Watchful waiting for depression using depathologization, advice and shared decision making

• Published in: Journal of affective disorders reports Vol. 16; p. 100753
• Main Authors: Kostic, Milutin, Milojevic, Teodora, Buzejic, Jelena, Spasić Stojakovic, Marija, Maslak, Jovana, Ilic, Mihailo, Jakovljevic, Ana, Munjiza Jovanovic, Ana, Podgorac, Ana, Dabetic, Marija, Vezmar, Milica, Lazarevic, Miloš
• Format: Journal Article
• Language: English
• Published: Elsevier B.V 01-04-2024; Elsevier
• Subjects: Adverse effects; Antidepressants; Depression; Pharmacotherapy; Pharmacotherapy; Depression; Adverse effects; Antidepressants
• DOI: 10.1016/j.jadr.2024.100753
• EISSN: 2666-9153

•Watchful waiting was shown to be an effective first line of treatment for non-suicidal patients with depressive symptoms.•Patients already arrive with expectations so depathologization should be addressed.•Expectation of pharmacotherapy before the arrival was the main driver of future medication use.
Antidepressant use is on the rise, while the problem of depression on a population wide level is not being tackled. One of the hypothesis why this may be happening is the effect of adverse effects and withdrawal symptoms of antidepressants, as well as pathologization of normal sadness.
In this study we did partial watchful waiting using (1) psychosocial advice; (2) depathologization; and (3) shared decision making. The study comprised of 83 consecutive non-suicidal out-patients with depressive symptoms.
The first among the three main findings of our study was that watchful waiting, when coupled with psychosocial advice, depathologization and shared decision making, was effective in 64.5 % of patients who ended up with no pharmaco- or psychotherapy after the three-month follow-up period. Severity of depression did not correlate with the efficacy of watchful waiting. Expectations from pharmacotherapy were the dominant factor influencing whether a patient will enter or finish the study without pharmacotherapy.
This was not a randomized control trial and the goal was to see if this approach is feasible. A randomized controlled trial comparing watchful waiting approach with pharmacotherapy could not factor in all parameters involved (i.e. self-fulfilling prophecy through pathologization, withdrawal and risk of chronicity).
Our study showed that watchful waiting might be effective, particularly when coupled with depathologization, psychosocial advice and shared decision making, suggesting that this approach should be tested as the first-line of treatment in non-suicidal patients with depressive symptoms.