Evidence-Based Medicine in Depression Essay Example

Masic, Miokovic & Muhamedagic, (2008) defines evidence-based medicine as the reliable, reasonable and explicit application of modern and evidence-backed decisions and practices in caring for individual patients. The method integrates clinical experiences and patient values with the best available research information. Depression is one of the most pervasive illnesses today, and there have been efforts to incorporate alternative treatment and management approaches to it. Admittedly, there are many causative agents of depression today due to high demands in our lives and careers, fatigue, inactivity, low sleep, and other factors. This paper explores the application of evidence-based medicine to prevention, promotion of better mental health, and management of depression. Evidence-based medicine has been practiced for many years, and scientific proof over their benefits back its components.

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Several modern treatment approaches are applied in the treatment and management of clinical depression. Firstly, diagnosis is universally based on the definitions and symptom provided by the Diagnostic and Statistical Manual of Mental Disorders, (DSM IV currently). Once the condition has been clinically identified from other mental health conditions, treatment is recommended depending on the stage. Treatment using medicines such as antidepressants have traditionally been used in the treatment and management of the health condition. Antidepressants are used to reduce the pain and elevate the patients' mood. An example of a common antidepressant is the Selective Serotonin Inhibitors which are the most prescribed antidepressants. Anxiolytics and Antipsychotics are also commonly prescribed medications. The main problem with modern treatment approaches is that they are not holistic and only address one aspect of the body. There is a need not just to treat the physical, but also consider the mental and behavioral well-being of the patients. This informs why some traditional treatment approaches have stood out as having better outcomes than this approach.

Traditional Chinese Medicine is known to apply a comprehensive summary of the causes, the location of pain or concentration of the medical condition, nature and other patterns elicited in considering treatment. Song, Liu & Deng et al., (2014) notes that ZHENG, or TCM syndrome, is an essential part of therapy in China, unlike the west. For more than 3000 years, TCM has developed and combines a variety of techniques to identify syndromes which are then managed through therapy. These techniques include listening, pulse analysis and questioning the patients. Song, Liu & Deng et al., (2014) presents a study of TCM and how it is applied in the treatment of depression. A critical feature of their research is that TCM syndrome analysis dissociates the various symptoms that are associated with the condition. They develop the depression network which further reveals that all signs are connected and interrelated. By use of weighting, it was easy to deduce how TCM combines the syndromes. It is easy to deduce that TCM addresses the core of the depression problem and further considers all the aspects of the condition before treatment. When treatment is done in such a way that directly addresses the syndrome as indicated by the symptoms and the way the condition presents, there is a higher degree of success.

Sarris, O'Neil, Coulson, Schweitzer & Berk, (2014) argue that there is compelling evidence that factors in our lifestyles today contribute to depression, yet the same elements can be modified. These modifying mechanisms often receive little to no attention, consideration or application in the standard treatment and management of depression. They describe "Lifestyle Medicine" as the evidence-based approach to managing the condition which is a combination of evidence-based medicine, increasing physical exercises, behavioral and psychological modification and improving mental wellbeing.

It is essential to appreciate that while modern medicine acts as a critical first line of defense, lifestyle medicine as described by Sarris, O'Neil, Coulson, Schweitzer & Berk, (2014) is low-cost and safe for management of depression. They argue that their approach comprises the inclusion of environmental, psychological and behavioral principles which has the advantage of improving both the physical and mental wellbeing of the patient, hence more holistic healing. Studies have shown that the diet we eat, our levels of physical activity, relaxation, work-life balance, smoking, alcohol consumption, and other behaviors can contribute to advancement in the depression problem. In their study, they detail how the different environmental and social factors influence depression and how patients can control their usage of the same. Lifestyle Medicine is essential in modifying our lifestyles alongside application of pharmacotherapies.

Evidence-based medicine practices has the advantage of improving the long-term mortality risk, especially among older patients. Depression and other mental illnesses are known to co-occur with other medical conditions such as diabetes and high blood pressure, especially among older patients. In their paper titled "Multimorbidity, Depression, and Mortality in Primary Care: Randomized Clinical Trial of an Evidence-Based Depression Care Management Program on Mortality Risk," Gallo, Hwang & Joo, (2015) argue that while antidepressants and other modern medical practices are effective in treatment of depression patients, especially those with other medical conditions such as those mentioned, they do not reliably impact the self-management practices of the patients. Evidence-based depression plays a role in care management which ends up improving the glycemic control in the patients. The paper highlights the need to combine self-management practices in the treatment programs of depression. Their study indicates that patients with other medical conditions alongside depression show more significant improvements and benefits when the treatment takes the integrated and holistic approach. On this note, it is critical that management of depression need not be secondary to the management of other conditions as well as managing other aspects of the individuals' health. Furthermore, Fortney, Pyne, Ward-Jones & Bennet, (2018) evidence-based care has the component of quality improvement which improves the outcomes of care.

It is true that mental illnesses such as depression places a significant burden, sometimes greater than general illnesses, and often results in loss of life of the affected individuals. Due to the cost of treatment coupled with the general burden associated with depression, healthcare facilities and policymakers have continuously sought to find solutions to this problem. As discussed above, adopting an integrated care approach to addressing depression is the better approach. While drawing comparisons between clinical practice and evidence-based approach, Oslin, Dixon, Adler & Winston et al., (2018) argue that there exists strong scientific evidence supporting the integration of behavioral healthcare into primary care interventions. Integrated care is an essential component of evidence-based medicine as it includes aspects of behavioral interventions including problem-solving therapy and behavioral activations to realize healing. In their paper, Oslin, Dixon, Adler & Winston et al., (2018) note that each of the two approaches applied in managing mental health has their strengths and weaknesses and that there is need to explore the common ground that builds on the advantages presented by each of them. Adopting an integrated and holistic approach to managing the condition enhances the recovery process from the health condition.

Conclusion

As discussed above, the area of mental health has received a lot of clinical attention over the years. It is also evident that modern clinical treatment approaches are limited in many ways and do not result in the best quality of care. There are many factors that affect the presentation of mental illnesses, and every focus has to be placed in properly diagnosing and addressing the syndromes. From the discussion above, many evidence-based practices have been adopted to manage mental health conditions in other places such as China with immense benefits, and their efficacy proves that they can be taken entirely in the clinical domain with success. Lifestyle medicine considers not just clinical interventions, but all other factors in the physical and mental domain that influence the success of care. By examining all these factors in a wholesome view, there is a higher degree of success. The complexity of mental illnesses such as depression informs the emergence of evidence-based medicine as a more integrated look at treatment. The best proof of the success of evidence-based medicine is the Traditional Chinese Medicine theory which is highlighted above and which shows the need to map out all the symptoms that constitute a given syndrome, arguing that they are all interrelated and interconnected and understanding each of them can result in a better way to address the medical condition.

References

Fortney, J. C., Pyne, J. M., Ward-Jones, S., Bennett, I. M., Diehl, J., Farris, K., ... & Curran, G. M. (2018). Implementation of evidence-based practices for complex mood disorders in primary care safety net clinics. Families, Systems, & Health, 36(3), 267.

Gallo, J. J., Hwang, S., Joo, J. H., Bogner, H. R., Morales, K. H., Bruce, M. L., & Reynolds, C. F. (2016). Multimorbidity, depression, and mortality in primary care: randomized clinical trial of an evidence-based depression care management program on mortality risk. Journal of general internal medicine, 31(4), 380-386.

Oslin, D., Dixon, L., Adler, D. A., Winston, H., Erlich, M. D., Levine, B., ... & Siris, S. G. (2018). Adaptation in Delivering Integrated Care: The Tension Between Care and Evidence-Based Practice.

Sarris, J., O'Neil, A., Coulson, C. E., Schweitzer, I., & Berk, M. (2014). Lifestyle medicine for depression. BMC psychiatry, 14(1), 107.

Song, J., Liu, X., Deng, Q., Dai, W., Gao, Y., Chen, L., ... & Guo, R. (2015). A network-based approach to investigate the pattern of syndrome in depression. Evidence-Based Complementary and Alternative Medicine, 2015.