Nonpharmacologic Versus Pharmacologic Treatment of Adult Patients With Major Depressive Disorder: A Clinical Practice Guideline From the American College of Physicians

This study analyzed nonpharmacological versus pharmacologic treatment of adults with major depressive disorder. More specifically the study compared how treatments such as acupuncture, exercise, yoga, St.John’s wort etc.. worked compared to that of second generation antidepressants. Depressive disorders are a growing concern in the health community since it affects a broad range of patients. In recent years more has been done to try to educate others on depression and possible treatments. The study was done by collecting randomized controlled trials through the years of 1990 through September 2015. The study utilized several databases to find appropriate studies that fit into the desired criteria. After comparing multiple studies, the data concluded that clinicians should choose between cognitive behavioral therapy or second generation antidepressants. The major point was made that the therapy should be picked based on the patient’s lifestyle, desires, and needs.

 

After reading the study and the conclusion of the data I found it refreshing that there are ways to manage Major Depressive Disorder without the use of medications. While as pharmacist our whole business is drugs, but this doesn’t mean we push unnecessary drugs onto our patients. As pharmacists we are obligated to provide the best possible information to patients in order to help them lead healthier lives. I think the big take away point it which therapy is more beneficial and which therapy is a patient more likely to stick with. If a patient is often considered with the possible side effects of antidepressants and doesn’t like the idea of taking a medication. Then if cognitive behavioral therapy has been shown to replicate the same outcomes as a medication then that would be the best course of action for them since they are more likely to stick with it. Overall, I think it’s important to remember that there are other options for certain disease states that require life style changes and may offer the same benefits as a medication.

 

http://annals.org.pitt.idm.oclc.org/article.aspx?articleid=2490527

 

Qaseem A, Barry MJ, Kansagara D, for the Clinical Guidelines Committee of the American College of Physicians. Nonpharmacologic Versus Pharmacologic Treatment of Adult Patients With Major Depressive Disorder: A Clinical Practice

Cannabis Use and Risk of Psychiatric Disorders Prospective Evidence From a US National Longitudinal Study

With many states beginning to legalize cannabis, whether medicinal or recreational, there has been an increase in interest as to what kind of consequences it might have.  This particular study wanted to test the psychiatry of those smoking cannabis–particularly if it would affect their tendencies to abuse other drugs afterwards.  They also attempted to evaluate whether smoking marijuana would cause mood disorders, like bipolar disorder or anxiety, as some studies have previously.

The study was conducted in two “waves.” One was held 2001-2002 and the second was held from 2004-2005 with the same participants to make it a longitudinal study.  The participants were screened for psychiatric disorders like depression, anxiety, substance abuse, etc. and assessed according to the DSM-IV.  This was done at the onset of the trial and again at the end.  34,653 participants were interviewed, and of those 1,279 used cannabis.

Those who were smoking cannabis at the time of Wave 1 were much more likely to struggle with mental health issues or substance abuse by the time of Wave 2.  However, after adjusting their data, the only firm conclusion they made was that smoking cannabis indeed increased the risk of abusing other substances like alcohol, nicotine, or other drugs.  They did not conclude that marijuana induced or worsened mental disorders.  They reasoned that maybe the mental health issues came first and the cannabis use was a result, making this relationship correlational but NOT causal.

 

Blanco C, Hasin DS, Wall MM, et al. Cannabis Use and Risk of Psychiatric Disorders-Prospective Evidence From a US National Longitudinal Study. JAMA Psychiatry. doi:10.1001/jamapsychiatry.2015.3229 (published 17 February 2016).