Treating depression is not easy. Pharmacotherapy and psychotherapy play a fundamental role here, however, psychoeducation of the patient and his immediate environment is also important. Other methods are also applicable in the treatment of depressive disorders. How is depression treated, when a depressed patient can be treated outpatiently and when he must be hospitalized, and what changes in the treatment of depression may be in the future?

Contents:

  1. Treatment of depression: drug treatment
  2. Treatment of depression: principles of pharmacotherapy
  3. Treatment of depression: psychotherapy
  4. Treatment of depression: psychoeducation
  5. Treatment of depression: management of children and adolescents
  6. Treating depression in pregnant women
  7. Treatment of depression: the role of exercise, diet and other interactions
  8. Treatment of depression: drug-resistant depression and psychotic depression
  9. Treatment of depression: electroshock
  10. Treatment of depression: modern methods
  11. Treatment of depression: outpatient treatment and hospitalization
  12. Treatment of depression: who should treat it?

Treatment of depression is one of the greatest challenges of modern psychiatry. The prevalence of depression is so great that it is slowly becoming one of the most common he alth problems in humans - the World He alth Organization (WHO) reports that over 264 million patients may struggle with it worldwide.

Depression can occur at any age, because it occurs in children as well as in young adults and seniors. In different age groups, not only the course and clinical picture of depressive disorders may differ, but also the problem in patients of different ages may require different therapeutic interventions. This is because the treatment of depression in a child is different than that of a young adult or a senior.

Treatment of depression: drug treatment

Pharmacotherapy is, in the opinion of many patients, the basic method of treating depression, and indeed, typically it is used as the first-line treatment for this mental disorder.

Among the various theories on the pathogenesis of depression, one of the most popular is the one according to which mood disorders would be caused by abnormallevels of various neurotransmitters in the central nervous system. Antidepressants, on the other hand, affect the concentrations of such neurotransmitters, such as dopamine, serotonin or noradrenaline.

Antidepressants can change the concentration of various neurotransmitters in the body, so they are grouped according to exactly which of these substances they affect. Individual antidepressants used in psychiatry are assigned to such groups as:

  • selective serotonin reuptake inhibitors,
  • SSRIs, examples include fluoxetine, escitalopram and sertraline),
  • serotonin norepinephrine reuptake inhibitors (SNRIs, including venlafaxine and duloxetine),
  • monoamine oxidase inhibitors (abbreviated MAOIs, their representative is, among others, moclobemide),
  • tricyclic antidepressants (TLPDs for short, this group includes e.g. opipramol and clomipramine),
  • selective noradrenaline reuptake inhibitors (NARI for short, reboxetine is a representative of this group),
  • drugs with an unusual structure and mechanism of action (such as, for example, tianeptine or mirtazapine).

It is difficult to clearly indicate which of the available antidepressants can be considered the most effective - individual of these drugs have a different action profile.

When recommending any of these measures to a patient, its age, accompanying diseases and other medications should be taken into account, but most of all, what symptoms of depression are dominant in the patient. This is because when the depression runs from:

  • significant inhibition and lack of energy - preferred are, among others, venlafaxine, bupropion or moclobemide,
  • significant intensification of anxiety - drugs from the group of serotonin reuptake inhibitors, venlafaxine,
  • obsessions - preferred clomipramine or SSRI drugs,
  • feeling anxious - tricyclic antidepressants, trazodone and mirtazapine are mainly effective,
  • sleep disorders - patients are recommended mirtazapine, mianserin or trazodone,
  • pain - venlafaxine and duloxetine are preferred,
  • cognitive impairment - vortioxetine and agomelatine are considered the most beneficial.

Depression is a serious disorder - about the methods of its treatment and diagnosis, as seen through the eyes of a psychologist, Katarzyna Kucewicz, interviewed by Michał in Eska RockPoklękowski:

Treatment of depression: principles of pharmacotherapy

In the case of treating depression, it is important not only to choose a drug appropriate to the patient's needs, but also to thoroughly discuss the principles of therapy with him - this increases the chances that he will follow the recommendations received from the doctor. First of all, it is necessary to inform the patient that antidepressants are not painkillers and do not work immediately - usually you should wait 2 to 4 weeks for their effects.

Antidepressant treatment is started with small doses of drugs and then gradually increased until the therapeutic dose is reached. The patient must be informed about the possible side effects of the treatment.

They are most intense in the initial stage of therapy and then, over time, they significantly decrease in intensity. It is necessary to draw the patient's attention to the above-mentioned dependence, because it sometimes happens that due to the fact that initially he feels worse after taking drugs, he decides to give them up on his own.

An issue that interests many patients is how long they will have to take antidepressants. It is worth mentioning here that there are several stages of pharmacotherapy of depression, which are:

  • acute phase (active treatment): it usually lasts from 6 to 8 weeks and its aim is to determine the dosage of the drug resulting in the relief of symptoms of depressive disorders in the patient,
  • continuation phase (maintenance treatment): a phase lasting, according to some authors, a minimum of 6, and according to others 9 or even 12 months, its aim is to achieve full stabilization of the patient's mental state,
  • prophylactic treatment: used in patients with bipolar disorder and in people with recurrent depressive disorders, its purpose is to prevent the recurrence of disorders.

There are some patients who - when they learn that they will have to take antidepressants for up to a year - become reluctant to drug treatment because they fear they will become addicted to antidepressants.

Here it should be emphasized that none of the antidepressants used in psychiatry is addictive. Symptoms that may arise after discontinuation of these drugs may occur in connection with the syndrome of discontinuation of antidepressants - their development may be prevented by, for example, a gradual, time-based reduction of the dose of the drug taken by the patient before its complete discontinuation.

Treatment of depression: psychotherapy

In various sources it is emphasized that, yes, pharmacological treatment is the primary influence inin the case of depressive disorders, it brings the most beneficial effects when it is combined with psychotherapeutic interactions.

Just as pharmacotherapy can solve a problem when it has a biological basis, it is not necessarily able to influence other possible causes of depression, such as family conflicts, bullying at school or experiencing a traumatic event.

Various types of psychotherapy can help depressed patients - examples include psychodynamic psychotherapy, cognitive behavioral therapy, psychoanalytic therapy or systemic therapy.

Treatment of depression: psychoeducation

In general, psychoeducation is an important element of therapeutic management in psychiatry, including the treatment of depression. It should cover both the patient and his immediate surroundings. Psychoeducation consists in making the patient aware of his he alth problem, its possible sources, as well as treatment methods and prognosis.

The family of a sick person should be included in it, first of all, so that they can understand the essence of the problem that torments them and learn how to deal with their relatives suffering from depression so as not to harm them, but to help them.

Treatment of depression: management of children and adolescents

As depression can occur in basically every human being, in certain specific groups of patients it requires special management. The first of these groups are children and adolescents for whom the primary method of treating depression is therapeutic interventions.

Family therapy plays a large role in this group of patients - quite often it turns out that family conflicts are responsible for mood disorders in a child or adolescent, which can be resolved by joint participation in the therapy of all family members.

Pharmacological treatment of depression in children and adolescents is also possible, but it is much more difficult than in the case of adult patients. The difficulties arise mainly from the fact that few antidepressants are approved for the treatment of depressive disorders in the youngest patients.

This is the registration of fluoxetine and sertraline in Poland, but not always these measures are effective - in such situations, off-label, other antidepressants are used to treat depression.

Treating depression in pregnant women

Depression in pregnant women also requires different treatment than usual. When depression occurs, it is usually during pregnancy, initially - especiallywith a slight severity of depressive symptoms - attempts are made to solve the problem with the use of psychotherapy.

If, however, pharmacological treatment becomes necessary, the aim is to use the minimum effective dose of the drug, in addition, preference is given to those preparations the use of which is associated with relatively the lowest risk to the fetus (usually in depression in pregnant women, drugs with SSRI groups).

Treatment of depression: the role of exercise, diet and other interactions

Contrary to appearances, not only drugs and work with therapists, but also other methods can help depressed patients. From time to time, medical publications report how regular physical activity has a beneficial effect on the condition of patients.

It is important for people with depression to have an appropriate, balanced diet, and quite unusual methods, such as acupuncture or drinking St. John's wort, can also help the sick. However, it should be emphasized here that, yes - these methods can bring beneficial results - they should, however, be used supportively and never constitute the basic methods used in the treatment of depression.

Treatment of depression: drug-resistant depression and psychotic depression

An issue that is definitely worth mentioning when discussing the therapy of depressive disorders is the treatment of a specific form of depression, which is drug-resistant depression. In its course, various therapeutic strategies are used - among others, combinations of different antidepressants in one patient (usually they are agents with different mechanisms of action).

Treatment of depression may, however, also be based on the patient taking an antidepressant with a preparation from a completely different drug group, e.g. with a mood stabilizer (such as lithium s alts) or an antipsychotic (such as, for example, quetiapine or aripiprazole).

Differences in treatment also apply to psychotic depression, i.e. such a form of depression in which there are both depressive symptoms and psychotic symptoms (in the form of delusions or hallucinations). In patients suffering from this problem, antidepressant medications alone usually do not lead to improvement - they are recommended to take antipsychotics with them.

Treatment of depression: electroshock

A method of treating depression that is still used in psychiatry is electroconvulsive therapy. However, electroconvulsive therapy is definitely not the first-line treatment option for depressive disorders - it is usually used indrug-resistant depression, depression with very strong suicidal tendencies and in patients with depressive disorders who refuse to drink and drink.

Electroconvulsive shock is a concern for many people, but in practice it is both safe (it can be used even in people suffering from cardiological diseases) and an effective method of treatment - it is estimated that the effectiveness of electroconvulsive therapy may range from 70 to up to 90 percent.

Treatment of depression: modern methods

Due to the increasing prevalence of depressive disorders and the fact that some patients suffer from their drug-resistant forms, various scientists are trying to search for modern methods of treating depression.

One of them is transcranial magnetic stimulation, which in a way resembles electroshock - this method activates nerve cells by inducing electrical phenomena in the parts of the brain to be stimulated.

The so-called psychosurgery - its aim is to break neural connections that may function improperly and thus generate depressive symptoms, but at the moment surgical treatment in psychiatry is used extremely rarely.

It is worth adding here that changes also occur in the pharmacological treatment of depression. There are new preparations, the action of which resembles the mechanism of action of antidepressants that have already been known and have been used for years, but there is also mention of the possibility of using drugs in the treatment of depressive disorders, which were previously not suspected of having an antidepressant effect.

One such preparation, which has been mentioned more and more in recent years, is ketamine - various clinical trials are currently underway regarding the possibility of its wider use in the treatment of depression.

Treatment of depression: outpatient treatment and hospitalization

A lot of doubts sometimes arise - not only among patients but also among doctors - as to whether depression should be treated outpatiently or in a hospital. Fortunately, most of the patients have such an intensity of symptoms of depression that it is possible for them to benefit from outpatient care.

However, when the patient develops significantly intensified symptoms of depressive disorders - e.g. strong suicidal thoughts and intentions or intense symptoms of psychotic depression - hospitalization becomes definitely necessary.

It is worth adding that one of the possible consequences of depression is committing suicide, which is whywhen the closest ones have concerns about the condition of their relative, there is nothing to wait for - it is simply necessary to seek help as soon as possible.

Treatment of depression: who should treat it?

In fact, the above question shouldn't be asked at all - depression should be treated by psychiatrists. The reality in Poland is different, however, and due to the shortage of doctors of this speci alty, patients with depression often first see other specialists, e.g. their family doctor.

Absolutely such a doctor can propose and introduce an antidepressant drug to the patient, however, there are several aspects to consider. First of all, in case of doubts as to whether the patient actually suffers from depression or from another individual, he or she should urgently be referred to a psychiatrist who has more experience and is easier for him to perform appropriate differential diagnosis.

Patients should also be referred to a psychiatrist who, despite being recommended by doctors of other speci alties to take antidepressants, do not observe the expected effects of treatment, and those who experienced a severe depressive episode.

Where to go for help

On the website www.forumpróbdepresja.pl, in the "Where to look for help" tab, you can find:

1. IMPORTANT ANTI-DEPRESSION PHONES, including:

Anttydepresacyjny Phone Forum Against Depression (22 594 91 00) - is open on Wednesdays and Thursdays from 17-19. Antydepresacyjny Helpline of the ITAKA Foundation (22 484 88 01) - you can call on Mondays and Thursdays between 17. and 20.

and many other telephone numbers where people with depression, mental disorders and victims of violence can get support.

2. HELP POINT MAP

This is a nationwide database of contacts to the Mental He alth Clinics, clinics where psychiatrists, Hospitals with Psychiatric Wards, and private offices of psychiatric specialists. Just enter a city or zip code to find a branch closest to your place of residence.

In addition, help and information about the disease can be found at www.stopdepresja.pl

About the authorBow. Tomasz NęckiA graduate of medicine at the Medical University of Poznań. An admirer of the Polish sea (most willingly strolling along its shores with headphones in his ears), cats and books. In working with patients, he focuses on always listening to them and spending as much time as they need.

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Category:

Psychiatry