ABSTRACT
How effective are cognitive behavioral therapy, prescribed exercise, dietary supplements, and other nonpharmacologic options for alleviating depression? Here's what the evidence tells us.
Subject(s)
Antidepressive Agents/therapeutic use , Cognitive Behavioral Therapy , Depression/therapy , Family Practice , Fatty Acids, Omega-3/therapeutic use , HumansABSTRACT
Cigarette smoking causes significant morbidity and mortality in the United States. Physicians can use the five A's framework (ask, advise, assess, assist, arrange) to promote smoking cessation. All patients should be asked about tobacco use and assessed for motivation to quit at every clinical encounter. Physicians should strongly advise patients to quit smoking, and use motivational interviewing techniques for patients who are not yet willing to stop smoking. Clinical contacts with unmotivated patients should emphasize the rewards and relevance of quitting, as well as the risks of smoking and anticipated barriers to abstinence. These messages should be repeated at every opportunity. Appropriate patients should be offered pharmacologic assistance in quitting, such as nicotine replacement therapies, bupropion, and varenicline. Use of pharmacologic support during smoking cessation can double the rate of successful abstinence. Using more than one type of nicotine replacement therapy ("patch plus" method) and combining these therapies with bupropion provide additional benefit. However, special populations pose unique challenges in pharmacotherapy for smoking cessation. Nicotine replacement therapies increase the risk of birth defects and should not be used during pregnancy. They are usually safe in patients with cardiovascular conditions, except for those with unstable angina or within two weeks of a coronary event. Varenicline may increase the risk of coronary events. Nicotine replacement therapies are safe for use in adolescents; however, they are less effective than in adults. Physicians also should arrange to have repeated contact with smokers around their quit date to reinforce cessation messages.
Subject(s)
Health Promotion/methods , Smoking Cessation , Smoking Prevention , Adolescent , Adult , Antidepressive Agents, Second-Generation/administration & dosage , Antidepressive Agents, Second-Generation/adverse effects , Benzazepines/administration & dosage , Benzazepines/adverse effects , Bupropion/administration & dosage , Bupropion/adverse effects , Complementary Therapies , Family Practice , Female , Humans , Male , Motivation , Nicotinic Agonists/administration & dosage , Nicotinic Agonists/adverse effects , Pregnancy , Quinoxalines/administration & dosage , Quinoxalines/adverse effects , Smoking/psychology , Smoking Cessation/psychology , Tobacco Use Cessation Devices/adverse effects , United States , VareniclineABSTRACT
Many psychosocial factors have been associated with successful aging. The impact of social relationships, personality factors, self-perceptions,and religiosity/spirituality is reviewed in this article and recommendations for enhancing psychological aging are provided.
Subject(s)
Aging/psychology , Attitude , Personality/physiology , Humans , Self ConceptABSTRACT
Evidence on the use of complementary and alternative medicine (CAM) modalities in the treatment of depression, anxiety, sleep disorders, and attention-deficit/hyperactivity disorder (ADHD) is reviewed. There is strong evidence to support the use of St. John's wort (SJW) in depression, and growing support for the use of omega-3 fatty acids and S-adenosyl-l-methionine as potential adjuncts to conventional therapies. Evidence is insufficient to support the antidepressant benefit of dehydroepiandrosterone, inositol, folate, and saffron. Only kava has high-quality evidence for use in the treatment of anxiety disorders, and its use is discouraged because of safety concerns. There is preliminary supportive evidence for valerian and inositol treatment of anxiety, but SJW and passionflower have achieved little research support. Melatonin is likely to be useful in treating delayed sleep phase, jet lag, or shift work, but there is little evidence for the benefit of valerian compared with placebo. There are currently no evidence-supported CAM treatments for ADHD (zinc and omega-3 fatty acids are reviewed).
Subject(s)
Complementary Therapies , Mental Disorders/therapy , Anxiety/therapy , Attention Deficit Disorder with Hyperactivity/therapy , Depression/therapy , Humans , Phytotherapy , Sleep Wake Disorders/therapyABSTRACT
The impact of stress on physical functioning (endocrine, gastrointestinal, immune, and cardiovascular systems) is reviewed. The effect of stress on psychiatric functioning and health behaviors also is discussed. The importance of stress screening in primary care is emphasized, and several methods of stress reduction (including exercise, cognitive-behavioral therapy, and mindfulness-based stress reduction) appropriate to primary care settings are described.
Subject(s)
Health Status , Mental Health , Stress, Psychological/complications , Stress, Psychological/therapy , Behavior Therapy , Cardiovascular Diseases/etiology , Digestive System Diseases/etiology , Emotions , Endocrine System Diseases/etiology , Exercise , Health Behavior , Humans , Immune System Diseases/etiology , Mass Screening , Relaxation Therapy , Social Support , Stress, Psychological/diagnosisABSTRACT
Evidence for alternative treatments for depression, anxiety, and insomnia are reviewed in this article. Treatment of depression with St. John's wort, L-tryptophan, 5-hydroxytryptophan, S-adenosylmethionine, dehydroepiandosterone, folate, exercise, acupuncture, and meditation are examined. Evidence for the efficacy of kava kava, exercise, relaxation therapies, and acupuncture in treatment anxiety is reviewed. The use of valerian, melatonin, chamomile, passionflower, exercise, acupuncture, and behavioral therapies (i.e., sleep restriction, stimulus control, relaxation, and sleep hygiene) for insomnia is discussed.
