title: Understanding the role of adjunctive nonpharmacological therapies in management of the multiple pathways to depression.
abstract: Major depressive disorder (MDD) is a common disorder with a lifetime prevalence of 16.2% and the fourth highest cause of disability globally. It is hypothesized to be a syndromatic manifestation of multiple pathological processes leading to similar clinical manifestation. MDD is associated with at least three categories of peripheral hormone-type factors including neurotrophic factors, proinflammatory cytokines, and processes that impair regulation of the hypothalamic-pituitary-adrenocortical axis. Neuroimaging studies have identified functional abnormalities including subcortical systems associated with reward and emotion processing, medial prefrontal and anterior cingulate cortical regions and the lateral prefrontal cortical systems involved in cognitive control and voluntary emotion regulation. Studies investigating the effects of psychotherapy and pharmacotherapy on functional brain measures show normalization of brain function with return to euthymia. Nevertheless, approximately 50% of patients with MDD will not respond sufficiently and 60 to 70% will not achieve full remission with first-line pharmacotherapy, therefore clinicians strive to improve patient responses through the use of adjunct therapies. This review discusses recent research in the various biological processes associated with MDD as well as recent data in support of the use of adjunctive non-pharmacological therapies including psychotherapy, bibliotherapy, Internet therapy, "natural" or herbal approaches, exercise therapy, and somatic therapies.
authors.affiliation: Toldo Neurobehavioral Institute, Windsor Regional Hospital, Windsor, ON, Canada; Schulich School of Medicine, Western University, London, ON, Canada. Electronic address: corina_velehorschi@wrh.on.ca.
authors.forename: Corina
authors.initials: C
authors.lastname: Velehorschi
authors.affiliation: Faculty of Medicine, McGill University; McGill University Health Centre, McGill University, Montreal, QC, Canada.
authors.forename: Pierre
authors.initials: P
authors.lastname: Bleau
authors.affiliation: START Clinic for Mood and Anxiety Disorders, Toronto, ON, Canada; Department of Psychology, Lakehead University, Thunder Bay, ON, Canada.
authors.forename: Monica
authors.initials: M
authors.lastname: Vermani
authors.affiliation: START Clinic for Mood and Anxiety Disorders, Toronto, ON, Canada.
authors.forename: Melissa
authors.initials: M
authors.lastname: Furtado
authors.affiliation: Eden Mental Health Centre, Winkler, MB, Canada.
authors.forename: Larry J
authors.initials: LJ
authors.lastname: Klassen
mesh_terms: D001921:Brain / Q000473:pathology* / Q000503:physiopathology; D003131:Combined Modality Therapy / Q000379:methods*; D003863:Depression / Q000473:pathology / Q000523:psychology / Q000628:therapy*; D003865:Major Depressive Disorder / Q000473:pathology / Q000523:psychology / Q000628:therapy*; D004644:Emotions / Q000502:physiology; D006801:Humans; D059906:Neuroimaging; D011613:Psychotherapy / Q000379:methods*
keywords: Adjunct therapy; Major depressive disorder; Metabolic syndrome; Psychotherapy; Somatic therapies