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THE FOUR ‘M’ THEORY FOR TREATING DEPRESSION

(A Collation of Related Literature and Related Studies)

Prof. Jose Maria G. Pelayo III, MASD, MP-MT

January 22, 2019

This is a collection of related literature and related studies that may support a construct
to treat depression. The Four “M” Theory for Treating Depression was formulated by
Prof. Jose Maria G. Pelayo IIII in order to have a guide for intervention in a dynamic
systematic method based on scientifically based data. This Theory includes
MEDITATION, MUSIC, MOVEMENT and MEDICATION inclusive of their specific
components. A combination of all methods can be utilized depending on the mental
health practitioner’s recommendation to their client. All of the contents of this collation of
literature are empirical based and had positive effects in treating depression.
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MEDITATION

a. Mindfulness - Studies have shown benefits against an array of conditions both

physical and mental, including irritable bowel syndrome, fibromyalgia, psoriasis,
anxiety, depression, and post-traumatic stress disorder. But some of those
findings have been called into question because studies had small sample sizes
or problematic experimental designs. Still, there are a handful of key areas —
including depression, chronic pain, and anxiety — in which well-designed, well-
run studies have shown benefits for patients engaging in a mindfulness
meditation program, with effects similar to other existing treatments.

Researcher Gaelle Desbordes is probing mindfulness meditation’s effect

on depression, using functional magnetic resonance imaging (fMRI) to take
before and after images of the brains of depressed patients who’ve learned to
meditate. The work seeks to understand the internal brain processes affected by
mindfulness meditation training in this population.

Desbordes’ research uses functional magnetic resonance imaging (fMRI),

which not only takes pictures of the brain, as a regular MRI does, but also
records brain activity occurring during the scan. In 2012, she demonstrated that
changes in brain activity in subjects who have learned to meditate hold steady
even when they’re not meditating. Desbordes took before-and-after scans of
subjects who learned to meditate over the course of two months. She scanned
them not while they were meditating, but while they were performing everyday
tasks. The scans still detected changes in the subjects’ brain activation patterns
from the beginning to the end of the study, the first time such a change — in a
part of the brain called the amygdala — had been detected.

In her current work, she is exploring meditation’s effects on the brains of clinically
depressed patients, a group for whom studies have shown meditation to be
effective. Working with patients selected and screened by Shapero, Desbordes is
performing functional magnetic resonance imaging scans before and after an
eight-week course in mindfulness-based cognitive therapy, or MBCT.

During the scans, participants complete two tests, one that encourages
them to become more aware of their bodies by focusing on their heartbeats (an
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exercise related to mindfulness meditation), and the other asking them to reflect
on phrases common in the self-chatter of depressed patients, such as “I am such
a loser,” or “I can’t go on.” After a series of such comments, the participants are
asked to stop ruminating on the phrases and the thoughts they trigger.
Researchers will measure how quickly subjects can disengage from negative
thoughts, typically a difficult task for the depressed.

The process will be repeated for a control group that undergoes muscle
relaxation training and depression education instead of MBCT. While it’s possible
that patients in the control part of the study also will have reduced depressive
symptoms, Desbordes said it should occur via different mechanisms in the brain,
a difference that may be revealed by the scans. The work, which received
funding from the National Center for Complementary and Integrative Health, has
been underway since 2014 and is expected to last into 2019.

Desbordes said she wants to test one prevalent hypothesis about how
MBCT works in depressed patients: that the training boosts body awareness in
the moment, called interoception, which, by focusing their attention on the here
and now, arms participants to break the cycle of self-rumination.

“We know those brain systems involved with interoception, and we know
those involved with rumination and depression. I want to test, after taking MBCT,
whether we see changes in these networks, particularly in tasks specifically
engaging them,” Desbordes said.

Desbordes is part of a community of researchers at Harvard and its

affiliated institutions that in recent decades has been teasing out whether and
how meditation works.

SOURCE: Alvin Powell (2018) Harvard Staff Writer “Researchers study how it
seems to change the brain in depressed patients”

https://news.harvard.edu/gazette/story/2018/04/harvard-researchers-study-how-
mindfulness-may-change-the-brain-in-depressed-patients/
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b. Prayer - What are your deepest beliefs regarding the nature of God? When you
pray, do you talk to a loving, protective and easily accessible God? Or does God
feel strangely distant and unreachable? Perhaps a disciplinarian? A new study
says that your beliefs about the “character” of God determine the effects of
prayer on your mental health.

Researchers from Baylor University found that people who pray to a loving
and protective God are less likely to experience anxiety-related disorders —
worry, fear, self-consciousness, social anxiety and obsessive compulsive
behavior — compared to people who pray but don’t really expect to receive any
comfort or protection from God.

Researchers looked at the data of 1,714 volunteers who participated in the

most recent Baylor Religion Survey. They focused on general anxiety, social
anxiety, obsession and compulsion. Their study, entitled “Prayer, Attachment to
God, and Symptoms of Anxiety-Related Disorders among U.S. Adults,” is
published in the journal Sociology of Religion.

For many people, God is a source of comfort and strength, says

researcher Matt Bradshaw, Ph.D; and through prayer, they enter into an intimate
relationship with Him and begin to feel a secure attachment. When this is the
case, prayer offers emotional comfort, resulting in fewer symptoms of anxiety
disorders.

Some people, however, have formed avoidant or insecure attachments to

God, explains Bradshaw. This means that they do not necessarily believe that
God is there for them. Prayer starts to feel like an unsuccessful attempt at having
a close relationship with God. Feelings of rejection or “unanswered” prayers may
lead to severe symptoms of anxiety-related disorders, he says.

The findings add to the growing body of research confirming a connection

between a person’s perceived relationship with God and mental and physical
health. In fact, a recent study by Oregon State University found that religion and
spirituality result in two distinct but complementary health benefits. Religion
(religious affiliation and service attendance) is linked to better health habits,
including less smoking and alcohol consumption, while spirituality (prayer,
meditation) helps regulate emotions.

Another recent study by Columbia University found that participating in

regular meditation or other spiritual practice actually thickens parts of the brain’s
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cortex, and this could be the reason those activities tend to guard against
depression — especially in those at risk for the disease.

SOURCE: Traci Pedersen (2018) “New Study Examines the Effects of Prayer on
Mental Health”

https://psychcentral.com/blog/new-study-examines-the-effects-of-prayer-on-
mental-health/

One study, published last year in PLoS One, found that people who
attended church more than once per week were 55 percent less likely to die
during the 18-year follow-up period than people who didn’t frequent church.

A 2016 study from JAMA Internal Medicine also showed that women who
attended church services more than once per week were 33 percent less likely to
die during the 16 years of follow-up than non-churchgoers. These studies,
though, don’t show whether it is religion that is giving the health boost or some
other factor, such as social support.

Solo prayer is harder for researchers to measure than church attendance

for a couple reasons. For one, “How often do you go to church?” is an easy
question for people to answer. And two, different people may have different ways
of praying. Also, people tend to turn to prayer when things are going badly —
such as when they are sick, lose a loved one, or are fired from a job.

“A lot of times prayer becomes a marker for distress or even greater

physical illness, because it’s during those times that people turn to prayer for
comfort,” said Dr. Harold Koenig, director of the Center for Spirituality, Theology
and Health at Duke University, and author of “Religion and Mental Health:
Research and Clinical Applications.” Studies done at one point in time in a
person’s life — cross-sectional studies — may include only people who are
struggling.

Overall, research on the benefits of praying for others, known as

intercessory prayer, has been mixed. One review of past studies found that
praying for someone else has small health benefits for the person being prayed
for. Another showed no effect at all. And one study suggests that prayer may
make things worse. This study, published in 2006 in the American Heart Journal,
found that people who knew that someone else was praying for their recovery
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from heart surgery had higher rates of complications than people who weren’t
being prayed for.

Praying for others might not help them that much, but several studies have
found benefits for the person doing the prayer — whether they are praying for
someone else or themselves. This may stem from the effect that the act of
praying has on a person’s mental well-being. “The compassion that people
display toward others when they pray for them is something that is good for the
person doing the praying,” Koenig told Healthline. Prayer may also have similar
effects on mental well-being as meditation and yoga, which spill over into
physical effects.

“Any benefit to mental well-being, which I think prayer has, is going to

translate into benefits for physical well-being over time,” said Koenig.

He is quick to point out, though, that he’s not talking about prayer
“miraculously curing someone.” Instead, prayer can improve a person’s mental
health, such as reducing anxiety and stress.

In turn, this can translate into “better physiological functioning,” such as

lower levels of the stress hormone cortisol, lower blood pressure, and improved
immune functioning.

A 2009 study by Koenig and colleagues found that six weekly in-person
Christian prayer sessions with patients at a primary care office lowered their
depression and anxiety symptoms and increased their optimism.

The prayer was led by a lay minister, but the patients sometimes joined
them in praying. So it’s uncertain if the effects are the result of being prayed for
or the act of praying.

Other studies have found that prayer decreased symptoms of pain after a
C-section and improved the quality of life in women undergoing radiation therapy.

Koenig said there’s a particular need for studies that follow people over
decades to “see if those who regularly spend time in prayer end up experiencing
better mental and physical health over time.”

Does this mean you can ditch your doctor or psychologist and pray
instead? “Absolutely not,” said Koenig.
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Serious mental and physical problems are not things to mess around with.
Left untreated, anxiety disorder can lead to physical problems and an increased
risk of suicide and depression. Depression is linked to physical illnesses, social
isolation, and premature death. Other untreated illnesses can also lead to death
or other serious complications.

A study last year in JNCI: Journal of the National Cancer Institute found
that people who chose only alternative medicine therapies for their cancer were
2.5 times more likely to die than those who used conventional cancer treatments.

This study didn’t look at prayer specifically, but it does show the risks of
avoiding medical care. Even though prayer may not “miraculously” cure you,
there may still be a place for it alongside traditional treatments. “The combination
of getting the best medical care and having a strong religious faith and prayer
can lead to better mental and physical health,” said Koenig.

SOURCE: Shawn Radcliffe (2018) “Does Prayer Help or Harm Your Health?”
https://www.healthline.com/health-news/does-prayer-help-or-harm-your-health#1

MUSIC

Depression is a very common mood disorder, resulting in a loss of social

function, reduced quality of life and increased mortality. Music interventions have
been shown to be a potential alternative for depression therapy but the number
of up-to-date research literature is quite limited. We present a review of original
research trials which utilize music or music therapy as intervention to treat
participants with depressive symptoms. Our goal was to differentiate the impact
of certain therapeutic uses of music used in the various experiments.
Randomized controlled study designs were preferred but also longitudinal studies
were chosen to be included. 28 studies with a total number of 1,810 participants
met our inclusion criteria and were finally selected. We distinguished between
passive listening to music (record from a CD or live music) (79%), and active
singing, playing, or improvising with instruments (46%). Within certain boundaries
of variance an analysis of similar studies was attempted. Critical parameters
were for example length of trial, number of sessions, participants' age, kind of
music, active or passive participation and single- or group setting. In 26 studies,
a statistically significant reduction in depression levels was found over time in the
experimental (music intervention) group compared to a control (n = 25) or
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comparison group (n = 2). In particular, elderly participants showed impressive

improvements when they listened to music or participated in music therapy
projects. Researchers used group settings more often than individual sessions
and our results indicated a slightly better outcome for those cases. Additional
questionnaires about participants confidence, self-esteem or motivation,
confirmed further improvements after music treatment. Consequently, the
present review offers an extensive set of comparable data, observations about
the range of treatment options these papers addressed, and thus might represent
a valuable aid for future projects for the use of music-based interventions to
improve symptoms of depression.

Term used primarily for a setting, where sessions are provided by a board-
certified music therapist. Music therapy [MT] (Maratos et al., 2008; Bradt et al.,
2015) stands for the “…clinical and evidence-based use of music interventions to
accomplish individualized goals within a therapeutic relationship by a
credentialed professional who has completed an approved music therapy
program” (AMTA)2. Many different fields of practice, mostly in the health care
system, show an increasing amount of interest in [MT]. Mandatory is a
systematic constructed therapy process that was created by a board-certified
music therapist and requires an individual-specific music selection that is
developed uniquely for and together with the patient in one or more sessions.
Therapy settings are not limited to listening, but may also include playing,
composing, or interacting with music. Presentations can be pre-recorded or live.
In other cases (basic) instruments are built together. The process to create these
tailor-made selections requires specific knowledge on how to select, then
construct and combine the most suitable stimuli or hardware. It must also be
noted that music therapy is offered as a profession-qualifying course of study.

A more precise analysis of results was also done for the Geriatric
Depression Scale (GDS-15/-30) scores. As already suggested by its name, all
223 participants were elderly. Because both GDS versions are based on the
same questionnaire, we combined scores of the long (i.e., GDS-30) with the
short (i.e., GDS-15) test version and found a total of 223 participants in six
articles (e.g., Chan et al., 2009; Verrusio et al., 2014). A possible bias could be
prevented because tests were evenly distributed in number, and with respect to
higher GDS-30 as well as lower GDS-15 scores, calculations were adapted
accordingly. Taking a closer look at the GDS-15/-30 results (Table (Table3),3),
some similarities could be found for the most successful (all p ≤ 0.01) four
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research articles (Chan et al., 2009, 2010; Guétin et al., 2009a; Verrusio et al.,
2014). All of them used and mainly focused on classical compositions as far as
their music title selection was concerned. The average reduction in depression
as measured by the GDS-15/-30 depression scores was 43% (−42.62%; SD =
6.24%). In comparison, every one of the remaining four research projects
(Hanser and Thompson, 1994; Ashida, 2000; Han et al., 2011; Chan et al., 2012)
also presented significant results, albeit not as good as the above-mentioned (all
p ≤ 0.05). Interestingly, as far as music genres were concerned, the focus of
these less successful projects was rhythmic drumming in two cases (Ashida,
2000; Han et al., 2011). For the remaining two (Hanser and Thompson, 1994;
Chan et al., 2012) primarily relaxing, slow paced titles43 were selected as
intervention.

Certain individual-specific attributes of music are recognizable, when the

medium of music is decomposed (Durkin, 2014)47 into its components.
Numerous researchers reported the beneficial effects of music, such as
strengthening awareness and sensitiveness for positive emotions (Croom, 2012),
or improvement of psychiatric symptoms (Nizamie and Tikka, 2014). Group
drumming, for example, helped soldiers to deal with their traumatic experiences,
while they were in the process of recovery (Bensimon et al., 2008). However, we
have concentrated our focus of interest on patients diagnosed with clinical
depression, one of the most serious and frequent mental disorders worldwide.

In this review we examined whether, and to what extent, music

intervention could significantly affect the emotional state of people living with
depression. Our primary objective was to accurately identify, select, and analyze
up-to-date research literature, which utilized music as intervention to treat
participants with depressive symptoms. After a multi-stage review process, a
total of 1.810 participants in 28 scholarly papers met our inclusion criteria and
were finally selected for further investigations about the effectiveness music had
to treat their depression. Both, quantitative as well as qualitative empirical
approaches were performed to interpret the data obtained from those original
research papers. To consider the different methods researchers used, we
presented a detailed illustration of approaches and evaluated them during our
investigation process.
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Interventions included, for example, various instrumental or vocal versions

of classical compositions, Jazz, world music, and meditative songs to name just
a few genres. Classical music (Classical or Baroque period) for treatment was
used in nine articles. Notable composers were W.A. Mozart, L. v. Beethoven and
J. S. Bach. Jazz was used five times for intervention. Vernon Duke (Title: “April in
Paris”), M. Greger (Title: “Up to Date”), or Louis Armstrong (Title: “St. Louis
Blues”) are some of the featured artists. The third major genre researchers used
for their experimental groups was percussion and drumming-based music.

Significant criteria were complete trial duration, amount of intervention

sessions, age distribution within participants, and individual or group setting. We
compared passive listening to recorded music (e.g., CD), with active
experiencing of live music (e.g., singing, improvising with instruments).
Furthermore, the analysis of similar studies has enhanced and complemented
our work. Previous studies indicated positive effects of music on emotions and
anxiety, what we tried to confirm in more detail. The length of an entire music
treatment procedure was suspected to be an important element for reducing
symptoms of depression. A longer treatment duration of 7 weeks for an
individual, compared to nearly 6 weeks in a group setting led to better (i.e., above
average) outcomes. Although a difference was discovered, 1 week was not
enough to draw further conclusions for each and every project. As far as intervals
between sessions were concerned, we found no differences between those
research articles that were among the best, compared to the remaining
experimental designs. Consequently no trend was becoming apparent, favoring
one over the others. We further investigated if there was any association
between an individual or a group setting, if the length of a single session and trial
duration were compared with regard to symptom improvement. Groups showed
better improvements in depression, if each session had an average duration of
60 min, and a treatment between 4 and 8 weeks long. In comparison, the two
variables, session length and trial duration, had different effects for individual
treatment approaches. Above average results were found for sessions lasting 30
min combined with a treatment duration between 4 and 8 weeks. Furthermore,
results were compared according to age groups (“young,” “medium,” and
“elderly”). Overall, elderly people benefitted in particular from this kind of non-
invasive treatment. During, but mainly after completion of music-driven
interventions, positive effects became apparent. Those included primarily social
aspects of life (e.g., an increased motivation to participate in life again), as well
as concerned participants' psychological status (e.g., a strengthened self-
confidence, an improved resilience to withstand stress).
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We described similarities, the integration of different music intervention

approaches had on participants in experimental vs. control groups, who received
an alternative, or no additional treatment at all. Additional questionnaires
confirmed further improvements regarding confidence, self-esteem and
motivation. Trends in the improvement of frequently occurring comorbidities (e.g.,
anxiety, sleeping disorders, confidence and self-esteem)48, associated with
depression, were also discussed briefly, and showed promising outcomes after
intervention as well. Particularly anxiety (Sartorius et al., 1996; Tiller, 2013) is
known to be a common burden, many patients with mood disorders are
additionally affected with. Interpreted as manifestation of fear, anxiety is a basic
feeling in situations that are regarded as threatening. Triggers can be expected
threats such as physical integrity, self-esteem or self-image. Unfortunately,
researchers merely distinguished between “anxiety disorder” (i.e., mildly
exceeded anxiety) and the physiological reaction. Also, the question should be
raised if the response to music differs if patients are suffering from both,
depression and anxiety. Sleep quality in combination with symptoms of
depression (Mayers and Baldwin, 2006) raised the question, whether sleep
disturbances lead to depression or, vice versa, depression was responsible for a
reduced quantity of sleep instead. Most studies used questionnaires that were
based on self-assessment. However, it is unclear whether this approach is
sufficiently valid and reliable enough to diagnose changes regarding to symptom
improvement. Future approaches should not solely rely on questionnaires, but
rather add measurements of physiological body reactions (e.g., skin
conductance, heart and respiratory rate, or AEP's via an EEG) for more
objectivity.

SOURCE: Daniel Leubner* and Thilo Hinterberger (2017) “Reviewing the

Effectiveness of Music Interventions in Treating Depression”

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5500733/

Findings of the present meta-analysis indicate that music therapy provides

short-term beneficial effects for people with depression. Music therapy added to
treatment as usual (TAU) seems to improve depressive symptoms compared
with TAU alone. Additionally, music therapy plus TAU is not associated with more
or fewer adverse events than TAU alone. Music therapy also shows efficacy in
decreasing anxiety levels and improving functioning of depressed individuals.
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Future trials based on adequate design and larger samples of children and
adolescents are needed to consolidate our findings. Researchers should
consider investigating mechanisms of music therapy for depression. It is
important to clearly describe music therapy, TAU, the comparator condition, and
the profession of the person who delivers the intervention, for reproducibility and
comparison purposes.

We included in this review nine studies involving a total of 421

participants, 411 of whom were included in the meta-analysis examining short-
term effects of music therapy for depression. Concerning primary outcomes, we
found moderate-quality evidence of large effects favouring music therapy and
TAU over TAU alone for both clinician-rated depressive symptoms (SMD -0.98,
95% CI -1.69 to -0.27, 3 RCTs, 1 CCT, n = 219) and patient-reported depressive
symptoms (SMD -0.85, 95% CI -1.37 to -0.34, 3 RCTs, 1 CCT, n = 142). Music
therapy was not associated with more or fewer adverse events than TAU.
Regarding secondary outcomes, music therapy plus TAU was superior to TAU
alone for anxiety and functioning. Music therapy and TAU was not more effective
than TAU alone for improved quality of life (SMD 0.32, 95% CI -0.17 to 0.80, P =
0.20, n = 67, low-quality evidence). We found no significant discrepancies in the
numbers of participants who left the study early (OR 0.49, 95% CI 0.14 to 1.70, P
= 0.26, 5 RCTs, 1 CCT, n = 293, moderate-quality evidence). Findings of the
present meta-analysis indicate that music therapy added to TAU provides short-
term beneficial effects for people with depression if compared to TAU alone.
Additionally, we are uncertain about the effects of music therapy versus
psychological therapies on clinician-rated depression (SMD -0.78, 95% CI -2.36
to 0.81, 1 RCT, n = 11, very low-quality evidence), patient-reported depressive
symptoms (SMD -1.28, 95% CI -3.75 to 1.02, 4 RCTs, n = 131, low-quality
evidence), quality of life (SMD -1.31, 95% CI - 0.36 to 2.99, 1 RCT, n = 11, very
low-quality evidence), and leaving the study early (OR 0.17, 95% CI 0.02 to 1.49,
4 RCTs, n = 157, moderate-quality evidence). We found no eligible evidence
addressing adverse events, functioning, and anxiety. We do not know whether
one form of music therapy is better than another for clinician-rated depressive
symptoms (SMD -0.52, 95% CI -1.87 to 0.83, 1 RCT, n = 9, very low-quality
evidence), patient-reported depressive symptoms (SMD -0.01, 95% CI -1.33 to
1.30, 1 RCT, n = 9, very low-quality evidence), quality of life (SMD -0.24, 95% CI
-1.57 to 1.08, 1 RCT, n = 9, very low-quality evidence), or leaving the study early
(OR 0.27, 95% CI 0.01 to 8.46, 1 RCT, n = 10). We found no eligible evidence
addressing adverse events, functioning, or anxiety.
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SOURCE: Aalbers S, Fusar-Poli L, Freeman RE, Spreen M, Ket JCF, Vink AC,
Maratos A, Crawford M, Chen X, Gold C (2017) “Music therapy for depression”

https://www.cochrane.org/CD004517/DEPRESSN_music-therapy-depression

Traditional depression treatments like psychotherapy or medication might

work better for some patients when doctors add a dose of music therapy, a
research review suggests. Researchers examined data on 421 people who
participated in nine previously completed short-term experiments testing the
benefits of music therapy on its own or added to traditional interventions for
depression. Overall, the analysis found patients felt less depressed when music
was added to their treatment regimen, according to the analysis in the Cochrane
Library.

Music therapy also appeared to help ease anxiety and improve functioning
in depressed individuals, and it appeared just as safe as traditional treatments.
“We can now be more confident that music therapy in fact improves patients’
symptoms and functioning, and that this finding holds across a variety of settings,
countries, types of patients, and types of music therapy,” said senior study author
Christian Gold of Uni Research Health in Bergen, Norway.

More than 300 million people worldwide have depression, which is

projected to become the leading cause of disability by 2020, Gold and colleagues
write.

Music therapy can include passive approaches that involve listening,

active treatments that involve playing an instrument or singing or participating in
a musical performance, or some combination of these approaches. What sets
therapy apart from other musical endeavors is that it is typically led by a person
with training in counseling, psychology or treating depression. Even though
music therapy has long been used all over the world, research to date hasn’t
offered a clear picture of its benefits, Gold said.

The last review of music therapy published by Cochrane in 2008 didn’t

offer as much evidence of benefits, Gold said. A milestone study that came out in
2011 concluded that music could help but was only done in one country and left
many unanswered questions, he said.
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“The present review update confirms these findings and broadens them,”
Gold said by email. “We still think that more research is needed; however, we
feel that research on music therapy for depression can now turn to more specific
questions, such as comparing different types of therapy to each other.” Studies
included in the current review ranged in duration from six to 12 weeks. The
smallest study had just 14 participants, and the largest one included 79 people.
The total number of treatment sessions ranged from eight to 48, and the duration
of sessions varied from 20 minutes to two hours. Only one of the studies in the
analysis compared active versus passive music therapy, and it didn’t find a
difference in the short-term severity of depression.

“The most important finding is that music therapy shows short-term

beneficial effects for people with depression when added on top of baseline
psychological or pharmacological treatment,” said Dr. Gjin Ndrepepa, a
researcher at Technical University in Munich, Germany, who wasn’t involved in
the study. How it works isn’t clear, Ndrepepa said by email.

But modern brain imaging studies have shown that music therapy
activates regions of the brain that are involved in regulating emotions. Joyful and
sad music can have different effects, too, Ndrepepa added. More research is still
needed to figure out what type of music therapy works best for specific patient
situations, Gold said. “Until we have more specific research results comparing
different music therapies to each other, music therapy should be seen as one of
a variety of options,” Gold said. “It is important to have choices because no
therapy works for everyone.”

SOURCE: Rapaport, L. (2017) REUTERS Health News

https://iorbitnews.com/music-therapy-in-depression-and-anxiety/

MOVEMENT

a. Exercise - One in 10 adults in the United States struggles with depression, and
antidepressant medications are a common way to treat the condition. However,
pills aren't the only solution. Research shows that exercise is also an effective
treatment. "For some people it works as well as antidepressants, although
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exercise alone isn't enough for someone with severe depression," says Dr. -
Michael Craig Miller, assistant professor of psychiatry at Harvard Medical School.

The exercise effect

Exercising starts a biological cascade of events that results in many health

benefits, such as protecting against heart disease and diabetes, improving sleep,
and lowering blood pressure. High-intensity exercise releases the body's feel-
good chemicals called endorphins, resulting in the "runner's high" that joggers
report. But for most of us, the real value is in low-intensity exercise sustained
over time. That kind of activity spurs the release of proteins called neurotrophic
or growth factors, which cause nerve cells to grow and make new connections.
The improvement in brain function makes you feel better. "In people who are
depressed, neuroscientists have noticed that the hippocampus in the brain—the
region that helps regulate mood—is smaller. Exercise supports nerve cell growth
in the hippocampus, improving nerve cell connections, which helps relieve
depression," explains Dr. Miller.

Depression manifests physically by causing disturbed sleep, reduced

energy, appetite changes, body aches, and increased pain perception, all of
which can result in less motivation to exercise. It's a hard cycle to break, but Dr.
Miller says getting up and moving just a little bit will help. "Start with five minutes
a day of walking or any activity you enjoy. Soon, five minutes of activity will
become 10, and 10 will become 15."

It's unclear how long you need to exercise, or how intensely, before nerve
cell improvement begins alleviating depression symptoms. You should begin to
feel better a few weeks after you begin exercising. But this is a long-term
treatment, not a onetime fix. "Pick something you can sustain over time," advises
Dr. Miller. "The key is to make it something you like and something that you'll
want to keep doing."

SOURCE: Harvard Health Publishing (2017) “Exercise is an all-natural treatment

to fight depression”

https://www.health.harvard.edu/mind-and-mood/exercise-is-an-all-natural-
treatment-to-fight-depression
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b. Hobbies - Hobbies can also be relaxing and relieve depression and anxiety.
Here are 10 great hobbies that can help you feel calm and fulfilled.

With the seeming epidemic of mental health problems in society currently,

scientists and social scientists have turned their attention to these subjects.
They have discovered many hobbies that can relieve issues such as anxiety
and depression. The best thing is, many of these great hobbies are fun, too.

Crafts

Often when you are feeling depressed it can be hard to get motivated.
Starting a new craft can be a great way to get your mojo back. You can start with
a simple project and move on from there. Completing a small project gives you a
sense of satisfaction, too.

Gavin Clayton, one of the founders of the National Alliance for Arts, Health
and Wellbeing, says: “Our evidence shows that taking part in creative activities
has a positive impact on people’s mental health”.

There are hundreds of crafts you can try. It’s nice to start by making
something for yourself or your home. You could try sewing, knitting, candle
making, woodwork or pottery.

If there is a craft you used to enjoy, try starting it up again. If there is

something that you have always wanted to try then make a start. There are
hundreds of resources available online to teach you the basics. Just remember to
start with something simple so that you don’t get overwhelmed.

Photography

Photography can be a great way to lift your mood. Looking through the
lens of a camera makes you view the world in a different way. You start to look
for the beauty in everything and this improves your mood. If you feel negative a
lot, then it is definitely worth giving photography a try. As with other arts and
crafts, there is scientific evidence to suggest that art can improve your mood.

In a survey, participant of an ‘Arts on Prescription’ Project reported the

following effects on their health and wellbeing:

• 76 % reported an increase in wellbeing

 17

• 73 % reported a decrease in depression

• 71 % reported a decrease in anxiety

Starting photography is also a great way to record and remind yourself of

good times. You can even create a gallery or blog of your work to look at
whenever you feel a bit low. Sharing your photographs with others could also
help other people who experience anxiety and depression.

Gardening

Gardening is another hobby that can boost your mood and relieve anxiety.
Getting involved in gardening can focus your attention and stop you from
worrying. It can be a very relaxing hobby and can reduce stress levels. As
gardening also involves getting outside you get the added benefits of fresh air
and exercise, too.

Research indicates that ‘Therapeutic horticulture may decrease

depression severity and improve perceived attentional capacity by engaging
effortless attention and interrupting rumination,’ (Gonzalez MT).

If you do not have a garden, you could get involved in a community

gardening project instead. If even the thought of that makes you anxious, then
you could at least grow herbs on your windowsill and keep houseplants around
your home. Making your garden look nice will also encourage you to spend more
time outside relaxing and enjoying it.

Hiking

Hiking has so many benefits to health and wellbeing it is hard to know

where to start. Obviously, there are the physical benefits of getting exercise, but
it is more than just that. Getting outside can increase your levels of vitamin D.
Low levels of vitamin D have been linked with depression.

Researchers at Stanford University found that people who walk for 90

minutes in nature (as opposed to high-traffic urban settings) were less likely to
worry and ruminate. Rumination is the focused attention on the symptoms of
one’s distress, and on its possible causes and consequences, as opposed to its
solutions. It is one of the factors associated with depression.
 18

As well as taking your mind off your worries, the exercise will increase
your levels of serotonin which is known to reduce depression and regulate
anxiety.

Writing

Writing is the simplest hobby to start. All you need is a pen and some
paper or your computer. There are dozens of different types of writing, from
keeping a gratitude journal, to recording how you feel each day, to writing poetry,
short stories, non-fiction or a novel.

Geoff Lowe from the Department of Clinical Psychology, University of Hull

has found that the benefits of journaling include improvements in health and well‐
being.

Studies have also shown that journaling can help:

 Manage anxiety
 Reduce stress
 Cope with depression

It can do this by:

 Helping you prioritize problems, fears, and concerns

 Tracking any symptoms day-to-day so that you can recognize triggers and
learn ways to better control them.

 Providing an opportunity for identifying negative thoughts and behaviors

and replacing them with healthier ones.

 If you don’t like the idea of keeping a journal, you could express yourself
through any other kind of writing. Becoming involved in writing a piece of
fiction or non-fiction can take your mind off your negative thoughts.

 If you have ever thought you would like to have a go at writing, then this
could be a great way to help you overcome anxiety and depression.

Yoga
 19

Many studies have found that yoga can improve wellbeing. In particular,
yoga can relieve stress, reduce muscle tension, and calm the nervous system.

A study by the American Psychological Association has suggested the

yoga can enhance social well-being and improve the symptoms of depression.

Also, yoga has been shown to increase the level of gamma-aminobutyric

acid, or GABA, a chemical in the brain that helps to regulate nerve activity. This
is especially relevant to people who have anxiety disorders in which GABA
activity is low.

Starting a simple yoga routine is easy to do and need only take a few
minutes a day to have significant positive effects. There are apps and online
resources that can guide you through simple poses. You could also join a class
with a qualified teacher to get you started and make sure you are doing the
poses correctly. Ending your yoga routine with a relaxation or meditation session
will also help you to feel calm and relaxed.

SOURCE: Pursey, K. (2018) Categories: Psychology & Mental Health, Self-

Improvement “Learning Mind”
https://www.learning-mind.com/great-hobbies-anxiety-depression/

MEDICATION

Not only does it take time to get an accurate depression diagnosis, finding
the right medication to treat depression can be a complicated, delicate process.
Someone may have a serious medical problem, such as heart disease or liver or
kidney disease, that could make some antidepressants unsafe. The
antidepressant could be ineffective for you or the dose inadequate; there may not
have been enough time to see an effect, or the side effects could be too
bothersome -- leading to a failure of treatment.

As you approach taking antidepressants to treat depression, it is important

to keep these points in mind:

 Could your child have the flu? How to tell -- and what to do.
 Only about 30% of people with depression go into full remission after
taking their first course of antidepressants. That’s according to a 2006
 20

study funded by the National Institutes of Health. Those who got better
were more likely to be taking slightly higher doses for longer periods.
 Some antidepressants work better for certain individuals than others. It's
not uncommon to try different depression medicines during treatment.
 Some people need more than one medicine for depression treatment.
 Antidepressants carry a boxed warning about increased risk compared to
placebo for suicidal thinking and behavior in children, adolescents, and
young adults 18-24 years old.
 Working with your doctor, you can weigh the risks and benefits of
treatment and optimize the use of medication that best relieves your
symptoms.

Antidepressants, sometimes in combination with psychotherapy, are often

the first treatment people get for depression. If one antidepressant doesn't work
well, you might try another drug of the same class or a different class of
depression medicines altogether. Your doctor might also try changing the dose.
In some cases, your doctor might recommend taking more than one medication
for your depression.

Here are the main types of antidepressants along with brand names:

Selective serotonin reuptake inhibitors (SSRIs) were launched in the mid

to late 1980s. This generation of antidepressants is now the most common class
used for depression. Examples include citalopram (Celexa), escitalopram
(Lexapro), paroxetine (Paxil, Pexeva), fluoxetine (Prozac, Sarafem), and
sertraline (Zoloft). Two newer medicines, classified as "serotonin modulators and
stimulators" or SMS's (meaning they have some similar properties as SSRIs but
also affect other brain receptors) are vilazodone (Viibryd) and vortioxetine
(Trintellix) Side effects are generally mild, but can be bothersome in some
people. They include nausea, stomach upset, sexual problems, fatigue,
dizziness, insomnia, weight change, and headaches.

Serotonin and norepinephrine reuptake inhibitors (SNRIs) are a newer

type of antidepressant. This class includes venlafaxine (Effexor), desvenlafaxine
(Pristiq and Khedezla), duloxetine (Cymbalta), and, levomilnacipran (Fetzima).
Side effects include upset stomach, insomnia, sexual problems, anxiety,
dizziness, and fatigue.

Tricyclic antidepressants (TCAs) were some of the first medications used

to treat depression. Examples are amitriptyline (Elavil), desipramine (Norpramin,
 21

Pertofrane), doxepin (Adapin, Sinequan), imipramine (Tofranil), nortriptyline

(Aventyl, Pamelor), protriptyline (Vivactil), and trimipramine (Surmontil). Side
effects include stomach upset, dizziness, dry mouth, changes in blood pressure,
changes in blood sugar levels, and nausea.

Monoamine oxidase inhibitors (MAOIs) were among the earliest

treatments for depression. The MAOIs block an enzyme, monoamine oxidase,
that then causes an increase in brain chemicals related to mood, such as
serotonin, norepinephrine and dopamine. Examples are phenelzine (Nardil),
tranylcypromine (Parnate) , isocarboxazid (Marplan), and transdermal selegiline
(the EMSAM skin patch). Although MAOIs work well, they're not prescribed very
often because of the risk of serious interactions with some other medications and
certain foods. Foods that can negatively react with the MAOIs include aged
cheese and aged meats.

Other medications:

Bupropion (Wellbutrin, Aplenzin) is a unique antidepressant that is thought

to affect the brain chemicals norepinephrine and dopamine. Side effects are
usually mild, including upset stomach, headache, insomnia, and anxiety.
Bupropion may be less likely to cause sexual side effects than other
antidepressants.

Mirtazapine (Remeron) is also a unique antidepressant that is thought to

affect mainly serotonin and norepinephrine through different brain receptors than
other medicines. It is usually taken at bedtime because it often causes
drowsiness. Side effects are usually mild and include sleepiness, weight gain,
elevated triglycerides, and dizziness.

Trazodone (Desyrel) is usually taken with food to reduce chance for

stomach upset. Other side effects include drowsiness, dizziness, constipation,
dry mouth, and blurry vision.

Other medicines may be prescribed in addition to antidepressants,

particularly in treatment resistant depression. Here are examples of medicines
that may be used to augment as an add-on to antidepressant treatment.

Several specific antipsychotic medications have been shown to enhance

the effects of an antidepressant when an initial response is poor. These include
Abilify (aripiprazole), Seroquel (quetiapine) and Rexulti (brexpiprazole).
Symbyax, a combination of the antipsychotic drug Zyprexa (olanzapine) and an
SSRI (Prozac, or fluoxetine), is approved for treatment-resistant depression or
depression in people with bipolar disorder.
 22

Lithium carbonate, usually thought of for its mood stabilizing effects in

bipolar disorder, has also long been considered a useful add-on treatment to
antidepressants for people with major depressive disorder.

Stimulant medicines (such as methylphenidate (Ritalin) or

lisdexamfetamine (Vyvanse)) are sometimes used "off label" as add-on
treatments for some forms of depression.

Buspar (buspirone), an anti-anxiety medicine, also is sometimes useful for

depression when added to an antidepressant drug.

Your doctor may recommend or prescribe other medications or

supplements not FDA approved for use in depression.

Monitor your mood. Monitoring your moods and behavior from time to time
can help your doctor treat your depression before it becomes hard to control. Try
to observe any patterns of mood swings each week and call your doctor if you
aren’t feeling at the top of your game.

Strengthen your social support. Although you cannot control your

depression diagnosis, there are some things you can control. You can seek or
create a positive support system for yourself. Whether your social network stems
from your spouse, family members, close friends, co-workers, religious
organizations, or community groups, support is available.

Stick with the prescribed treatment. Antidepressants can take up to eight

weeks before they take full effect. Don't skip doses or quit treatment early. If you
don't take your depression medicine exactly as prescribed, you’re not giving it a
fair chance to work.

See a depression expert. It's important to talk with a trained professional

during your treatment. Although psychologists cannot prescribe medication, they
are well-trained in psychiatric assessment and psychotherapy. You can work with
a psychologist while taking antidepressants prescribed by your regular doctor, or
you can see a psychiatrist for both your depression medication and talk therapy.
Try to find someone who has a lot of experience helping people with treatment-
resistant depression. Mood disorder experts can often be found through
university-based hospitals or organizations such as the American Society of
Clinical Psychopharmacology, the American Psychiatric Association, or the
Depression and Bipolar Support Alliance (DBSA) "Find a Pro" online search
engine.
 23

Develop good habits. Take your depression medicine at the same time
every day. It's easier to remember if you do it along with another activity such as
eating breakfast or getting into bed. Get a weekly pillbox, which will make it easy
to see if you've missed a dose. Since people sometimes forget a dose now and
then, make sure you know what to do if that happens.

Don't ignore side effects. Side effects are one of the main reasons that
people give up on medication. If you have side effects, talk to your doctor. See if
there's any way to minimize or eliminate them. However, keep in mind that side
effects might be worse when you first start a medicine. Side effects often ease up
over time.

Let your doctor know if you are prescribed other medicines by another
health care professional. Some medicines can have important interactions with
antidepressant medicines. Tell your doctor if you are already taking, or begin
taking, any other medicines so he or she can safely monitor your treatment.

Never stop taking your depression medicine without your doctor's

permission. If you need to stop taking your medicine for some reason, your
doctor may want to reduce your dose gradually. If you stop suddenly, you could
have side effects and your depression could get worse.

Don't assume that you can stop taking your depression medicine when
you feel better. If you feel that you’d like to come off your medication, talk to your
doctor. Don’t stop on your own; quitting abruptly can lead to symptoms
associated with discontinuing a drug as well as risk for relapse.

SOURCE: WebMD, LLC. (2017) “Depression Medicines” All rights reserved.

https://www.webmd.com/depression/guide/optimizing-depression-medicines#1

REFERENCES

Aalbers S, Fusar-Poli L, Freeman RE, Spreen M, Ket JCF, Vink AC, Maratos A,
Crawford M, Chen X, Gold C (2017) “Music therapy for depression”
https://www.cochrane.org/CD004517/DEPRESSN_music-therapy-depression
 24

Harvard Health Publishing (2017) “Exercise is an all-natural treatment to fight

depression”
https://www.health.harvard.edu/mind-and-mood/exercise-is-an-all-natural-treatment-to-
fight-depression

Leubner, D and Hinterberger, T. (2017) “Reviewing the Effectiveness of Music

Interventions in Treating Depression”
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5500733/

Pedersen, T. (2018) “New Study Examines the Effects of Prayer on Mental Health”
https://psychcentral.com/blog/new-study-examines-the-effects-of-prayer-on-mental-
health/

Powell, A. (2018) Harvard Staff Writer “Researchers study how it seems to change the
brain in depressed patients”
https://news.harvard.edu/gazette/story/2018/04/harvard-researchers-study-how-
mindfulness-may-change-the-brain-in-depressed-patients/

Pursey, K. (2018) Categories: Psychology & Mental Health, Self-Improvement “Learning

Mind”
https://www.learning-mind.com/great-hobbies-anxiety-depression/

Radcliffe, S (2018) “Does Prayer Help or Harm Your Health?”

https://www.healthline.com/health-news/does-prayer-help-or-harm-your-health#1

Rapaport, L. (2017) REUTERS Health News

https://iorbitnews.com/music-therapy-in-depression-and-anxiety/

WebMD, LLC. (2017) “Depression Medicines” All rights reserved.

https://www.webmd.com/depression/guide/optimizing-depression-medicines#1