Treatment of depression

Between 80-90% of all depressed people respond to treatment and almost all sufferers who are appropriately treated will experience at least some symptom relief.

The first aim of treatment is to ensure the safety of the patient for which hospitalisation may be required (i.e. suicidal/unable to care for self). Secondly, a complete diagnostic evaluation must be carried out. This includes a full personal and family history as well as a history of illnesses, medication and recreational drugs/alcohol used, activities, personality type and support system.

A physical examination may also be required to evaluate underlying physical illness, which may cause or worsen depression e.g. thyroid illness. It is important to detect medical problems, as these require separate, appropriate treatment.

Thirdly, a treatment plan has to be formulated which takes into account both immediate symptoms and the patient's future well being. This would include medication, psychotherapy, life-style changes and the addressing of stressors. Stressful life events are associated with an increased relapse rate in mood disorder sufferers.

Psychotherapy

Psychotherapy is also known as "talking therapy" and involves a verbal interaction between a trained mental health professional and a patient who may be experiencing emotional or behavioural problems. There are several different types of psychotherapy, which may differ in the techniques used on the psychological principles emphasised, but the underlying aim is to enable the patient to gain insight into him or herself and thereby change maladaptive thoughts, feelings and behaviour.

Research has shown that some forms of psychotherapy are as effective as medication in treating mild to moderate depression. Medication tends to bring about results more rapidly, but the benefits of psychotherapy may be more enduring. It is generally agreed that the best form of treatment is a combination of both pharmacotherapy or psychotherapy.

Antidepressants

Pharmacotherapy for depressive disorders has advanced considerably over the past twenty years and there are now a large number of drugs to choose from. All antidepressants are equally effective providing an adequate dosage is taken for a sufficiently long time. Different drugs may be prescribed for different individuals depending on the symptoms presented. Some antidepressants are more energising, while others may cause weight loss or gain. A decision regarding which drug to use is often made on the basis of tolerability of potential side effects.

Antidepressants do not act rapidly. A certain dosage and concentration has to be reached before they become effective. This usually takes about a month but may take 6-8 weeks in the elderly. It is important to persevere and to use the prescribed drug at the correct dosage for long enough.