Depression
How is it treated?
Severe depression is a complex illness that should be treated by professionals who are familiar with all of its manifestations. A complete clinical evaluation will include a physical examination, a medical and psychiatric history, and a mental status examination.
The first step in the treatment of depression is a physical examination. This is done to rule out disorders like thyroid disease, anemia or a recent viral infection, which can produce symptoms similar to those found in a depressive illness. In an estimated 20 to 25 % of major depressive episodes, the cause is an underlying factor such as a particular medication or a medical condition.
A neurological examination should also be done to rule out the possibility that the depressive symptoms are being caused by a neurological disorder.
An important part of the evaluation should be a detailed case history, which can give the family practitioner or mental health specialist valuable clues about the person's condition. Usually, the doctor will ask about the reasons for the visit and carefully discuss all of the person's symptoms. This will permit the doctor to evaluate whether specific events in the person's life could be contributing to their depression or whether the depression appears to have occurred for no obvious reason. The doctor will probably also inquire whether other family members have suffered from depression. A vital element of this examination is to assess the severity of the depression, particularly whether there is any danger that the patient will attempt suicide. In cases such as this, the individual may be hospitalized until the danger passes.
The treatment of depression is tailored to the individual, with the severity and cause of the depressive episode taken into account. Antidepressant medications are frequently prescribed, but it is usually helpful for depressed individuals to receive some form of psychotherapy as well.
The two most common types of antidepressants used are selective serotonin reuptake inhibitors (SSRIs) and tricyclic antidepressants (TCAs). With these medications, it may take up to eight weeks before an improvement in depressive symptoms is seen. Since it can take several weeks for the symptoms of depression to improve after treatment has begun, it is helpful for friends and family to encourage the depressed person to continue taking his or her medication. In some cases, different types of antidepressants will need to be tried to find the right match. Antidepressants may cause significant side effects, so drugs and dosages must be monitored closely by a doctor. SSRIs are associated with fewer side effects than TCAs or monoamine oxidase inhibitors (MAOIs). Treatment is usually evaluated six weeks after starting an antidepressant medication. It is then generally re-evaluated after 12 weeks. If the person improves somewhat on a particular medication, treatment can appropriately be continued with dosage adjustments. If there is no improvement, however, treatment should be augmented or changed.
Usually, by the twelfth week of treatment, the most suitable medication for the person has been established. If the individual clearly appears to be benefiting from the medication, it should be continued for four to nine months. After this time, maintenance therapy may be considered.
Studies are ongoing to establish the optimal length of time that antidepressant medications should be taken. Most mental health professionals now recommend that persons who suffer from recurring episodes of major depression and those with bipolar, or manic-depressive disorders stay on maintenance therapy.
Drug classes used to treat Depression Miscellaneous Antidepressants Monoamine Oxidase Inhibitors Selective Serotonin Reuptake Inhibitors Selective Serotonin and Norepinephrine Reuptake Inhibitors (SNRI) Tricyclic Antidepressant & Benzodiazepine Combination Tricyclic Antidepressants
|
How is it treated?
