Comprehensive Guide for Therapy of Depression. Introduction
The guide for depression therapy consists of a blend of self-help strategies, talking therapies, and medicinal interventions. The choice of therapy for depression depends on its specific type and severity.
Patient’s Adherence (Compliance)
Effective communication is essential in helping patients better understand the benefits and risks of various treatment options, enabling them to make informed decisions. Adherence, as a product of building a strong patient-therapist relationship and participatory decision-making, poses a significant challenge in treating depression.
Additionally, involving family members is a key therapy principle in treating patients with depressive disorders, as they can provide vital support.
Mild Depression: Tailored Therapy Strategies
Watchful Waiting
For mild depression, the initial approach may involve watchful waiting. Your GP might recommend monitoring your progress after an initial diagnosis, typically revisiting after 2 to 4 weeks.
Guided Self-Help
Engage in guided self-help, involving 6 to 8 sessions where you collaborate with a therapist, working through a workbook or an online course. This approach aims to reshape thinking and behaviour and is rooted in Cognitive Behavioral Therapy (CBT).
Exercise as a Therapeutic Path
Recognizing the positive impact of exercise on mild depression, you may be encouraged to join group exercise classes tailored to alleviate depressive symptoms.
Talking Therapies for Mild Depression
If mild depression persists, explore talking therapies such as Cognitive Behavioral Therapy (CBT) and counselling for personalized support.
Treatment Options for Moderate to Severe Depression
Antidepressants
Transitioning to moderate or severe depression, the introduction of antidepressants becomes a common recommendation. These medications, prescribed by doctors, target to alleviate depressive symptoms. Although proven effective, antidepressant do not work for everyone.
Combination Therapy
In cases of severe depression, a combination of antidepressants and talking therapy, especially Cognitive Behavioral Therapy (CBT) is the most promising therapy method.
Mental Health Teams
Severe depression may warrant referral for in-patient treatment involving mental health teams comprising psychologists, psychiatrists, specialist nurses, and occupational therapists. These teams provide intensive, specialized treatments, including psychotherapy, occupational therapy, and medication helping patients to establish daily routine and improve their coping skills facilitating their return to normal life.
Distinct Psychotherapy Forms in Therapy for Depression
Cognitive Behavioral Therapy (CBT)
CBT delves into understanding thoughts and behaviours, emphasizing present-focused strategies to change negative thinking patterns. Sessions, lasting 8 to 16 weeks, occur weekly or bi-weekly, either individually or in groups.
Interpersonal Therapy (IPT)
Focusing on relationships, IPT addresses communication difficulties issues and aims to improve interpersonal functioning in 8 to 16 sessions, tailored to the severity of the condition.
Behavioral Activation Therapy
Cantered on the connection between activities and mood, this therapy targets behaviour changes to improve mood. Typically involves 12 to 16 individual sessions.
Individual Problem-Solving
Tailored for more severe depression, this therapy concentrates on identifying and solving problems. A structured approach, with 6 to 12 sessions, is recommended.
Psychodynamic Psychotherapy
Psychoanalytic in nature, psychodynamic psychotherapy unfolds through 8 to 16 sessions, encouraging people to explore and reveal all the thoughts and feelings that come to mind.
Counselling
Ideal for individuals facing crises, counselling supports problem-solving without providing directives. Confidential sessions help navigate challenges like anger, relationship issues, bereavement, redundancy, infertility, or serious illness.
Behavioral Couples Therapy
Involving partners in treatment, behavioral couples therapy extends over 15 to 20 sessions across 5 to 6 months.
Use of Antidepressants
In moderate and severe courses of depression the therapy should involve the use of antidepressants.
Antidepressant Diversity
There are several types of antidepressants. The efficacy of each type of antidepressant per person varies. It might be necessary to try multiple treatments before finding the most effective one.
Understanding SSRIs and TCAs
The older Tricyclic Antidepressants (TCAs) are the first-generation antidepressants. Today they are rarly used due to their pronounced side effects. Therfore, TCAs have been replaced by the second-generation antidepressants such as Selective Serotonin Reuptake Inhibitors (SSRIs) or Selective Serotonin-Norepinephrine Reuptake Inhibitors (SSNRI).
SNRIs, Mirtazapine, and Vortioxetine
Serotonin-Noradrenaline Reuptake Inhibitors (SNRIs) such as Mirtazapine, and Vortioxetine are alternative options for managing depression.
Monitoring and Maintenance
Regular monitoring during the initial weeks ensures the effectiveness of antidepressants in therapy for depression. Continuation for at least 6 months post-symptom improvement is common, with long-term use assessed at least qurtally.
Management for Discontinuing Antidepressants
Antidepressants are not addictive, however a sudden interruption of the intake can cause unpleasant withdrawal symptoms. Thus, a slow reduction of the dosage is necessery to mitigate potential withdrawal symptoms.
Holistic Approaches and Additional Interventions
Mindfulness Practices
Embrace mindfulness practices, recommended for less severe depression, involving focused attention on the present moment.
Brain Stimulation Techniques
When the psychotherapy and treatment with antidepressants turns ineffective other methods can be applied. This could be brain stimulation includes transcranial direct current stimulation (tDCS) and repetitive transcranial magnetic stimulation (rTMS).
Guide for Therapy of Depression. Conclusion
Therapy for depression involves a nuanced understanding of patient’s circumstances, guiding patients and their relatives through a spectrum of tailored interventions. Thus, clear communication, trust-building, and family involvement play pivotal roles in enhancing adherence and improving the overall treatment management.
The therapy for depression can be broadly divided into three phases: acute therapy, maintenance therapy, and relapse prevention.
Therapy Options
The use of therapy options, either individually or in combination, depends on the severity and phase of depression:
- Self-help and enhancing self-management skills through psychoeducation, low-threshold conversational interventions, including technology-assisted formats (i.e. online sessions).
- Psychotherapy
- Therapy with medication (antidepressants)
- Neurostimulation techniques (such as electroconvulsive therapy or repetitive transcranial magnetic stimulation)
- Psychosocial interventions (occupational or social therapy)
- Supportive measures (including sports and physical therapy, meditation, etc.)
The chois of a proper treatment option adjusted to patient’s needs and the illness severity is the pre-requisite for an effective cure of depression.