Treatment for Depression

Biomedical Treatment for Depressive Disorder
Include the use of medication and other interventions that affect various brain systems such as circadian related treatment (light therapy and sleep deprivation) and brain stimulation techniques.

Medication
believed to work by correcting chemical imbalances in the brain. They block the reabsorption of certain neurotransmitters, thus increasing their availability for neural communications.

Medication
Three classes of antidepressants, the tricyclics, the monoamine oxidase inhibitors (MAOIs) and the serotonin norepinephrine reuptake inhibitors (SNRIs), block the reabsorption of norepinephrine and serotonin, whereas SSRIs block the reuptake of serotonin.

Medication
Atypical antidepressants, a group of unique medications used to treat depression, affect other neurotransmitters including dopamine. MAOIs are the least frequently used due to serious effects when they are combined with certain food, beverages or medication.

Medication
The selection of an antidepressant is often rather arbitrary, but can be influenced by prior response to antidepressants, desire to avoid certain side effects or presence of other symptoms such as anxiety or nicotine addiction that might also be helped by certain antidepressants.

Medication
Antidepressants are not addictive, but they do have a variety of potential side effects. Greatest concern involves possible increase in suicidality in those younger than 25 taking certain antidepressants. Additionally, abrupt cessation of certain antidepressants can result in a discontinuation syndrome. Individuals with this syndrome experience severe flue like symptoms, intense fatigue or insomnia or increased emotionality, including irritability or suicidal thoughts due to biochemical changes occurring as the body adjust.

Medication
Although antidepressants are commonly used in treatment. Concerns have ben raised regarding publication bias in studies. Evidence for antidepressant efficacy is rather weak. Placebos are often as effective as antidepressants in treating minor depression. Benefits of these medications over placebos for treating mild or moderate was minimal or nonexistent. Many individuals affected by depression do not respond to antidepressant medications, chronic depression and old age are associated with decreased response.

Circadian-Related Treatment
Some treatment for mood disorders involve efforts to reset the circadian clock. A night of total sleep deprivation followed by a night of sleep recovery can improve depressive symptoms. Additionally use of bright, visible spectrum or blue wavelength light is an effective and well tolerated treatment for those with SAD and other depressive disorders.

Circadian-Related Treatment
Light therapy appears to influence circadian rhythms by stimulating several photoreceptors system. This therapy involves dawn light stimulation or daily use of a box, visor, or lighting system that delivers light of a particular intensity for a designated period of time.

Circadian-Related Treatment
study evaluating treatment for SAD compared light therapy along with light therapy combined with antidepressants. Both groups made similar improvement, advantages of light therapy included an absence of side effects and more rapid treatment response. Suggest that light therapy is as beneficial as antidepressants treatment not only for SAD, but also for other depression. Light therapy is typically continued throughout the low light season for SAD or depressive patterns involving winter exacerbation of symptoms.

Brain Stimulation Therapies
Electroconvulsive therapy, vagus nerve stimulation and transcranial magnetic stimulation are sometimes used to treat severe or chronic depression, especially when life threatening symptoms are present.

Brain Stimulation Therapies
ECT is FDA approved for treatment resistant depression and is considered a first line treatment for profound, life threatening depressive symptoms. ECT, typically conducted several times weekly, involves application of moderate electrical voltage to the brain. Appropriate use of anesthetics during ECT treatment minimises side effects such as headaches, confusion and memory loss.

Brain Stimulation Therapies
Regularly implemented vagus nerve stimulation (approved for use if four prior treatments for chronic, recurrent depression have failed.) has shown therapeutic promis when combined sequentially or concurrently with ETC or when used alone.

Brain Stimulation Therapies
Repetitive transcranial magnetic stimulation, an ETC alternative in which an electromagnetic field stimulates the brain. Although recent meta analysis concluded that this technique has sufficient research to support its use for MDD and for auditory hallucination, other lit. has expressed more skepticism, in part because of the weak design of many studies evaluating the procedure. A factor confounding the research may be intensity of stimulation, high intensity stimulation appears to produce most significant results.

Psychotherapy and Behavioural Treatments for Depressive Disorder
Three approaches that have received extensive research support (behavioural activation, cognitive behavioural, and interpersonal therapy) and one technique (mindfullness based cognitive therapy).

Behavioural Activation Therapy
Based on the idea that depression results from diminished reinforcement. Consistent with this perspective, the focus of treatment is on increasing exposure to pleasurable activities, improving social skills and facilitating social interactions.

Behavioural Activation Therapy
Steps involving treatment are 1) identifying and rating different activities in terms of pleasure and mastery, 2) performing some of the selected activities, 3) identifying problems and using behavioural techniques to deal with it, 4) improving social and assertiveness skills. Behavioural activation has been shown in one study to be as efficacious as medication and more efficacious than cognitive therapy.

Interpersonal Psychotherapy
evidence based approach focused on current problems and the interpersonal context in which they occur. Focuses on altering current relationship patterns using strategies found in psychodynamic, cognitive behavioural and other forms of therapy.

Interpersonal Psychotherapy
Presumes that depression occurs within an interpersonal context, relationship issues are the target of therapy. Focus is on conflicts and problems that occur in four areas (grief, role transition, role disputes and interpersonal difficulties). Clients gain insight into their role in interpersonal conflict and strive to change their relationships.

Interpersonal Psychotherapy
By improving communications with others, identifying role conflicts and increasing social skills, clients come to find relationships more satisfying and pleasant.

Interpersonal Psychotherapy
Resembles psychodynamic approaches in acknowledging the role of early life experiences and trauma, it is oriented primarily towards present relationships. It has proven to be an efficacious treatment for acute depression and is as effective as continuing use of antidepressant medication in preventing relapse.

Cognitive Behavioural Therapy
Focuses on altering the habitually negative or extreme thought patterns associated with depression. Believe that because distorted thinking causes depression, altering thoughts can eliminate depression. Helps individuals learn to identify thoughts that precede upsetting emotions, distance themselves from these thoughts and examine the accuracy of problematic beliefs.

Cognitive Behavioural Therapy
Clients are taught to identify negative self critical thoughts, note the connection between negative thoughts and subsequent feelings, examine each negative thought and decided if it is true and replace distorted negative thoughts with realistic interpretations.

Cognitive Behavioural Therapy
Ruminative positive thoughts (worry will help) and negative metacognition (other people will reject me) are also linked to depression and are targeted in therapy.

Cognitive Behavioural Therapy
Effective in treating adolescents from diverse backgrounds and adapted versions of the therapy have shown promising results in non-Western cultures. Overall, individuals treated with CBT are less likely to relapse following treatment termination compared to individuals taking antidepressants.

Cognitive Behavioural Therapy
Cognitive changes in explanatory styles and alterations in negative self biases may help prevent recurrence of depressive symptoms. CBT has produced changes in the same brain regions affected by the use of SSRI antidepressants. PET scans have revealed changes in the functioning of limbic and cortical regions of the brain.

Mindfulness-Based Cognitive Treatment
Involves calm awareness of one’s present experience, thoughts and feelings and have an attitude of acceptance rather than being judgemental, evaluative or ruminative. Mindfulness allows one to disrupt the cycle of negative thinking by focusing on the present.

Mindfulness-Based Cognitive Treatment
Focusing on experiences with curiosity and without judgement prevents the development of maladaptive beliefs and thus prevents depressive thinking. The training was effective in reducing depressed mood and heart rate. Clinical studies have found that MBCT reduces residual symptoms in chronic depression, effective in treatment resistant depression, and associated with a decreased risk of relapse or recurrence of depression among recovered patients.

Combining Biomedical and Psychological Treatment
Current treatment produce symptom remission in less than two thirds of those treated for depression. Only 1/3 of those treated for depression achieve sustained recovery from depressive symptoms. Evidence that antidepressant medications may be particularly advantages with severe cases of depression, psychotherapies especially CBT appear to have longer lasting effects.

Combining Biomedical and Psychological Treatment
Effective psychological treatment appears to produce more enduring results, whereas medication relieves depression only during active treatment. The changes resulting from cognitive treatment may enable clients to think differently, even after treatment has been stopped.

Combining Biomedical and Psychological Treatment
Appears to have some advantages in combined treatment that involves medication and psychotherapy. Medication tends to produce rapid and reliable reductions in some individuals with severe depression, whereas psychotherapy can enhance social functioning and reduce risk of relapse. Additionally, it is likely that effective psychotherapies and antidepressants medications influence similar neural mechanisms as well as mechanisms unique to each mode of intervention.

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