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How is depression treated?

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Mild episodes of depression often get better without treatment or will respond to simple measures such as changes in the social environment or the family situation. Their doctor can treat many other patients adequately. Only a minority of patients ought to be referred to specialist psychiatric services. Patients who should be referred include those:

  • Who are thought to have a high risk of committing suicide.
  • Who fail to respond to the usual treatments.
  • In whom the diagnosis is confusing or difficult to make.

If depression co-exists with other conditions that complicate treatment, such as a physical illness, patients should usually be referred to a specialist. Patients with a psychotic depression, who are troubled by delusions (abnormal beliefs) or hallucinations, should always be referred.

Psychotherapy and counseling: Surveys clearly show that patients prefer a psychotherapeutic approach (counseling or talking about their problems) or at least expect such an approach in combination with their medication. Evidence indicates that certain specific forms of psychotherapy are useful for patients with mild, moderate and severe depression. Their usefulness is most obvious in the milder forms and in the prevention of further episodes of depression. Men are less likely to ask for this form of treatment.

Antidepressant medication: Since the late 1950s, effective medication has been available for depressive illness. In recent years, new antidepressants, with fewer side effects, have become available. These are effective for most people and relatively easy to tolerate. Whichever antidepressant is used, it is important to continue treatment for six to nine months after symptoms resolve otherwise symptoms might return quickly. Antidepressants are equally effective in men and women.

Approximately half of all patients with depression only ever have one episode. The others suffer from a recurrent form of the illness. Taking this into consideration, the doctor might think it wise to prescribe maintenance treatment, which means continuing antidepressants for a number of years to prevent further episodes.

The art of treatment is to combine social, psychological and pharmacological approaches to reduce suffering and mortality. We can be optimistic about treating depression because of the advent of new forms of counseling and new antidepressant medications. However, depression becomes chronic in 10-20% of cases.

Psychotic depression: Patients with psychotic depression are seriously ill and will almost always require hospitalization. Antidepressant therapy alone is unlikely to be effective. The treatments of choice are either electro convulsive therapy (a highly effective but controversial treatment which involves passing electricity through the brain under general anesthetic) or a combination of an antidepressant with an anti-psychotic drug (a type of medication which treats delusions and hallucinations)

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