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Page 1 of 2 Hospitalization
The first and most critical decision the therapist must make is whether to hospitalize a patient with major depression, or to attempt outpatient treatment. Clear indications for hospitalization are: (1) risk of suicide or homicide, (2) grossly reduced ability to care for food, shelter, and clothing, and (3) the need for medical diagnostic procedures. A patient with mild to moderate depression may be safely treated in the office if the therapist evaluates the patient frequently. The patient's support system should be strengthened and involved in treatment whenever possible.
Antidepressants
Studies have show that antidepressant therapy for major depression can dramatically reduce suicide rates and hospitalization rates. Unfortunately, very few suicide victims receive antidepressants in adequate doses, and - even worse - most receive no treatment for depression whatsoever.
One of the biggest problems with antidepressant therapy is that most patients don't stay on their antidepressant medication long enough for it to be effective. A recent study found that only 25% of patients started on antidepressants by their family physician stayed on it longer than one month. Antidepressant therapy usually takes 2-4 weeks before any significant improvement appears (and 2-6 months before maximal improvement appears).
First Line Antidepressants
The SSRI antidepressants, escitalopram (Lexapro), fluoxetine (Prozac), paroxetine (Paxil), fluvoxamine (Luvox), or sertraline (Zoloft), are considered excellent choices as the patient's first antidepressant because of their low incidence of side-effects (especially weight gain) and their low lethality if taken in an overdose. All SSRI antidepressants are equally effective.
Because many patients with major depression also suffer with intense anxiety, your doctor may also give you Fluvoxamine (Luvox) or lorazepam (Ativan) to reduce anxiety in mixed anxiety-depression.
Both fluoxetine (Prozac) and paroxetine (Paxil) tend to be stimulating (elevate your mood); thus patients with mixed anxiety-depression can often dramatically benefit from the addition of clonazepam (Klonopin) to the fluoxetine (Prozac) or paroxetine (Paxil) therapy.
Keep in mind, prescribing the right antidepressant is not an exact science. It may take some experimentation on the part of the doctor (make sure you're seeing a psychiatrist, a specialist in psychiatric medications) to find the right antidepressant and right dosage for you. Do not give up if everything doesn't come together right away.
SSRI antidepressants should be taken for 6 to 12 months. Antidepressant therapy should not be withdrawn before there have been 4 to 5 symptom-free months. Withdrawal from antidepressant therapy should be gradual. Never discontinue taking your medication without telling your doctor first. Suddenly stopping your medication could produce severe withdrawl symptoms and unwanted psychological effects, including a return of major depression.
read more about antidepressants and antidepressant therapy here
Psychotherapy
In general, psychiatrists agree that severely depressed patients do best with a combination of antidepressant medications and psychotherapy. Medications relieve the symptoms of depression quickly, while psychotherapy can help the patient deal with the illness, easing some of the potential stresses that can trigger or exacerbate the illness.
Dynamic Psychotherapy
Dynamic Psychotherapy is based on the premise that human behavior is determined by one's past experience (particularly in childhood), genetic endowment and current life events. It recognizes the significant effects of emotions, unconscious conflicts and drives on human behavior.
Interpersonal Therapy
Interpersonal Therapy is based on the theory that disturbed social and personal relationships can cause or precipitate depression. The illness, in turn, may make these relationships more problematic. IPT helps the patient understand his or her illness and how depression and interpersonal issues are related.
There is some evidence in controlled studies that IPT as a single agent is effective in reducing symptoms in acutely depressed patients of mild to moderate severity.
The National Institute of Mental Health studied interpersonal therapy as one of the most promising types of psychotherapy. Interpersonal therapy (IPT) is a short-term psychotherapy, normally consisting of 12 to 16 weekly sessions. It was developed specifically for the treatment of major depression, and focuses on correcting current social dysfunction. Unlike psychoanalytic psychotherapy, it does not address unconscious phenomena, such as defense mechanisms or internal conflicts. Instead, interpersonal therapy focuses primarily on the "here-and-now" factors that directly interfere with social relationships.
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