Topic One - comorbidity, anxiety and depression
Motion: Lifestyle change is the only intervention needed for the treatment of anxiety and depression
For…
People leading healthy lifestyles do not suffer from anxiety or depression. It follows that any intervention that can bring about a reduction or elimination of an unhealthy lifestyle is going to be the best and most cost-effective treatment for comorbidity.These interventions are widely available including as self-help.
Against…
Lifestyle interventions are a crucial part of treating addiction problems; however, anxiety and depression are barriers to change and pharmacotherapies which have a much more rapid effect will benefit these people more. Moreover some comorbidity is too severe to respond to lifestyle change alone.
These summaries of two research articles should help you clarify your thoughts on the issues raised by the debate…
Healthy lifestyles
This study aimed to identify adult lifestyle behaviours (diet, physical activity, sedentary time, smoking, alcohol, cannabis, and other drug use) at age 20 years and their associations with depression, anxiety, and stress symptoms at age 22 and 27 years. Three groups were identified:
Healthy group evenly split between men and women – 65% of study participants: 98% non-smokers, 82% low level drinkers or abstainers, 71% non-cannabis users, 69% physically active, diets were poor.
High substance use and low activity group – 84% women.
High substance use and very poor diet group – 99% men.
Of 27yr olds, the percentage with anxiety, depression and stress was:
Healthy group: 10.3% | 14.2% | 13.2%
High use, low activity group: 26.2% | 21.2% | 29.4%
High use, high activity & poor diet group: 15.7% | 17.6% | 13.7%
Prescribing for anxiety and depression
This study examined the prescriptions of people referred to a specialist addiction unit. 67% of drinkers, 39% of opiate users, and 82% using other drugs (mainly stimulants) had been prescribed at least one psychotropic medication (did not include opiate substitutes). It is estimated that in the general population 7.5% of individuals with anxiety or depression need pharmacotherapy.
Antidepressants have only a modest benefit in people with co-morbid depression and substance use problems and only in more severe cases. A high prevalence of comorbidity has been questioned due to problems inherent in distinguishing independent mental health disorders from substance-induced disorders. Dependence, intoxication and withdrawal symptoms mimic mood and anxiety disorders.
Find the full text of the articles here…
Collins S et al (2023) A longitudinal study of lifestyle behaviours in emerging adulthood and risk for symptoms of depression, anxiety, and stress. Journal of Affective Disorders 327: 244-253 doi.org/10.1016/j.jad.2023.02.010
Oluyase AO et al (2013) A study of the psychotropic prescriptions of people attending an addiction service in England. Advances in Dual Diagnosis 6: 54-65 DOI: 10.1108/ADD-03-2013-0005
Do you think lifestyle change is enough for these people? Will you alter your own practice?
