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Can an Integrative Approach to the Management of Depression Help Patients Achieve Functional Recovery? A Review of Current Literature

Pratap Rao Chokka

The neurobiology of emotion regulation is complex and multifactorial. Current models suggest that connections between information processing by the brain and its communications with the mind and body are impaired by chronic stress and the system is dysregulated in Major Depressive Disorder (MDD). Despite the high prevalence of MDD, the condition remains poorly managed with current treatment approaches, which have traditionally been aimed at correcting a single level of dysfunction, notably in neurotransmitters. A substantial proportion of patients who achieve symptomatic improvement with conventional therapy continue to report residual depressive symptoms and/or poor psychosocial
functioning. Few clinical trials have been powered to detect changes in measures of functioning, resulting in a lack of evidence-based guidance for clinicians. The present paper reviews the evidence for an integrated, multipronged approach to the management of depression that may involve  pharmacotherapy, psychotherapy, Complementary and Alternative Medicine (CAM) approaches such as yoga/meditation, exercise, diet and dietary supplements, and social support groups. The author advocates for the use of a patient-centric approach founded on a strong patientprovider alliance for the management of MDD. A shared decision-making approach should consider the potential role of pharmacotherapy, psychotherapy and CAM, which may enhance symptomatic remission and functional recovery in patients with MDD. These results may be mediated, at least in part, through improved regulation of the Hypothalamic- Pituitary-Adrenal (HPA) axis, and reduced allostatic stress load.