Trillian's Depression Page

Electroconvulsive Therapy (ECT)

ECT is primarily used for severely depressed patients who have not responded to antidepressant medicines, and who frequently have psychotic features, acute suicidality, or food refusal. It can also be used for patients who are severely depressed and have other chronic general medical illnesses which make taking antipsychotic medications difficult. Changes in the way ECT is delivered have made ECT a better tolerated treatment.

Importance of Continuation of Treatment:

There is a period of time following the relief of symptoms during which discontinuation of the treatment would likely result in relapse. The NIMH Depression Collaboration Research Program found that four months of treatment with medication or cognitive behavioral and interpersonal psychotherapy is insufficient for most depressed patients to fully recover and enjoy lasting remission. Their 18-month follow-up after a course of treatment found relapses of between 33 and 50 percent of those initially responding to a short-term treatment.

The current available data on continuation of treatment indicate that patients treated for a first episode of uncomplicated depression who exhibit a satisfactory response to an antidepressant should continue to receive a full therapeutic dose of that medication for at least 6-12 months after achieving full remission.

The first eight weeks after symptom resolution is a period of particularly high vulnerability to relapse. Patients with recurrent depression, dysthymia or other complicating features may require a more extended course of treatment.

Self-management

Lifestyle management is crucial in maintaining recovery from depression. It is important to:

1. Maintain a consistent daily schedule.
2. Take medications as prescribed.
3. After an episode of depression, resume responsibilities slowly and gradually.
4. Set realistic goals.
5. Ask for help when you needed.
6. Meet regularly with your therapist.
7. Sleep adequately, getting to sleep and arising at approximately the same times everyday.
8. Eat a well-balanced diet.
9. Get regular aerobic exercise--a minimum of a half-hour, three times each week.
10. Before taking any new prescription or over-the-counter medication, check with the person who prescribes your psychiatric medication.
11. Discuss the social use of alcohol with your prescriber.
12. Avoid street drugs.
13. Work at forming and maintaining friendships and a network of support.
14. Take a course in stress management or assertiveness.
15. Work diligently in therapy.
16. Accept that there may be setbacks.

Dealing with Relapse

Since major depression is an illness that may recur, it is necessary for the patient and therapist to plan what to do if signs of relapse appear. The plan should include what specific symptoms are warnings that immediate measures must be taken. Make an agreement to call your therapist immediately when those specific symptoms occur, and at the same time increase the amount of daily structure and ask friends and family members to help temporarily decrease stress and responsibility.

Sources:

Kenneth S. Kendler, Ellen E. Walters, Kim R. Truett, et al. Sources of individual differences in depressive symptoms: analysis of two samples of twins and their families. American Journal of Psychiatry, 51:1605-1614 (November 1994).

Diagnosis and Treatment of Depression in Late Life. NIH Consents Statement 1991 Nov 4-6:;9(3):-27.

Javad H. Kashani and Gabrielle A. Carlson. Seriously depressed preschoolers. American Journal of Psychiatry, 144:348-350 (March 1987).

David D. Burns, M.D. Feeling Good.

A Clinical Psychotherapy Trial for Adolescent Depression Comparing Cognitive, Family, and Supportive Therapy David A. Brent, MD; Diane Holder, MSW; David Kolko, PhD; BorisBirmaher, MD; Marianne Baugher, MA; Claudia Roth, MSW; Satish Iyengar, PhD; Barbara A. Arch Gen Psychiatry. 1997;54:877-885

Anne Brown MD, Mood Disorders in Children and Adolescents, NARSAD Research Newsletter, Winter 1996

American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, 4th ed. Washington: American Psychiatric Association; 1994

Robins LN, Helzer JE, Weissman M M, et al. Lifetime prevalence of specific psychiatric disorders in three sites. Arch Gen Psychiatry. 1984;41:949-958.

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