By Dr Ananya Mandal, MD
The treatment approach to depression usually involves prescribing a combination of medication and counselling, behavioural therapy or support group therapy. A general outline for treating different degrees of depressive illness is given below:
Mild depression - In cases of mild depression, the patient is usually advised to adhere to a healthy, balanced diet, regular physical exercise and stress relief techniques such as meditation. They are then monitored by their physician every two weeks to assess progress. Cognitive behavioural therapy and self-help therapy may be recommended in some cases.
Mild-to-moderate depression - If mild depression fails to improve with the above measures, psychotherapy or cognitive behavioural therapy is prescribed.
Severe depression - Moderate depression that fails to respond to therapy is treated with medication. There are several types of antidepressants that can be prescribed but individuals who do not respond to any of those treatments may be given electroconvulsive therapy.
Cognitive behavioural therapy
Cognitive behavioural therapy works by changing the way a person thinks in order to adjust their behaviour. Unlike with other forms of talking therapy, the patient's past is not the focus of cognitive behavioural therapy but rather their attitudes and behaviour that manifest on a day-to-day basis. Daily obstacles that arise are analyzed one by one and the behavioural response to them broken down and tackled individually.
Usually, six to eight sessions over a ten to twelve week period are needed. One-to-one sessions are preferred but sometimes group therapy may be arranged.
Other forms of psychotherapy
Another form of talking therapy that may be used to treat depression is interpersonal therapy, which focuses on relationship problems. Counselling is also commonly prescribed and helps a person cope with life changing events in a more positive manner.
Antidepressants prescribed to treat moderate-to-severe depression can cause side effects but are generally safe and may be used for years in some cases without causing dependency. The effect of an antidepressant is evaluated every six to eight weeks. Some examples of antidepressants are:
Selective serotonin reuptake inhibitors - This drug class is one of the most commonly used for treating depression and includes fluoxetine, paroxetine and escitalopram. For those aged under 18 years, only fluoxetine may be safely used.
Tricyclic antidepressants - These are the more traditional antidepressants used for treating moderate-to-severe depression but they cause more severe side effects than more recent agents. Drugs of this class include amitriptyline and imipramine.
A more recent class of antidepressants is the serotonin-norepinephrine reuptake inhibitors and examples include venlafaxine, mirtazapine and duloxetine.
Severe non-retractable depression may sometimes be treated with electroconvulsive therapy which involves an electric shock being applied using electrodes placed over the head. The procedure is usually performed under general anaesthesia twice a week for 3 to 6 weeks..
Reviewed by Sally Robertson, BSc
Last Updated: Oct 14, 2013