How is depression treated?

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Treatment of Depression: An Overview

Antidepressant Medications

Antidepressant medications are a cornerstone in the treatment of depression. They are relatively safe and effective for many patients, although about half of all patients may not respond to a given medication and may require a different agent or a combination of medications. Different classes of antidepressants, such as selective serotonin reuptake inhibitors (SSRIs), are commonly used, especially in older adults due to their favorable side effect profile. However, there is no evidence that antidepressants reduce the risk of recurrence once their use is terminated.

Psychotherapy: Cognitive Behavioral Therapy (CBT) and Interpersonal Psychotherapy (IPT)

Cognitive Behavioral Therapy (CBT) and Interpersonal Psychotherapy (IPT) are two psychological treatments that have shown efficacy in treating depression. CBT is effective in relieving acute distress and reducing the risk of symptom recurrence long after treatment has ended. IPT has also been shown to reduce acute distress and prevent relapse as long as it is continued or maintained. Both therapies can be particularly effective when combined with medication, offering quick results and enduring effects.

Electroconvulsive Therapy (ECT) and Other Somatic Therapies

For severe and treatment-resistant depression, Electroconvulsive Therapy (ECT) is highly effective, although it is often reserved for cases where multiple medications have failed due to concerns about potential cognitive side effects . Other somatic therapies include repetitive transcranial magnetic stimulation (rTMS), magnetic seizure therapy, deep brain stimulation, transcranial direct current stimulation, and vagus nerve stimulation, which are emerging as potential treatments for treatment-resistant depression.

Behavioral Interventions

Behavioral interventions, although less studied than cognitive therapies, have shown promise in recent trials. These interventions focus on modifying behavior through techniques such as social learning principles and reciprocal behavioral contracts, which have demonstrated significant improvements in depressive symptoms and interpersonal communication.

Acupuncture

Acupuncture has been explored as an adjunctive treatment for depression. Meta-analyses have shown that acupuncture can significantly reduce the severity of depression, especially when used alongside standard antidepressant medication. However, the majority of studies have been conducted in China, and the applicability of these findings to other populations remains uncertain.

Treatment in Different Settings

Primary Care

Psychological treatments for depression in primary care settings have been found to be effective, particularly when patients are referred by their general practitioners (GPs) rather than recruited through systematic screening. However, barriers such as stigma, limited time, and lack of availability of providers and treatments often hinder the optimal management of depression in these settings.

Inpatient Care

In inpatient settings, psychological treatments have a small but statistically significant additional effect on depression compared to usual care and structured pharmacological treatments. This suggests that integrating psychological treatments into inpatient care can provide additional benefits for patients.

Older Adults

Depression in older adults is often underdiagnosed and inadequately treated. SSRIs are the antidepressants of choice for this population due to their safety profile. However, treatment resistance remains a challenge, necessitating optimization strategies, drug changes, and combined pharmacological treatments.

Conclusion

The treatment of depression involves a multifaceted approach, including medications, various forms of psychotherapy, somatic therapies, and behavioral interventions. While significant progress has been made, challenges such as treatment resistance, under-treatment in certain populations, and barriers in primary care settings highlight the need for continued research and improved access to effective treatments.