Closing Arguments

During closing arguments, the experts give a synopsis of their positions from each of the three rounds.

Transcript:

Brooke Kempf, MSN, PMHNP-BC: Hi, everyone, and thank you for joining us for the closing arguments of our Great Debates in this Psychiatry series. Tina, Desiree, this is your last chance to support your side for the viewers. We want to hear your closing argument to support either the mental health approach or the holistic approach for treating MDD. Tina, you may begin with your closing argument.

Tina Matthews-Hayes, DNP, FNP, PMHNP: Thank you, Brooke. I'm going to step back to what I originally had mentioned earlier in the conversation. You know, if I can't get my patient off the bed, off the couch, or out of the bed or to take a shower, sometimes it has been of benefit to start an antidepressant first. With novel medications, hopefully soon reaching the market, that even increases my toolbox to get patients maybe not to remission yet, but at least get those depression scores down to the point where they, you know, where sleep is better, where motivation is better. And then when we start to discuss lifestyle changes, diet, exercise—sometimes even bigger lifestyle changes, as far as unhealthy relationships— those things that could come out in therapy, patients, in my experience, have been more open and receptive to making bigger lifestyle changes. And more importantly, keeping those interventions in place. Continuing to go to the gym, continuing to follow WeightWatchers® or their MyFitnessPal once I've lifted some of that depression with an antidepressant. Also acknowledging, again, we've talked about STAR*D that, you know, if an antidepressant does not work first-line and you've done your due diligence as a prescriber, considering an atypical antipsychotic in the treatment of major depression is appropriate. However, again, it is our due diligence to watch weight gain and metabolic syndrome in those patients as well. So again, in all fairness, it is a holistic approach. Well, I would love to argue, you know, completely down the line of medication management. I think any provider who is treating patients would have to say that not, you know, one piece can't run without the other. Medications, I always tell people, is only part of the puzzle that we're building. The lifestyle changes are going to be another piece to that. So, with complete respect and an agreement and everything that Desiree has said today, you know, I do believe in certain medications first to try to release some of symptomology and then making the lifestyle modifications as my patients are more receptive in the end, or once you've had, again, some relief from symptomology to get remission and stay in remission.

Brooke Kempf: Thank you, Tina. Now Desiree, we're ready for your closing argument.

Desiree Matthews, PMHMP-BC: Thank you. So, as we reach the end of this debate, again, I want to emphasize the benefits of incorporating a diet, such as the Mediterranean diet, and exercise into depression treatment. The evidence presented throughout the discussion underscores the critical role that lifestyle factors play in improving or decreasing mental well-being. First and foremost, we can consider exercises—like cardiovascular exercise—really showing the powerful impact on the decrease in depressive symptoms, including the release of endorphins, which can uplift mood, increasing neuroplasticity to help the brain adapt and rewire itself, leading to potential improved cognition and enhanced emotional resilience. In addition, we see that a Western diet tends to show increased risk of developing depression. On the other hand, having a balanced or nutrient-rich diet, such as the Mediterranean diet, can really help provide protective effects against depressive symptoms. I am hopeful that in the future, we have these new and novel antidepressant treatments that can really take effect much sooner and hopefully with a more tolerable side effect profile.
Many people are in camps as medication only, and some are truly holistic practitioners prescribing exercise, nutraceuticals or supplements. But at the end of the day, it's really about meeting patients where they're at. For the most part, many patients are looking to us as health care professionals on advice and recommendations for medications that work. They're effective. They work quickly, as well as they are tolerable. But many patients are also very open and receptive—at least when you introduce it at the right time—to tools that they can use to manage their own symptoms, like empowering them to change their lifestyle with diet and exercise. So, I don't think that we can overlook the power of medications. These are truly lifesaving in many cases, but we can also not overlook the power of diet and exercise and the fight against depression by embracing a truly integrative approach. I would argue that medication and lifestyle changes can help make significant strides in improving the lives of individuals facing this debilitating condition. It's time to prioritize the role of medication, diet, and exercise together as a way to provide patients the tools they need to thrive.

Brooke Kempf: Wow, there you have it. That is just a wealth of information you guys have both provided us, and I hate to say it, but that brings us to the end of this series. But thank you both. I want to thank you both for all of the information that you have provided us. And you know what, I don't think that there is a winner amongst us because you guys have given us so much information whether we have individuals out there that are using a simple, just holistic approach or just medication approach. I think you have both agreed, from what I hear, that we really have to utilize both of these. And no matter what, I think all of us are on the same page meeting the patient where they are trying to figure out what is best for each individual patient, as everyone's treatment plan needs to be individualized. So, thank you for the information that we'll now be able to take back and apply to our own patients at home. But I am still interested out there from our audience. Please be sure and answer the poll questions you see on your screen and tell us who you think won this debate and we'll see you next time. Thank you.