Effectiveness Of Cognitive Behavioral Therapy And Exercise Therapy Without Antidepressants For Depression Treatment

Search Strategy

Depression has become one of the primary reasons for disability throughout the world which has increased the disease related burden affecting 35% of the world population. As per the world health organization, the prevalence of depression is 25-30% for women and 10 to 15% for men (Avenevoli et al., 2015). The conventional treatment for depression includes antidepressant medications as well as several type of psychotherapy that helps people to come out of their depression condition (Panagioti et al., 2014). However, it has been seen that inclusion of exercises and/or cognitive behavioral therapy without antidepressant drugs could also increase the efficiency of the recovery and decrease the dependency of such anti-depressant drugs, which could be an adverse side effect of the drug.

The primary aim of this paper is to provide a detailed search strategy in which keywords and the databases used to search for the research evidences. Further, the methodology, the PICO question developed to conduct succinct search, a precise literature review, and the findings of the five research articles would be provided.

The question: is inclusion of cognitive behavioral therapy and/or exercise therapy without antidepressants effective for improvement of depression condition in people affected with depression compared to Therapies with Antidepressants?

To find evidences related to the developed PICO question, databases containing research articles were searched. The databases included in the search strategy was Google scholar, Pub Med, CINAHL, and Medscape and keyword combinations with Boolean operators were used to collect relevant and concise research articles. The keywords which were used for this search process are ‘cognitive behavioral therapy in depression’, ‘exercise therapy in depression’, ‘cognitive behavioral therapy in depression without antidepressant’, ‘exercise therapy without anti depressants’, ‘cognitive behavioral therapy and/or exercise therapy without antidepressant’. These keywords were then connected suing Boolean operators that is ‘And/Or’ and then with permutation and combination, these keywords were used in all these databases. After obtaining the results, several inclusion and exclusion criteria were used to select and eliminate research article from the search results. Research article that included primary study, systematic review, meta-analysis, proper methodology, finding and data analysis in English language were included in the study. On the other hand, descriptive papers, language other than English, and improper data analysis and methodology were neglected and excluded from the study. Finally, five research article related to the topic were included in the study. The prisma diagram for search strategy is as follows: 

Literature Review

Methodology and participants

Five research articles were selected in this paper for discussion about the effectiveness of cognitive behavioral therapy or exercise therapy without antidepressants in the care process of people affected with depression. The first research article by Gilbody et al. (2015) was selected for the discussion about computerized cognitive behavioral therapy as a replacement of usual practice care process using antidepressants and to find out the effectiveness, a large scale pragmatic randomized control trial was used. Patients affected with depression were provided with questionnaires and were provided with unconventional computerized cognitive behavior therapy was used (Gilbody et al., 2015). After the conduction of the process, after 4 months of the process, PHQ-9 was used for the assessment of the presence of depression condition.

The second research article, whereas, discussed about the non-stigmatized, accessible and affordable nonconventional care process such as the internet based cognitive behavioral therapy, physical exercise and treatment as usual or antidepressants so that their effectiveness for their quality of life could be assessed (Hallgren et al., 2015). Total 946 participants were included in a 12 week interventions and after the process, they were reassessed after 3 months to determine recurrence of the depression condition (Hallgren et al., 2015). On the other hand, the primary method used in the third article was associated to mindfulness based cognitive therapy (MBCT) and compared with a study group where antidepressants were included in the study (Chiesa et al., 2015). With application of the process, anxiety level was assessed at baseline, and 4, 8, 17 and 26 weeks of the study (Chiesa et al., 2015).

The fourth article was focused on assessment of presence and absence of antidepressants in making the cognitive based therapy for the depression condition and then comparing their effectiveness (Hollon et al., 2014). In this aspect, total 452 patients were selected and the treatment process was continued for 42 months continuously. The treatment outcomes were then assessed through the usage of sub-distribution hazard model and hence, they were provided with all the interventions. The depression was assessed using the Hamilton rating scale that provided detail of the depression condition and determined the effectiveness of the process (Hollon et al., 2014). The fifth article whereas, was based on the evidence based treatment for the depression condition and used cognitive behavioral therapy with physical exercise to determine the their combined effectiveness in treating depression condition and then compared it with the conventional and usual care process used for the depression treatment condition (Hallgren et al., 2016). They used three study groups for each of the intervention and then after 12 months assessed the entire 945 adult patient included in the study for their effective recovery. After conduction of the test or research, depression condition was assessed using the Montgomery–Åsberg Depression Rating Scale (Hallgren et al., 2016). 

Research Findings

Study description and findings

The study conducted by Gilbody et al. (2015) aimed towards determination of effectiveness of cognitive behavioral therapy and hence, after completion of the study analyzed the PHQ-9 level after four months of intervention application, psychological wellbeing using CORE-OM at four, 12 and 24 months of intervention application as well as assessed the quality of the life after conduction of the study as the secondary outcome of the study. After the conduction of the study, it was found that CBT alone does not substantially improve the patient condition, however, with the presence of antidepressants or conventional medications, provides substantial growth in self confidence and esteemed to the patients affected with severe depression (Gilbody et al., 2015).

The second article, after conduction of their intervention, found that majority of the patient involved in the study were responsible and responded to the study effectively as the response rate was 78% (Hallgren et al., 2015). The findings indicated to the fact that exercise effectively decreases the depression condition compared to the treatment as usual and this improvement was seen in all the three groups. Therefore, indicated towards the usage of exercise therapy as an unconventional treatment process to remove depression condition among adults (Hallgren et al., 2015). 

Chiesa et al. (2015), in their research study, that aimed to determine the effectiveness of mindfulness based cognitive therapy and focuses in the application of these in the care process with or without conventional treatment options, found positive result for the research group. After conduction of 26 weeks of the study and 4 interval assessments after 4^th, 8^th, 17^th and 26^th week, researchers found that the MBCT were able to provide effective treatment to patients who had severe depression and the chance of remission were also minimal. Therefore, provides detail of its effectiveness in treating depression condition (Chiesa et al., 2015).

The fourth research article directly compared the cognitive therapy with the antidepressant medications and with or without involvement of the cognitive therapy provides a detail of the effectiveness of the drug alone (Hollon et al., 2014). After conduction of the study, it was found that patients who were provided with antidepressants showed no significance risk of adverse effects and the rate of recovery of depression was improved if the care process involved cognitive therapy as unconventional therapy. Hence, through the research it was proved that cognitive therapy should be used as a primary treatment option for patients affected with depression (Hollon et al., 2014). 

Discussion

The fifth research article that aimed to understand the effect of exercise, cognitive therapy and conventional anti depressants on the depression condition of patients and then assessed their depression condition using MADRS scale (Hallgren et al., 2016). It was found after 12 month follow up that significance difference was present in case of exercise as MADRS score for exercise, cognitive therapy and medication was 12.1, 11.4 and 9.7 respectively that clearly demonstrates that cognitive therapy and exercise worked as an effective tool to decrease depression of patients. Hence, it provided an optional therapy of depression condition (Hallgren et al., 2016).

Conclusion

While concluding the paper, it could be said that depression is the mental condition in which people should be provided with counseling, support and care instead of a conventional care process, as people are affected from mental perspective, in which medication might not work. Cognitive therapy and exercise hence, provides an effective and optional approach ij which using patient and their thought process, abilities care is provided to patients. This paper discusses few such papers in which exercise and cognitive therapy and its effectiveness was provided, so that their effectiveness could be determined. 

References

Avenevoli, S., Swendsen, J., He, J. P., Burstein, M., & Merikangas, K. R. (2015). Major depression in the National Comorbidity Survey–Adolescent Supplement: prevalence, correlates, and treatment. Journal of the American Academy of Child & Adolescent Psychiatry, 54(1), 37-44.

Chiesa, A., Castagner, V., Andrisano, C., Serretti, A., Mandelli, L., Porcelli, S., & Giommi, F. (2015). Mindfulness-based cognitive therapy vs. psycho-education for patients with major depression who did not achieve remission following antidepressant treatment. Psychiatry research, 226(2-3), 474-483.

Gilbody, S., Littlewood, E., Hewitt, C., Brierley, G., Tharmanathan, P., Araya, R., … & Kessler, D. (2015). Computerised cognitive behaviour therapy (cCBT) as treatment for depression in primary care (REEACT trial): large scale pragmatic randomised controlled trial. Bmj, 351, h5627.

Hallgren, M., Helgadóttir, B., Herring, M. P., Zeebari, Z., Lindefors, N., Kaldo, V., … & Forsell, Y. (2016). Exercise and internet-based cognitive–behavioural therapy for depression: multicentre randomised controlled trial with 12-month follow-up. The British Journal of Psychiatry, 209(5), 414-420.

Hallgren, M., Kraepelien, M., Lindefors, N., Zeebari, Z., Kaldo, V., & Forsell, Y. (2015). Physical exercise and internet-based cognitive–behavioural therapy in the treatment of depression: randomised controlled trial. The British Journal of Psychiatry, 207(3), 227-234.

Hollon, S. D., DeRubeis, R. J., Fawcett, J., Amsterdam, J. D., Shelton, R. C., Zajecka, J., … & Gallop, R. (2014). Effect of cognitive therapy with antidepressant medications vs antidepressants alone on the rate of recovery in major depressive disorder: a randomized clinical trial. JAMA psychiatry, 71(10), 1157-1164.

Panagioti, M., Scott, C., Blakemore, A., & Coventry, P. A. (2014). Overview of the prevalence, impact, and management of depression and anxiety in chronic obstructive pulmonary disease. International journal of chronic obstructive pulmonary disease, 9, 1289