficacy of short-term psychodynamic therapy in the treatment of depression has also been demonstrated through a meta-analysis of 23 studies.9

For more information on the role that psychological therapies can play in the treatment of depression, read the clinical guidance from NICE here.

References
  1. National Institute for Health and Clinical Excellence 2009. Depression in adults: the treatment and management of depression in adults. CG90.
  2. Goldberg D. The heterogeneity of “major depression”. World Psychiatry 2011; 10(3): 226-228.
  3. Ebrahim S et al. Effectiveness of cognitive behavioural therapy for depression in patients receiving disability benefits: a systematic review and individual patient data meta-analysis. PLoS One 2012; 7(11): e50202. doi: 10.1002/14651858.CD008705.pub2.
  4. Churchill R et al. ‘Third wave’ cognitive and behavioural therapies versus treatment as usual for depression (Review). Cochrane Database Syst Rev 2013; 10: CD008705.
  5. Van Hees MLJM et al. The effectiveness of individual interpersonal psychotherapy as a treatment for major depressive disorder in adult outpatients: a systematic review. BMC Psychiatry 2013; 13: 22.
  6. Cuijpers P et al. Interpersonal psychotherapy for depression: a meta-analysis. Am J Psychiatry 2011; 168(6): 581–592.
  7. Piet J, hougaard E. The effect of mindfulness-based cognitive therapy for prevention of relapse in recurrent major depressive disorder: a systematic review and meta-analysis. Clin Psychol Rev 2011; 31(6): 1032–1040.
  8. Williams JMG et al. Mindfulness-based cognitive therapy for preventing relapse in recurrent depression: a randomised dismantling trial. J Consult Clin Psychol 2014; 82(2): 275–286.
  9. Gibbons MBC et al. The empirical status of psychodynamic therapies. Annu Rev Clin Psychol 2008; 4: 93–108.
  10. Johansson R et al. Psychodynamic guided self-help for adult depression through the internet: a randomised controlled trial. PloS One 2012; 7(5): e38021.
  11. Driessen E. The efficacy of short-term psychodynamic psychotherapy for depression: a meta-analysis. Clin Psychol Rev 2010; 30: 25–36.
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