Psychotherapy

There are a number of effective psychotherapies that have been developed specifically to treat depression, including cognitive-behavioral therapy, interpersonal psychotherapy, and short-term or focused psychodynamic psychotherapy. Clinical trials show that these approaches are equally effective as antidepressant medications for patients with mild to moderate depressive symptoms. Basically, these therapies target one or more aspects of a patient’s thoughts, feelings, or personal interactions that bring on and sustain an episode of depression. Patients should avoid therapies that seem open-ended or that have poorly defined goals. More information about specific types of pscyhotherapies can be found in the Psychotherapy section of the Mental Health Center.

ECT (Electroconvulsive Therapy)

ECT involves the deliberate induction of a brain seizure by passing a small electrical current through the brain. This treatment is recommended for patients with severe, chronic depression, medication-resistant depression, catatonia, or serious medical problems. ECT has a success rate of over 80 percent and can produce a rapid remission of symptoms within one to three weeks. However, ECT cannot prevent a relapse. Patients who have completed a course of ECT are prescribed antidepressant medication, or they receive ECT once a month to prevent recurrence. ECT is performed on an inpatient or outpatient basis and requires general anesthesia. Overall, modern ECT is considered generally safe, but there is a varying degree of risk of memory loss and confusion. The memory loss varies from person to person. Some individuals lose only memories surrounding each ECT treatment, while others lose entire chunks of memories of significant past life events. This side effect should be thoroughly discussed with your doctor before proceeding with ECT treatment.

Treatment-Resistant Depression
If two adequate antidepressant regimens fail to help an individual, he or she is considered to have treatment-resistant depression and should see a psychiatrist immediately.

Treating Relapses

Once depression is under control, patients should continue taking their antidepressant medications at the same dose for nine to 12 months to prevent a relapse. After a second depressive episode, the doctor may prescribe an antidepressant for as long as two years. Patients who have had three or more episodes of depression have a very high risk of recurrence. These patients may need to take an antidepressant for an indefinite period (possibly for life) to decrease the chance of future depressive episodes.

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    Last reviewed: By John M. Grohol, Psy.D. on 30 Aug 2006
    Published on PsychCentral.com. All rights reserved.