The first aim of treatment is to ensure the safety of the patient for whom hospitalisation may be required. Secondly, a complete diagnostic evaluation must be carried out. Thirdly, a depression treatment plan has to be formulated which would include medication, psychotherapy, life-style changes and the addressing of stressors.
The vast majority of people respond to treatment (between 80-90%) and almost all sufferers who are appropriately treated will experience at least some symptom relief (yet over 70% of South Africans don’t get assistance or treatment). Medical treatment with anti-depressants may take up to 7 weeks to start being effective so it is strongly advised that all patients go for psychotherapy – which helps to empower the patient in case of future setbacks.
The first aim of treatment is to ensure the safety of the patient for which hospitalisation may be required (i.e. suicidal/unable to care for self). Secondly, a complete diagnostic evaluation must be carried out. This includes a full personal and family history as well as a history of illnesses, medication and recreational drugs/alcohol used, activities, personality type and support system.
A physical examination may also be required to evaluate underlying physical illness, which may cause or worsen depression e.g. thyroid illness. It is important to detect medical problems, as these require separate, appropriate treatment.
Thirdly, a treatment plan has to be formulated which takes into account both immediate symptoms and the patient’s future well being. This would include medication, psychotherapy, life-style changes and the addressing of stressors. Stressful life events are associated with an increased relapse rate in mood disorder sufferers.
PsychotherapyPsychotherapy is also known as “talking therapy” and involves a verbal interaction between a trained mental health professional and a patient who may be experiencing emotional or behavioural problems. There are several different types of psychotherapy, which may differ in the techniques used on the psychological
principles emphasised, but the underlying aim is to enable the patient to gain insight into him or herself and thereby change maladaptive thoughts, feelings and behaviour.
Research has shown that some forms of psychotherapy are as effective as medication in treating mild to moderate depression. Medication tends to bring about results more rapidly, but the benefits of psychotherapy may be more enduring. It is generally agreed that the best form of treatment is a combination of pharmacotherapy or psychotherapy.
Pharmacotherapy for depressive disorders has advanced considerably over the past twenty years and there are now a large number of drugs to choose from. All anti-depressants are equally effective providing an adequate dosage is taken for a sufficiently long time. Different drugs may be prescribed for different individuals, depending on the symptoms presented. Some anti-depressants are more energising, while others may cause weight loss or gain.
A decision regarding which drug to use is often made on the basis of tolerability of potential side effects.
Anti-depressants do not act rapidly. A certain dosage and concentration has to be reached before they become effective. This usually takes about a month, but may take six to eight weeks in the elderly. It is important to persevere and to use the prescribed drug at the correct dosage for long enough.
Patients often feel significantly better after two to three months on anti-depressants, but it is important that medication be continued for as long as your doctor advises. For a first episode of depression this usually means taking medication six to nine months on optimal dosage after symptom relief has been achieved, two to five years for a subsequent episode and possibly life-long if episodes recur frequently and are severe. Stopping medication too soon increases the likelihood of relapse and the development of a chronic recurring illness.
Reviewed by Zane Wilson, South African Depression and Anxiety Group (SADAG), March 2015.
(Previously reviewed by Dr Stefanie van Vuuren, Psychiatrist, MB ChB (Stell), M Med (Psig) (Stell), FC (Psych) SA, May 2011.