Research on Treatments for Depression

Ultra feedback Survey

Background
Between August 2006 and January 2007, a link was established from the depressioNet website inviting visitors to participate in an online survey (read more). The URL for the survey was publicised in media articles throughout November. The survey was completed by 271 people.

Prepared and managed by Ultrafeedback, the survey sought to find out what people living with depression would ask people that had recovered, if they had the chance. It also asked participants to rate how effective different therapies were in helping with their depression. We then asked them to rate the effectiveness of various lifestyle factors.

Results
While I do not pretend that this survey was conducted in a rigorous scientific manner, I think the results demonstrate some interesting trends which mirror my own experiences.

 

Ratings of Effectiveness in Treating Depression
1= very low 5= very high
Strategy/Treatment	N	Avg Rating
1. Exercise	238	3.85
2. Support of family and friends	238	3.83
3. Counselling therapies (CBT, IPT, etc)	243	3.70
4. Fulfilling work	208	3.67
5. Relaxation/ meditation	222	3.60
6. Nutrition	238	3.55
7. Alcohol and Drug Avoidance	187	3.54
8. Prescription medicine	243	3.51
9. Support groups	165	3.41
10. Religious or spiritual beliefs	176	3.14
11. Contributing to a charity	169	3.08
12. Massage Therapy	154	2.72
13. Non Prescription Medicines	209	2.19
14. Electro Convulsive Therapy (ECT)	72	2.04
15. Acupuncture	89	1.98
16. Transcranial Magnetic Stimulation	40	1.48

 

Exercise is the winner in this assessment. This is interesting when you realise it is accessible to all and very inexpensive.
When you consider the epidemic of depression in the western world and the general decline in physical activity, you can’t
help thinking there may be a connection.

Support of family and friends and counselling therapies is not very surprising. Some people will be relieved that short-term
therapy from registered psychologists is now partly covered by Medicare.

Perhaps the most surprising of all the results is the ranking of Fulfilling Work which stresses how important this is to our
mental health. When I reflect on my 15 years experience as a recruiter interviewing people, I know there are a lot of people unhappy with their work.

The next group of factors (relaxation/meditation, drug and alcohol avoidance, nutrition, and prescription medicine) are rated
so closely together that it is difficult to differentiate between them.

It is interesting to note that of the top 10 factors that most help people with depression, eight are lifestyle related. Prescription medicine and counselling therapies are the only exceptions.

The other feature is that many strategies have very similar scores. What this indicates to me is that no one can afford to try
just one or two approaches. If you are serious about making progress you should consider the top 10 strategies and
determine with expert help which six you will focus on.

Other Helpful Strategies/Things Nominated by Respondents
Pets, Music, Journal Writing, Art, Hypnosis, Kinesiology, Reading, Gardening, Hobbies, contributing to others depressioNet.

Conclusion
It is clear that many factors positively affect people living with depression. Exercise, the winner, is probably one of the easiest to implement. The eight lifestyle factors in the top 10 show that there is much a person can do to contribute to their own recovery without waiting for drugs to work or to have a breakthrough with therapy.

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Black Dog Institute
 
A Web-Based Survey:
Judged Effectiveness of Treatments for Depression

Background
Professionals treating depression tend to favour a relatively brief set of options for treatment, such as medications, counselling and psychological therapies.  However, several reports suggest that self-help and complementary strategies are also commonly used.

The aim of this study was to examine the frequency of use, and judged effectiveness, of a wide range of strategies for treating depression. A sample of 2692 people living in Australia (71% female), who had ever received treatment for depression, participated in an online survey attached to the Black Dog Institute website (www.blackdoginstitute.org.au). Participants rated the effectiveness of each of the treatments for depression that they had tried, including medications, psychological therapies and self-help strategies.

Caution when interpreting results
It is important to interpret the results of this survey with caution. Each individual is unique, and all decisions regarding medication should be made with an appropriate doctor. Importantly, it is likely that some treatments (e.g. a particular antidepressant) might be very effective for one type of depression (e.g. melancholia) but not for others. Also, some of the strategies examined in the survey may have been used on their own, whereas others may have been used in combination with other treatments. For example, a person who rated exercise as ‘moderately effective’ may also have been taking an antidepressant and receiving psychological therapy. As this study was not a randomised controlled trial, we did not control for various factors that could influence ratings of treatment effectiveness. Finally, we did not conduct tests of ‘statistical significance’ between treatments.

Results
How was the ‘effectiveness’ of treatments determined?
‘Effectiveness’ scores were computed for each of 31 strategies (including 15 different antidepressants, 5 psychological therapies and 11 self-help strategies) that had been trialled by at least 100 people responding to the survey. The ‘effectiveness’ scores were created by summing scores for each treatment (very effective = 3; moderately effective = 2; slightly effective = 1; not at all effective = 0) and dividing that score by the number of people who had tried that treatment – but not including those who reported ceasing the treatment before they could judge its effectiveness.  The higher the ‘effectiveness’ score, the more effective the treatment.

Effectiveness of antidepressant medications

     SSRI antidepressants a

Antidepressant	Description of antidepressant	Number who used this antidepressant	Average ‘effectiveness’ score
citalopram	Brand names include: Cipramil, Celexa	600	1.51
escitalopram	Brand names include: Lexapro	185	1.55
fluoxetine	Brand names include: Prozac, Zactin, Lovan, Auscap, Erocap, Fluohexal	569	1.43
fluvoxamine	Brand names include: Luvox, Faverin	260	1.22
paroxetine	Brand names include: Aropax	600	1.36
sertraline	Brand names include: Zoloft	1043	1.47

        a An SSRI antidepressant is a ‘selective serotonin reuptake inhibitor’, which affects the
           neurotransmitter serotonin.

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     Tricyclic antidepressants a

Antidepressant	Description of antidepressant	Number who used this antidepressant	Average ‘effectiveness’ score
amitriptyline	Brand names include: Endep, Tryptanol, Tryptine, Amitrol	222	1.14
dothiepin	Brand names include: Dothep, Prothiaden	260	1.40
doxepin	Brand names include: Sinequan, Deptrn	160	1.12
imipramine	Brand names include: Tofranil, Melipramine	131	1.23

        a Tricyclic antidepressants are named after their chemical structure (three rings) and affect two
           neurotransmitters serotonin and norepinephrine. They may also interact with other chemicals in the body. 

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     Other antidepressants

Antidepressant	Description of antidepressant	Number who used this antidepressant	Average ‘effectiveness’ score
moclobemide	Brand names include: Aurorix, Arima	288	1.17
mirtazapine	Brand names include: Avanza, Remeron	268	1.31
nefazodone	Brand names include: Serzone	114	1.01
reboxetine	Brand names include: Endronax	123	1.38
venlafaxine	Brand names include:Efexor, Effexor XR	672	1.73

Top 10 Treatments for Depression
The 10 highest rating treatments for depression (out of all strategies – not restricted to antidepressants) are displayed below.  The higher the ‘effectiveness’ score, the more effective the treatment.


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     Top 10 Treatments for Depression

Strategy	Description of strategy	Number who used this strategy	Average ‘effectiveness’ score
1. venlafaxine	An SNRIa  antidepressant medication. Brand names include: Efexor, Effexor XR	672	1.73
2. exercise		2141	1.70
3. cognitive behaviour       therapy (CBT)	A type of psychological therapy	1221	1.63
4. ‘other psychotherapy’		1181	1.59
5. interpersonal therapy       (IPT)	A type of psychological therapy	700	1.58
6. escitalopram	An SSRI b antidepressant medication. Brand names include: Lexapro	185	1.55
7. citalopram	An SSRI b antidepressant medication. Brand names include: Cipramil, Celexa	600	1.51
8. yoga/meditation		1215	1.47
9. sertraline	An SSRI b antidepressant medication. Brand names include: Zoloft	1043	1.47
10. counselling		1754	1.46

           a An SNRI antidepressant is a ‘serotonin and norepinephrine reuptake inhibitor’, which affects the two
            neurotransmitters serotonin and norepinephrine.
           b An SSRI antidepressant is a ‘selective serotonin reuptake inhibitor’, which affects the neurotransmitter serotonin.

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Five key messages

1. Both exercise and yoga/meditation were rated in the Top 10 Treatments for Depression, as shown in the above table. 
   89% of people who exercised rated it as ‘slightly’ to ‘very’ effective in improving their depression. While it should be acknowledged that many of these people were also receiving other treatments for depression, the results support the
   use of exercise as an additional strategy.

2. Both antidepressant medications and psychological therapies were rated as having some benefit for depression.
   The Top 10 Treatments included four different types of antidepressant medications, and four different types of
   psychological therapies.

3. In our survey, both antidepressant medications and psychological treatments were used frequently.  74% had tried one
   or more antidepressants and 78% had received counselling or a psychological treatment.  83% reported consulting a
   general practitioner (GP) about their depression; 58% a psychologist and 52% a psychiatrist.

4. Among the psychological therapies, cognitive behaviour therapy (CBT), interpersonal therapy (IPT) and ‘other
   psychotherapy’ had similar effectiveness scores.

5. A variety of self-help and complementary strategies were used frequently. Many offered some benefit, as shown below.

 

Strategy	Number who used this strategy	% rated ‘slightly’ to ‘very’ effective	Average ‘effectiveness’ score
Acupuncture	317	59%	1.07
Exercise	2141	89%	1.70
Homeopathy	266	56%	0.98
Massage	1059	84%	1.36
Relaxation	1910	78%	1.34
Yoga/Meditation	1215	80%	1.47
Supplements/Herbs
L-Tryptophan	163	50%	0.74
Omega-3 fatty acids	461	54%	0.88
Other herbal remedies	582	60%	0.98
SAM-e	111	39%	0.73
St John’s Wort	875	46%	0.79

The results of this online survey are to be published in the following paper:

Parker, G.B. & Crawford, J.G. (2007). Judged effectiveness of differing antidepressant strategies by those with clinical depression. Australian and New Zealand Journal of Psychiatry, in press.

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