Depression Treatment
By JOHN M. GROHOL, PSY.D.
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Topics Covered in This Depression Treatment Article:
Introduction
Psychotherapy
Hospitalization
Medications
Electroconvulsive Therapy (ECT) and Repetitive Transcranial Magnetic Stimulation (rTMS)
Self-Help
Psychotherapy, Medication or Both?
References
Introduction
This article outlines some general treatment information and guidelines which you may want to take into consideration when seeking treatment for clinical depression. There are a wide variety of treatment options available for depression, and it’s highly likely you will find one that works for you.
You should know upfront that research does not predict individual responses to the specific depression treatments. In other words, just because it works for some (or even most) people does not mean it will work for you. It’s important to keep this in mind as you or a loved one undergoes treatment for depression, because the first treatment or set of treatments tried may not be effective.
Most clinicians practicing today believe that depression is caused by an equal combination of biological (including genetics), social, and psychological factors. A treatment approach that focuses exclusively on one of these factors is not likely to be as beneficial as a treatment approach that addresses both psychological and biological aspects (through, for example, psychotherapy and medication). Depression remains a complicated, complex disorder and researchers are only beginning to fully grasp the multitude of factors — personal, genetic, biological, societal, and environmental — that are involved. Any explanation or approach which emphasizes only one factor as the cause of depression is misleading and simplistic. Individuals should avoid accepting a simplistic answer to such a devastating and complex disorder.
Treatment for depression, like for most mental disorders, usually relies on psychotherapy and medication for the quickest, strongest effects (read the article Psychotherapy, Medication or Both? if you’d like to learn more about the research). Treatment is usually begun immediately after the initial clinical interview with a mental health professional.
Depression treatment takes time and patience is needed. The effects of medications will usually be felt within 6 to 8 weeks of taking an antidepressant, but not everyone feels better on the first medication tried. You may have to try 2 or 3 different medications before finding the one that works for you. The same may also be true for psychotherapy — the first therapist may not be the one you end up working with. Most modern psychotherapy treatment for depression takes 6 to 12 months, going once per week for 50 minutes at a time.
Psychotherapy
There are a wide number of different types of effective therapeutic approaches utilized for the treatment of depression today. These range from cognitive behavioral therapy, to behavioral therapy (ala Lewinsohn), to interpersonal therapy, to rational emotive therapy, to family and psychodynamic approaches. Both individual and group modalities are commonly used, depending upon the severity of the depressive episode and the local resources within an individual’s community.
Cognitive-behavioral therapy is the most popular and commonly used therapy for the effective treatment of depression. Hundreds of research studies have been conducted to date which verify its safety and effectiveness in use to help treat people who suffer from this disorder. Aaron T. Beck is the father of this therapeutic technique and he has authored books and studies supporting cognitive-behavioral therapy. Consisting of a number of useful and simple techniques which focus on the internal dialogue which takes place within a person’s mind, cognitive-behavioral therapy is not concerned with causes of the depression so much as what a person can do, right now, to help change the way they are feeling.
Therapy begins by establishing a supportive therapeutic environment which is positive and reinforcing for the individual. Educating the client within the first session or two is usually the next step about how depression for many people is caused by faulty cognitions. The numerous types of faulty thinking that we as humans do are discussed (e.g., “all or nothing thinking,” “misattribution of blame,” “overgeneralization,” etc.) and the client is encouraged to begin noting his or her thoughts as they occur throughout the day. This is imperative to further success in treatment, for the individual must understand how common and often these thoughts are occurring during a single day.
In cognitive-behavioral therapy, emphasis is placed on discussing these thoughts and the behaviors associated with depression. While emotions are certainly a focus of some of the time throughout therapy, it is thought within this theoretical framework that thoughts and behaviors are more likely to change emotions than trying to attempt a post-mortem analysis of why a person is feeling the way they are. Because of this approach, cognitive-behavioral therapy is short-term (usually conducted under two dozen sessions) and works best for people experiencing a fair amount of distress relating to their depression. Individuals who can approach a problem from a unique perspective and those who are more cognitively-oriented are also likely to do better with this approach.
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http://psychcentral.com/lib/depression-treatment
