An Integrative Approach to Adjunctive Management of Treatment-Resistant Depression

Authors

Benjamin J. Epstein, University of LynchburgFollow

Specialty

Psychiatry

Advisor

Nancy E. Reid, MHA, DHSc, PA-C, DFAAP

Abstract

Purpose: A common occurrence in the practice of mental health is medication aversion. It is not uncommon for patients to search for alternative treatments. The purpose of this review is two-fold. First, identify the importance of evidence-based psychopharmacology in the management of mental health disorders. The second is to understand augmenting strategies to better accommodate patient preference and compliance in medication management with augmenting strategies for the management of Treatment-Resistant Depression (TRD) with an integrative approach.

Method: An initial PubMed search was performed after establishing the PICO question to assess the validity of the problem. The initial terms searched were related to medication aversion and compliance followed by a second search to assess the evidence related to nutraceuticals in the management of TRD. The search was limited to review articles, meta-analysis and clinical trials. Terms included in the search include nutraceuticals and Major Depressive Disorder (MDD), revealing 275 results. Upon limiting results to the most recent five years the number of results reduced to 134 articles. Additional criteria of TRD entered in advanced search yielding nine results. Articles excluded were not relevant to the PICO question and mostly relate to more traditional augmentation strategies including second-generation antipsychotics (SGA), brain stimulation and psychotherapy. The search revealed inflammation and the gut microbiome has a strong correlation to mental health which are important factors when looking into a more integrative approach. However, results with less focused disease states such as rheumatological and pain conditions as a primary diagnosis were excluded to help prevent confounding of desired results. The research chosen presents the best data in answering and validating the PICO question.

Results: It is clear there is a strong interest in more natural approaches to the treatment of MDD. There is little evidence supporting the management of MDD as monotherapy with nutraceutical options. However, evidence-based research does present integrative options showing benefit regarding the management of TRD as an augmenting strategy.

Conclusion: Integrative approaches to depression may be a viable option for patients experiencing failure to more traditional monoamine reuptake inhibitors. While many supplements are sold on the market with little evidence showing resolve in depressive symptoms, options do present in the literature with potential benefits. S-adenosylmethionine (SAMe), Omega-3 fatty acids, L-methylfolate, bright white light, probiotics as well as targets of inflammation such as specific exercise and diet regimens deserve more in-depth research.

Recommended Citation

Epstein BJ. An Integrative Approach to Adjunctive Management of Treatment-Resistant Depression. University of Lynchburg DMSc Doctoral Project Assignment Repository. 2021; 3(1).