A critical tool

Supported Self-Management (SSM) for mood problems is a form of intervention in which:

• distressed individuals are provided with workbooks or websites designed to teach behavioural skills for mood self-management; and
• a healthcare provider or other supporter acts as a coach to help learn and apply the self-management skills.

This intervention has shown an impressive degree of effectiveness for common mental health problems of mild to moderate severity.[1] [2]

For mild-range depression, SSM is recommended by high-quality care guidelines as a safer, more effective alternative to antidepressant medication:

“For people with persistent subthreshold depressive symptoms or mild to moderate depression, consider offering … individual guided self-help based on the principles of cognitive behavioural therapy (CBT) …. Do not use antidepressants routinely to treat persistent subthreshold depressive symptoms or mild depression because the risk–benefit ratio is poor.”[3]

Yet, antidepressant medication is routinely prescribed for mild depression:

“Evidence suggests that patients with minor depression and adjustment disorders are frequently treated with antidepressant medications, which represents ‘overuse’ in the IOM nosology since there is little evidence of effectiveness of medication in these populations.”[4]

Compared to SSM, antidepressant medication is far more expensive and associated with a high rate of side effects, particularly sexual dysfunction, with substantial negative impact on quality of life. From a risk-benefit perspective, a strong argument can be made for the dissemination of SSM to health providers as an alternative to the use of pharmacological treatments in mild-range depression. SSM may also play an important role as an adjunct to other forms of treatment for more severe cases.

Our research group at Vancouver’s Simon Fraser University has developed a number of self-management workbooks for low mood and depression that are available for free download (see the file’s links page), including a French version developed with the Institut national de santé publique du Québec. Whether using these or other self-management tools, it is increasingly clear that the knowledge required to support self-management for mood problems should be disseminated to health care providers across the country.

[1] Gellatly, J., Bower, P., Hennessy, S., Richards, D., Gilbody, S. and Lovell, K. (2007). What makes self-help interventions effective in the management of depressive symptoms? Meta analysis and meta regression. Psychol Med. 2007 Sep; 37(9): 1217-28

[2] Cuijpers P, Donker T, van Straten A, Li J, Andersson G. (2010) Is guided self-help as effective as face-to-face psychotherapy for depression and anxiety disorders? A systematic review and meta-analysis of comparative outcome studies. Psychol Med. 2010 Dec; 40(12): 1943-57.

[3] UK National Institute for Clinical Excellence (2009). Quick Reference Guide to Treatment and Management of depression in adults; CG90.

[4] Katon W (2003). The Institute of Medicine “Chasm” report: implications for depression collaborative care models. General Hospital Psychiatry, 25: 222-229. P. 225.