Effects of psychodrama combined with antidepressants on anxiety and depression, coping style and neuroimaging features in patients with major depressive disorder and childhood trauma

Abstract

Objective To compare the effects of the combination of (Yishu) psychodrama versus general mental health education with antidepressants on clinical symptoms, coping style and neuroimaging features in patients with major depressive disorder (MDD) who experienced childhood trauma. Methods This prospective case-control study was conducted in MDD patients with childhood trauma recruited from our department of psychiatry. The patients were randomly assigned into observation group (n=16) for treatment with antidepressants combined with (Yishu) psychodrama and control group (n=16) treated with antidepressants and general mental health education, and selective serotonin reuptake inhibitors (SSRIs) was used as the main antidepressants for 6 months in both groups. After the interventions, the patients were assessed using Beck Depression Inventory-13 item (BDI-13), Beck Anxiety Inventory (BAI), and Trait Coping Style Questionnaire (TCSQ), and the amplitude of low frequency fluctuations (ALFF) in resting functional magnetic resonance imaging (fMRI) was determined and compared between the two groups. Results After 6 months of intervention, no significant differences were found in the changes of BDI score (P>0.05) or BAI score (P>0.05) between the two groups, but the changes in TCSQ positive score (P 0.05) and showed significant enhancement of activation in the right parahippocampal gyrus (P < 0.01) with attenuated activation in the left precuneus lobe (P < 0.05). Conclusion Antidepressants combined with psychodrama can more effectively modify the coping style of depressed patients with childhood trauma than the combination of medications and general mental health education, possibly due to the effect of psychodrama to enhance the activation of the right parahippocampal gyrus and attenuate the activation of the left anterior cuneiform lobe, which leads to reduction of the adverse effects of negative experiences on emotion and cognition-coping. Psychodrama combined with medications can be used in the treatment of depressed patients with childhood trauma.

Keywords

• major depressive disorder
• childhood trauma
• (yishu) psychodrama
• functional magnetic resonance imaging
• anxiety and depressive symptoms
• coping style