Treatment options for depression

Jul 26, 2018 | Articles

Treatment options for depression

Non-pharmacologic treatment options for depression

Sometimes women ask me if they can treat an episode of depression without medication. Depending on the duration and severity of the depression, this may be an option. Several non-pharmacologic treatments have been found to be helpful in women with depression.

Exercise
Regular moderate exercise, such as water aerobics or studio classes, can be beneficial for improving mood in women with mild depression both during and after pregnancy. Women should consult with their obstetrician prior to engaging in exercise, as certain types of exercise may be less safe in pregnancy and some women may have contraindications. Exercise during breastfeeding is also permissible.[i]

Psychotherapy
Psychotherapy is an effective treatment for depression. Two forms of therapy, cognitive behavioral therapy (CBT) and interpersonal therapy (IPT), are well studied and have been shown to effectively treat perinatal depression. Women who receive psychotherapy are twice as likely to recover from depression as women who receive no treatment.[ii]

Bright light therapy (or phototherapy)
Bright light therapy may be helpful in depression. It is thought to be safe in pregnancy and breastfeeding.[iii]

Acupuncture
Acupuncture may help some women with depression. There is no strong evidence suggesting it is unsafe in pregnancy.[iv]

Transcranial Magnetic Stimulation
Repetitive Transcranial Magnetic Stimulation (TMS or rTMS) is a relatively new procedure in which magnetic fields are used to stimulate certain portions of the brain. It is noninvasive. Generally, TMS is used in patients with depression who have found at least one medication to be ineffective. For women currently taking an antidepressant, adding TMS may double the chance a woman will “respond” to treatment. To date, the scientific literature suggests that TMS is safe in pregnancy and breastfeeding.[v]

 

[i]

  1. Tjoa C, Pare E, Kim DR. Unipolar depression during pregnancy: nonpharmacologic treatment options. Womens Health (Lond). 2010 Jul;6(4):565-76.
  2. Brandon AR, Crowley SK, Gordon JL, Girdler SS. Nonpharmacologic treatments for depression related to reproductive events. Curr Psychiatry Rep. 2014 Dec;16(12):526.
  3. ACOG Committee Opinion No. 650: Physical Activity and Exercise During Pregnancy and the Postpartum Period. Obstet Gynecol. 2015 Dec;126(6):e135-42.
  4. Exercise. https://reprotox.org/member/agents/19512. Accessed June 26, 2018.

[ii]

  1. Bobo WV, Yawn BP. Concise review for physicians and other clinicians: postpartum depression. Mayo Clin Proc. 2014 Jun;89(6):835-44.
  2. Cuijpers P, Karyotaki E, Weitz E, Andersson G, Hollon SD, van Straten A. The effects of psychotherapies for major depression in adults on remission, recovery and improvement: a meta-analysis. J Affect Disord. 2014 Apr;159:118-26.
  3. Stuart-Parrigon K, Stuart S. Perinatal depression: an update and overview. Curr Psychiatry Rep. 2014 Sep;16(9):468.

[iii]

  1. Tjoa C, Pare E, Kim DR. Unipolar depression during pregnancy: nonpharmacologic treatment options. Womens Health (Lond). 2010 Jul;6(4):565-76.
  2. Brandon AR, Crowley SK, Gordon JL, Girdler SS. Nonpharmacologic treatments for depression related to reproductive events. Curr Psychiatry Rep. 2014 Dec;16(12):526.
  3. Phototherapy. https://reprotox.org/member/agents/23346. Accessed June 26, 2018.

[iv]

  1. Tjoa C, Pare E, Kim DR. Unipolar depression during pregnancy: nonpharmacologic treatment options. Womens Health (Lond). 2010 Jul;6(4):565-76.
  2. Brandon AR, Crowley SK, Gordon JL, Girdler SS. Nonpharmacologic treatments for depression related to reproductive events. Curr Psychiatry Rep. 2014 Dec;16(12):526.
  3. Acupuncture. https://reprotox.org/member/agents/24057. Accessed June 26, 2018.

[v]

  1. Liu B, Zhang Y, Zhang L, Li L. Repetitive transcranial magnetic stimulation as an augmentative strategy for treatment-resistant depression, a meta-analysis of randomized, double-blind and sham-controlled study. BMC Psychiatry. 2014 Nov 30;14:342.
  2. rTMS. https://reprotox.org/member/agents/26850. Accessed June 26, 2018.