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Could music therapy combined with drugs treat patients with depression?

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Published: 27 Mar 2019
By Raya Akhtar

Depression is a neurological disorder that is characterised by an alteration in the mood of an individual. The cognitive and emotional symptoms that are commonly associated in sufferers of depression include fatigue, amotivation, insomnia, and anhedonia. Although the aetiology of depression is currently unknown, there are multiple potential factors that have been implicated to cause depression such as genetic, environmental and neurochemical factors. Neuroscientists currently attribute the biological basis of depression to result from the rapid degradation of monoamines such as serotonin, dopamine and noradrenaline.

The Mental Health Foundation Report in 2012 referred to depression as the most common problem that exists in the UK. In more recent studies it has also been shown that about 4% of children aged five to 16 in the UK are anxious or depressed, which is very worrying. Thus, it is of paramount importance to devise efficient treatment strategies that are efficacious, economically viable and relatively safe, when treating neurological conditions. Currently depression is treated using various pharmacological agents including Selective Serotonin Reuptake Inhibitors (fluoxetine, citalopram) and Tricyclic Antidepressants (amitriptyline, imitriptyline). However, what is the long-term impact of prescribing these medications to each patient suffering from depression? Could musical therapy prescribed in conjunction with pharmaceutical therapy enhance the beneficial effects of the medications while simultaneously reducing some of their adverse effects?

Musical therapy is a type of non-medical treatment that is undertaken throughout Britain and is delivered by an experienced Health and Care Professions Council qualified music therapist. The principal objective of this treatment is to provide effective psychological and cognitive support by using music to aid individuals who have been affected by neurological impairment. This was demonstrated in the clinical study undertaken by Loewy et al, whereby recorded music and sung lullabies significantly influenced the outcome of vital signs, feeding and sleep in premature infants. There were improvements in oxygen saturation, non-nutritive sucking, cardiac function and the rate of weight gain in premature infants less than or equal to 32 weeks. A key highlight from this study was that lullabies sung by parents not only deepened the bond between the parent and their progeny but also significantly reduced the parent’s stress levels which, could help prevent the manifestation of postnatal depression.

The study conducted by Castillo-PĂ©rez’s research team discovered that music is able to induce the neurotransmitter dopamine to be synthesised and transmitted to the regions of the brain (such as the nucleus accumbens and ventral tegmental area) responsible for regulating the reward and emotional responses. Hence, patients who are experiencing mild or moderate levels of depression could benefit from listening to music (classical, baroque) or singing music, as it can induce a positive and pleasurable response regulation of mood, due to the physiological activation of several mechanisms that can both increase brain plasticity and inhibit neurodegeneration.

To ensure that musical therapy exerts a hedonic effect, there needs to be a rapport between the patient and the therapist, and the music of choice needs to be established in the early stages of the therapy. Instruments such as the piano, violin, flute or recorder have been the preferred choice of instrumentation as they can provide melodious tones. Musical therapy is often carried out in different clinical settings (hospitals, universities, day centres, and in the patient’s own home) by the qualified and experienced music therapist. The advantages of utilising music as therapy in treating depression is that it is economically feasible, easy to carry out, and has been found to exert positive therapeutic effects without producing certain untoward side effects characteristic of antidepressant drugs, such as sexual dysfunction (citalopram), epilepsy (amitriptyline) and postural hypotension (phenelzine). Thus, the presence of pharmacotherapy is essential in the treatment of clinically diagnosed severe depression or neurological disorders such as mania, schizophrenia and bipolar disorder.

Musical therapy has been ineffective in patients that suffer from a more severe type of depression (mania, unipolar depression, and bipolar disorder) as the synthesis and transmission of dopamine alone is not sufficient. This is because people with depression suffer from a degradation of the other monoamines, serotonin and noradrenaline, which are coupled with other factors (both genetic and environmental) that are influencing this condition. Thus, pharmacotherapy still remains the first line therapeutic approach utilised by the British healthcare system to treat patients with depression.

Notwithstanding the promising results obtained by the scientists that carried out research in the field of music therapy, more clinical research studies are expected to be undertaken before music therapy in conjunction with pharmaceutical therapy can be prescribed to patients suffering from neurological conditions throughout Britain. Thus, it can be concluded that antidepressants should currently remain as the first line of treatment, as they are the most effective type of treatment in the prophylaxis of depression.

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Published: 27 Mar 2019
By Raya Akhtar

About the author

Raya Akhtar

Raya is a BSc pharmacology and physiology graduate with an interest in developing synergistic treatment options for depression. Her other areas of research interest include exploring the use of stem cell therapy for the treatment of diabetes, stroke, Parkinson’s disease and multiple sclerosis. During Raya’s third year of university, she undertook a research project, which evaluated the efficacy of a technique used to measure the concentration of microalbuminuria in several samples. She also conducted research into diseases (kidney disease and pre-eclampsia) indicated by high urinary albumin levels, and assessed the precision, accuracy and validity of other techniques that are used to screen microalbuminuria.

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