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FOUR. TREATMENT

Psychosocial treatments include individual therapies, group therapies, vocational services, and family/couples therapies.

What are the different types of treatment for depression?

Types of treatment for depression fall into two broad categories: psychosocial[1] and pharmacologic[2]. Within each category are many choices. Psychosocial treatments include individual therapies, group therapies, vocational services, and family/couples therapies. Furthermore, there are different types of individual therapies, such as supportive, insight oriented, or cognitive-behavioral. There are also various levels of treatment settings, ranging from private practice settings, outpatient clinic settings, day treatment or partial hospital programs, and inpatient treatment.

Pharmacologic treatment involves the use of medications from various groups, such as antidepressants[3], anticonvulsants[4], antipsychotics[5], or anxiolytics[6]. Psychotropics[7] are those medicines primarily used in psychiatric care for the treatment of mental disorders, including depression. However, there is often a crossover use of medicines from other medical specialties, such as from neurology, wherein antiseizure medications (anticonvulsants) are frequently found to have efficacy[8] in the treatment of many psychiatric conditions.

As part of an evaluation your clinician will consider the most appropriate treatment plan for your depression. For a mild depression psychotherapy alone may be recommended first. For more severe depressions both medication and therapy may be recommended. If already in psychotherapy, your therapist may refer you to a psychiatrist for a medication evaluation if there are concerns about the level of response, the severity of symptoms, or confounding comorbid conditions. The type of therapy chosen can depend on many factors such as cost, duration, or patient fit (Table 3). Frequency of psychotherapy typically starts at once per week but may be more or less often depending on your individual needs or therapy type.

As part of the treatment plan, the treatment setting also needs to be determined. Most individuals can be treated in private office settings or outpatient clinic settings. Sometimes, a higher level of structure is needed in which more services can be provided, on a daily basis, such as in a day treatment program. If

Table 3. Types and Characteristics of Therapy

Therapy

Duration

Illness/Focus

Theory

Psychoanalytic or psychodynamic

few months to few years

personality disorders, coping skills

unconscious conflicts from childhood

Behavioral

6 to 20 sessions

anxiety disorders, depression, psychosomatic symptoms

symptom reinforcement

Cognitive

10 to 20 sessions

depression, obsessive-compulsive disorder

negative thoughts

Interpersonal

12 sessions

depression

relationship focused

Dialectical behavioral

one year or greater

borderline personality disorder

reduction of self-injurious behaviors

Psycho-educational

long-term

families of schizophrenic patients

support and education

Supportive

brief

acute grief reactions

reinforcing

patient's

strengths

Group

open-ended or time-limited

mood disorders, anxiety disorders, schizophrenia

support and education

Family

short to long-term

family roles, support, education, dynamics

various

impairments are severe or if safety is in question, hospitalization may be warranted. Within the hospital several modalities of treatment are provided on a daily basis, making the treatment more intense.

  • [1] pertaining to environmental circumstances that can impact one's psychological well-being.
  • [2] pertaining to all chemicals that, when ingested, cause a physiologic process to occur in the body. Psychopharmacologic refers to those physiologic processes that have direct psychological effects.
  • [3] a drug specifically marketed for and capable of relieving the symptoms of clinical depression. It is often used to treat conditions other than depression.
  • [4] a drug that controls or prevents seizures. Anticonvulsants often are used in psychiatric practice to treat mania, mood instability, or other mental conditions.
  • [5] a drug that treats psychotic symptoms, such as hallucinations, delusions, and thought disorders. Antipsychotics can be used to treat certain mood disorders as well.
  • [6] a substance that relieves subjective and objective symptoms of anxiety.
  • [7] usually referring to pharmacologic agents (medications) that, as a result of their physiologic effects on the brain, lead to direct psychological effects.
  • [8] the capacity to produce a desired effect, such as the performance of a drug or therapy in relieving symptoms of depression, such as feeling down, trouble concentrating, and so on.
 
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