Greg Mattingly, MD, on Nonpharmacological Tools for Reducing Depressive Symptoms
In this video, Greg Mattingly, MD, discusses nonpharmacological strategies that patients can take to help reduce depressive symptoms.
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Dr. Mattingly is Associate Clinical Professor, Washington University, St. Louis, Missouri, principal investigator in clinical trials for Midwest Research Group and founding partner of St. Charles Psychiatric Associates, St. Charles, Missouri.
Medications are one piece of the puzzle for our patients, but they're certainly not the only piece. We know that depression doesn't just damage the brain, but it damages someone's life. We know that depression can damage a marriage. It can damage my ability to be a parent. It can damage my self‑identity.
When we talk about holistic treatment for our patients, I think the first step for patient struggling with chronic depression is to offer hope: "We're going to stick together, and we're going to get you through this. "I'm going to listen to you, you're going to guide me, but we now have a lot of treatment options that can help to improve what's going to happen with you." So, offering hope to our patients.
The second thing when we think about in a holistic model is the importance of interpersonal connections. Our relationships tend to define us, and many of our patients with depression, their relationships with their husband, with their spouse, with their parents, with their boyfriend, or girlfriend, or their significant other, those relationships have been damaged.
One of my good friends, Vladimir Maletic, he showed me a study that looked at people that come into depression that have damaged dyadic relationships, my relationship with my most important other, they tend not to respond to standard antidepressants. For that group of patients, interpersonal therapy, relationship therapy, beyond just taking a medicine.
Number three, never underestimate the importance of exercise. Study after study, after study, has shown that exercise, it just doesn't make you feel good.
Exercise turns on neural growth factors in the brain. It helps the brain to be more resilient, that improves your chance of responding to an antidepressant that has the chance to take an antidepressant partial responder and make them a full responder, so the importance of exercise.
Finally, life events, living a life with purpose, with positive life events. There's a wonderful article that was published several years ago in JAMA that looked at young women that were genetically predisposed to depression. It was full in their family.
They followed them into their 20s, and the question was, why did some of these girls not get depression even though, genetically, they were highly at risk? What did they find?
They found the girls that were resilient to depression, had very neurally connected brains. One part of the brain could cross‑talk to another part during stress. They then said, "Why do some of these girls have such neutrally connected brains?"
The number one factor was positive life events. Every positive life event that we can give to our patients who are at risk of depression, who've already experienced depression, each positive life event in my simplistic way of thinking about it, gives us a little puff of neural growth factors.
Each positive life event gives us a puff of neural growth factors, which increases neural connectivity, which makes our brain more resilient to not decompensating under stress.
So, those modifiable risk factors that define us, those modifiable risk factors that are highly important to our patients and a holistic approach to treatment.