Treating Depression

Introduction. Treatment for depression

Clinical depression also known as Major Depressive Disorder (MDD) is a psychiatric disorder characterized by persistent feelings of sadness, fatigue, loss of interest in activities and sleep deprivation.

Untreated depression has a devastating impact on people individual’s well-being, including decreased quality of life and increased suicide risk. People with depression are mor likely to die on high blood pressure, diabetes, stroke, or heart attack. Therefore, treatment for depression restores individual’s performance, his life quality and improves his general health outcome.

Before starting the treatment

Depression requires proper diagnosis which can be secured by your psychiatrist. The diagnosis is based on the criteria outlined in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), mostly used in the US, or the International Classification of Diseases (ICD-10) deployed worldwide, among others in Europe.

Your psychiatrist will first make the diagnosis and then develop an individualized treatment plan tailored to your specific needs. The treatment for depression lasts months to years. Thus, it’s crucial for you to have a supportive social network foremost your family and friends.

It’s important to understand that depression is a treatable illness and seeking help early improves your chances of recovery. Without proper treatment, depression can worsen having destructive effect on your life.

Treatment for depression includes psychotherapy, medication, or a combination of both. Early detection and treatment improve the chances of recovery. The most effective, evidenced based treatment for depression is the combination of medication and psychotherapy (counselling). The effect of medication appears after few days to a few weeks. In contrary the benefits of psychotherapy unfold over a longer period and have much deeper impact on your life.

Making psychiatric diagnosis

1. Anamnesis (medical history review):

-asking about patient’s personal and family medical history to rule out any possible genetic or environmental factors contributing to depression.

-Symptom assessment: assessing the severity and duration of symptoms such as persistent sad or empty mood, loss of interest or pleasure, fatigue, difficulty sleeping or sleeping too much, feelings of worthlessness or guilt, and thoughts of suicide.

2. Physical exam: consist of

-General physical exam: assessment of patient’s general health status (depression may be linked to an underlying physical health problems).

-Neurological exam: allows to roll out major problems of the central nervous system.

3. Lab tests: evaluating the status of the patient before starting the treatment excluding different health issues. In case of starting treatment with medication the initial result is a benchmark for further controls.

4. ECG: excluding problems of the heart. A “native” ECG is also a point of reference for further controls under medication.

5. Psychological evaluation: in some case it’s necessary to use standardized interviews, questionnaires, and assessments to further understand the symptoms and determine the diagnosis of depression.

6. Additional diagnostics: a profund investigation will be needed in case of more severe mental disorders such as psychosis or bipolar disorder. Such diagnostic includes brain scan (CT-scan or MRI) and the record of the brain generated electrical activity EEG (Electroencephalogram).

7. Establishing diagnosis based on (ICD 10) or (DSM-5)

Psychotherapy methods in treatment for depression

There are variety of psychotherapeutic methods. The majority of them belong to two psychotherapeutic branches: psychodynamic and behavioral therapy.

Cognitive-Behavioral Therapy

The main approach of CBT (Cognitive Behavioral Therapy) is based on the idea that problems are the result of the way people interpret situations, thoughts, and feelings. CBT addresses the underlying root cause giving the patient insight about the symptoms triggering mechanisms. This allows the patient to control the patterns of his thinking and behaviour causing negative emotions. It helps the individual identify thoughts that make them feel bad (e.g. I am not good enough).

Psychodynamic psychotherapy

Psychodynamic psychotherapy has not been studied as extensively as behavioural therapy in the treatment for depression. Even though psychodynamic psychotherapy, including the eldest technique called “psychoanalysis”, has a long-standing history, the empiric research on its effectiveness is less large. Despite the higher number of studies referring to behavioral methods those done for psychodynamic psychotherapy prove its efficacy. The main reason for the lower volume of research related to psychodynamic methods is explicable by the therapy setting. The psychodynamic psychotherapy done by an analyst in his private practice, is less accessible for empiric evaluation.

Psychodynamic psychotherapy relates to several methods of in-depth psychotherapy. These are classical psychoanalysis, psychoanalytical psychotherapy, and different modifications of this methods.

Unlike cognitive-behavioral therapy, psychodynamic psychotherapy places a large emphasis on the layer of our psyche not accessible to the consciousness. The upsetting contents such as aggressive impulses and anti-social desires are stored in the unconscious. However, even though they are not accessible to our conscious perception, they influence our feelings and behaviour.

Despite the different approach, just as with cognitive-behavioral therapy, psychodynamic therapy also wants to bring about changes in behaviour. Psychodynamic approaches focus on several varied factors. These are early childhood experiences (particularly the attachment level to the parents), current relationships and current defence mechanisms. Reducing the intensity of the underlying tension leads to symptom reduction. Making unbearable feelings conscious and employing the ego (the conscious part of the psyche) in understanding cause and effect brings about healing.

Eye Movement Desensitization and Reprocessing (EMDR)

Francine Shapiro developed and studied EMDR (Eye Movement Desensitization and Reprocessing) which is a form of psychotherapy. This is a technique which uses eye movements to help the brain access and integrate the traumatic events “pushed” by sudden trauma (for example by war trauma or accidents) in the unconscious in their row unprocessed shape. Psychologists use the eye movement to facilitate emotional processing of memories to attend to more adaptive information.

Interpersonal Psychotherapy

Interpersonal Psychotherapy involves meeting with a group of other people who have been through the same, or a similar traumatic event. It can be easier to talk about what happened if you are with other people who have been through a similar experience. An open trial of interpersonal psychotherapy reported high rates of remission from symptoms.

Treatment for clinical depression with medication

Medication is the fastest method of treatment for depression. However, the best long-term effect can be achieved by combining medication with psychotherapy. The main medication used in the treatment for depression are antidepressants. Modern research has developed several antidepressants with different courses of action. The common denominator for their efficacy is the influence of different neurotransmitters in the brain. The two biggest groups of antidepressants in use are SSRIs (Selective Serotonin Reuptake Inhibitors) and SNRIs (Serotonin-Norepinephrine Reuptake Inhibitors).