Medication alone and psychotherapy (cognitive-behavioral therapy, interpersonal therapy) alone can relieve depressive symptoms. A combination of medication and psychotherapy has been associated with significantly higher rates of improvement in more severe, chronic, and complex presentations of depression.
Electroconvulsive therapy is useful for patients who are not responding well to medications or are suicidal.
Antidepressant medications work well to treat depression. Sometimes different antidepressant medications would have to be tried before finding the one that works best for the individual. Medications that have helped a close family member of the individual are likely to help the individual seeking treatment as well. Antidepressants usually take some time (2 to 4 weeks) before they impact the symptoms. Appetite, sleep and concentration typically improve before mood begins to lift. It is important for individuals receiving treatment to give the medication time before deciding that the medication is not working. Antidepressants can have side effects, but many side effects may lessen over time. Talking to a health care provider about the side effects and not discontinuing the antidepressant by oneself is important. Stopping the medication early when one starts feeling better is also not a good idea. Stopping the medication suddenly can cause unpleasant withdrawal symptoms and can be unsafe. It would be best to follow the prescribed course of time and then to stop the medication slowly and safely with the help of a health care provider.
Antidepressants are an effective modality of treatment. They may present risks to some individuals, especially children, teens, and young adults. Antidepressants are not usually prescribed in children and are not the first line of treatment in adolescents. Antidepressants may cause some people to have negative reactions when they first start taking the medication. Some may become agitated at first before it begins to work. Others may have suicidal thoughts or make suicide attempts. It is important for individuals taking antidepressants to be monitored closely, especially when they first start taking them. It should be kept in mind that for most people the risks of untreated depression far outweigh those of antidepressant medications when they are used under a doctor’s careful supervision.
Electroconvulsive Therapy (ECT):
ECT is an effective treatment for patients who do not respond to drug therapy, are psychotic, or are suicidal or dangerous to themselves. Onset of action may be more rapid than that of drug treatments, with benefit often seen within 1 week of commencing treatment. The indications for the use of ECT include the following:
- Failure of drug therapies
- History of good response to ECT
- Patient preference
- High risk of suicide
- High risk of medical morbidity and mortality
Although advances in ECT treatment has improved the safety and tolerability of this modality there are some risks such as those associated with postictal confusion, and, more rarely, short-term memory difficulties.
Cognitive Behavior Therapy and Interpersonal Therapy are evidence based psychotherapies that have been found to be effective in the treatment of depression.
Cognitive-Behavioral Therapy (CBT)
CBT is based on the premise that patients with depression have thinking that is characterized by dysfunctional negative views of oneself, one’s life experiences (and world in general) and one’s future – the cognitive triad. Thus, a clinically depressed person is likely to believe themselves as being incapable and helpless, to view others as being judgmental and critical and the future as being bleak and unrewarding. CBT is a structured and didactic form of therapy that focuses on helping individuals identify and modify maladaptive thinking and behavior patterns. There is research evidence supporting the effectiveness of CBT with individuals of all ages. It is also considered to be efficacious for the prevention of relapse.
Interpersonal Therapy (IPT)
Interpersonal therapy (IPT) is a time-limited treatment for major depressive disorder. It aims at reducing or eliminating depressive symptoms by improving the quality of the patient’s current interpersonal relations and social functioning. Specific areas of empha
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4. Sadock, B. J., Sadock, V. A., & Ruiz, P. (2009). Comprehensive Textbook of Psychiatry (Ninth edition.) Philadelphia: Wolters Kluwer.