Pharmacologic vs Non-pharmacologic Treatments for Depression Ferris State University Brittany Torok,...
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Pharmacologic vs Non-pharmacologic Treatments for Depression Ferris State University Brittany Torok, Heather Torre, Erin VanderHorst, and Jamie Wilson NURS 315
Pharmacologic vs Non-pharmacologic Treatments for Depression Ferris State University Brittany Torok, Heather Torre, Erin VanderHorst, and Jamie Wilson
Pharmacologic vs Non-pharmacologic Treatments for Depression
Ferris State University Brittany Torok, Heather Torre, Erin
VanderHorst, and Jamie Wilson NURS 315
Slide 3
Introduction Depression is common in the terminally ill person
and frequently these symptoms will go unrecognized. It is important
to remember persistent feelings of helplessness, hopelessness,
inadequacy, and suicidal ideations are not normal at the end of
life (Dodds, Kumar & Veering, 2014).
Slide 4
Depressive symptoms can respond quickly and positively to
pharmacological and non- pharmacolgic treatment. Medications Used
alone of in combination with other psychotropics. Antidepressants -
(SSRIs- fluoxetine, sertraline & citalopram) Stimulants
(methylphenidate, Concerta/Ritalin) Non-benzodiazepines (Buspirone
hydrocholoride)
Slide 5
Analysis of Pharmacological Studies Brown University Report 300
participants over the age of 60 years in a 12- week, double blind,
placebo-controlled trial yielded: o 86% of the patients treated
with paroxetine and 55% of the patients given the placebo responded
to treatment o 12.3% patients receiving paroxetine discontinued
treatment due to adverse side effects, compared to 8.3% of the
placebo- treated patients that stopped use. (Paxil CR has favorable
tolerability in elderly depression, 2003)
Slide 6
Analysis: Non-Pharmacological Studies Psychotherapy: Cognitive
Behavior Therapy Meta-analysis of literature from 23 randomized
controlled trials (RCTs) were chosen from 485 studies. Participants
were older adults with major or minor depressive symptoms, and
selected from the community and clinical settings. In most studies,
the subjects were from similar demographics and not very
generalized. Active controls = social support, placebo, case
management, discussion group, etc. Non-active controls = Treatment
as usual. (Gould et al., 2012)
Slide 7
Psychotherapy: Cognitive Behavior Therapy This research is
competitive since: Meta-analyses, as well as randomized controlled
trials, are considered to have stronger levels of evidence.
______________________ Results: CBT is more effective at reducing
depressive symptoms than nonactive, but not active controls. (Gould
et al., 2012)
Slide 8
Analysis: Pharmacological + Non-pharmacological Combination
Reynolds Study of paroxetine+therapy 116 patients over 59 years
participated. 28 took paroxetine plus psychotherapy. 35 took
placebo plus psychotherapy. 35 took paroxetine and only clinical
management. 18 took placebo and only clinical management.
(Reynolds, et al., 2006)
Slide 9
Reynolds Study of paroxetine+therapy o Paroxetine plus
psychotherapy had the lowest recurrence rate of depression. o
Paroxetine and only clinical management was more effective than
placebo plus psychotherapy (Renyolds et al., 2012)
Slide 10
Descriptive Summary Psychotherapy There is an abundance in
opportunities for psychotherapy interventions in our aging
population Psychotherapy can assist family members and other care
givers to provide enhanced care to the elderly Psychotherapy can be
a life-saving measure for elderly who are considering suicide
Slide 11
Psychotherapy Psychotherapy can be an effective non-
pharmacological option to treat depression in elderly. Especially
when: Pharmacological treatment produces undesired side effects.
Noncompliance or forgotten doses are a problem.
Slide 12
Descriptive Summary Psychotherapy Combination When used in
combination with Paxil lead to a reduction of reoccurrence of
depression in the elderly Where as a placebo use in combination
with psychotherapy did not show a reduction in reoccurrence of
depression
Slide 13
Descriptive Summary Pharmalogical Intervention Paxil Reynolds
2-year study revealed: the risk of reoccurrence in depression was
2.4 times higher in individuals who took a placebo rather than
Paxil. Many elderly have comorbidities, which can lead to drug
interactions with Paxil
Slide 14
Recommendations Psycotherapy VS paroxetine According to the
analysis of evidence above, depression is best treated with both
Paroxetine and psychotherapy. Using both treatments together can
lower the recurrence rate of depression. Treatment also depends on
how depressed the patient is. In patients that are severely
depressed, antidepressant drug therapy is more effective than
psychotherapy. (Long, 1988)
Slide 15
Patients that have non-severe depression usually recover in
less than 4 months. If the average episode of major depression
lasts 4 months, then for these mild cases, all that is required is
seeing a therapist frequently for brief, supportive visits until
the depression spontaneously recovers. (Long, 1988)
Slide 16
If a patient has severe major depression an antidepressant is
highly effective and must be given. In this case the drug must be
given for at least 6-12 months (Long, 1988) Severely depressed
patients suffer greatly and are high suicide risks. It takes weeks
before antidepressant drug therapy starts to work, thus these
patients desperately need a caring professional who will
emotionally support them and their family until their body
recovers. (Long, 1988)
Slide 17
Conclusion/Summary Psychotherapy is an effective treatment for
mild cases of depression Paxil is effective for mild-severe
depression The combination of psychotherapy and Paxil can improve
effectiveness rather than when used alone Similar to other
medications used to treat depression Paxil or psychotherapy may not
be effective for every patient and different pharmalogical or
nonpharmalogical interventions may need to be tried before finding
the right medication or combination
Slide 18
References Anderson, D., Wattis, J. (2014). Psychotherapeutic
approaches in the elderly. GM. 8. Retrieved from
http://www.gmjournal.co.uk/psychotherapeutic_ap
proaches_to_the_elderly_25769815462.aspx Dodds, C.,Kumar, C.,
Veering, B. (2014). Oxford textbook of anesthesiology for the
elderly patient. New York, NY. Oxford University Press. Long, P.
(1988, February 9). Major Depressive Disorder: Treatment. Retrieved
February 28, 2015, from http://www.mentalhealth.com/rx/p23-
md01.html#Head_2av Paxil CR has favorable tolerability in elderly
depression. (News Updates). (2003, January). The Brown University
Geriatric Psychopharmacology Update, 7(1), 8. Retrieved from
http://0- go.galegroup.com.libcat.ferris.edu/ps/i.do?id=GALE
%7CA96381216&v=2.1&u=lom_ferrissu&it=r&p=ITOF&s
w=w&asid=7f608b010d1c0a973cba307164e48e7b
Slide 19
References Frank, C. (2014). Pharmacologic treatment of
depression in the elderly. Canadian Family Physician, 60(2),
121-126. Retrieved from:
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC39 22554/ Reynolds,
Frank, E., Perel, J. (2006). Trial tests maintenance paroxetine and
psychotherapy in elderly patients. The Brown University
Pshychopharmacology Update.(17.6)p1. Retrieved from: http://0-
go.galegroup.com.libcat.ferris.edu/ps/i.do?&id=G
ALE|A146790178&v=2.1&u=lom_ferrissu&it=r&p=IT
OF&sw=w
Slide 20
References Gould, R., Coulson, M., Howard R. (2012). Cognitive
Behavioral Therapy for Depression in Older people: A meta-analysis
and meta- regression of randomized controlled trials. Journal of
the American Geriatrics Society (60)pp1817- 1830. Retrieved from:
http://0- onlinelibrary.wiley.com.libcat.ferris.edu/doi/10.111
1/j.1532-5415.2012.04166.x/epdf