DEPRESSION

Treatment of  depression

How does one treat depression?

There are different ways to treat depression. At present, the most important treatment options include psychotherapy, pharmacotherapy (medication), as well as general methods such as relaxation techniques and physical exercise. In addition to the standard methods, alternative treatment approaches, such as phototherapy or ketamine therapy, are also available.

Irrespective of the method, all of the different treatment options pursue a similar goal: to reduce the symptoms of depression and minimize the risk of a possible relapse, thus enabling patients to regain their mental well-being and to enhance their ability to live a fulfilled life.

The approach and duration of the treatment can vary, based on the type, the development and the severity of the depressive symptoms, as well as the individual situation of the patient. Often, several approaches are combined. Which therapy is ultimately “the right one”, should ideally be determined in accordance with the attending therapist or psychiatrist.

Does one have to seek treatment for depression right away?

Even without therapeutic treatment, a depressive episode may subside “on its own” after a certain time, usually after 6 to 8 months. However, the probability of developing another episode is considerably higher if the previous depressive episode was not treated therapeutically [1].

In the case of a mild depressive episode, depression-specific treatment does not always have to be implemented immediately. The German National Treatment Guideline for unipolar depression recommends initially monitoring the appearance of mild symptoms (preferably in consultation with the treating physician/psychotherapist), confiding in relatives, partners, and friends, and making use of online programs or self-help groups.

However, if symptoms persist for a longer period of time (longer than two weeks) or if symptoms should increase in severity, professional support should be sought out, especially if thoughts of self-injury or suicide are present [7]!

Don’t forget: depression is a mental illness that has a very good chance of recovery, if it is properly treated in time!

The following sections provide an overview of the most common treatment methods.

Psychotherapy

In psychotherapy, mental health illnesses (disorders related to one’s thoughts, behaviors or experiences) are treated with psychological methods (e.g., psychotherapeutic conversations, cognitive training, or relaxation techniques) via verbal and nonverbal communication [2]. Nowadays, psychotherapy plays an important role in the treatment of depression. A large number of studies have demonstrated the effectiveness of psychotherapeutic treatments for depressive disorders [5]. The final outcome seems to depend on individual characteristics of the depression (e.g., the severity or the pre-existing duration of the symptoms or co-occurring disorders) [1].

Most psychotherapeutic approaches will adapt the content and techniques to the specific symptoms of the disorder and the patient’s current life situation. The main goals are to help the patient uncover possible underlying inner and/or interpersonal conflicts, to develop coping strategies, to increase the range of their behavioral responses and to strengthen self-confidence in their own abilities [4]. Psychotherapy can be conducted as a short-term or a long-term treatment [7].

What are the different types of psychotherapy?

In Germany, the costs of the following psychotherapeutic treatment options are covered by the public health insurance, for patients suffering from depression or other psychological illnesses [3]:

  • psychodynamic psychotherapy
  • analytical psychotherapy (psychonanalysis)
  • behavioral therapy
  • systemic therapy

Would you like to learn more about these methods?

Psychotherapy for depression

Medication

For some patients suffering from depression, medication might be an option. The most common psychotropic drugs prescribed for depression are “antidepressants”, which have an effect on the psyche and aim to alleviate depressive symptoms and prevent potential relapses [10]. Although medication cannot address the root causes of symptoms (e.g., stress due to challenges at work, interpersonal conflicts or other problematic life situations), they do have the ability to affect the mood and motivation of the individual, giving them the courage and strength to address the underlying factors.

What are the doses and duration of a treatment with antidepressants?

Compared to other medication, antidepressants have to be taken regularly for several weeks to achieve a noticeable effect. In most cases, a low dose is given at the beginning and gradually increased until the right dose is found for the individual [7]. Antidepressants should never be discontinued abruptly, even in cases where the medication is effective and patients experience an improvement in symptoms, as there is a considerable risk of the occurrence of withdrawal symptoms (e.g., insomnia, nausea, anxiety) or a resurgence of depressive symptoms [11, 12]. To prevent relapses, it is recommended to continuously take the medication for 4 to 9 months after the depressive episode has subsided (the so-called “maintenance phase”).

Psychotherapy and medication can also be combined. Studies have shown that in severe depression, a combined treatment of medication and psychotherapy is more effective than psychotherapy or medication alone [13].

Learn more about the treatment with antidepressants.

Antidepressants for depression

What other types of medication are there?

In addition to antidepressants, sometimes doctors will prescribe other psychotropic drugs, such as mood stabilizers or, in cases of psychotic depression, certain neuroleptic medications [11].

Herbal substances, such as St. John’s wort, are sometimes used to treat mild to moderate depression, although experts are currently not in accordance on their efficacy. However, it is important to note that St. John’s wort can impair the efficacy of other medications (e.g., blood-thinning agents or the contraceptive pill) [7] and can even interact with certain substances in dangerous and sometimes life-threatening ways [27].

What are alternative treatment options?

Medication and psychotherapy alone are often insufficient to alleviate the symptoms [19]. Therefore, increased research has been conducted in recent years regarding alternative treatment options for depression. Currently, non-invasive brain stimulation techniques are being intensively investigated in relation to depression. First study results indicate clinical benefits and a good tolerability. Transcranial magnetic stimulation (TMS) in particular is considered promising. In this procedure, a magnetic coil is used to stimulate the nerve cells of the brain, activating regions that are linked to a decreased activity during depression [20].

For some individuals sleep deprivation or – in certain severe and chronic cases – electroconvulsive therapy (ECT) could also be an option, however only under medical supervision. ECT is a procedure, that takes place under general anesthesia and is intended to trigger a brief epileptic seizure that “reboots” the brains networks [22].

Light therapy or phototherapy has been proven to be an effective treatment method for seasonal depression [21].  However, in recent years, an increasing number of studies have suggested that light therapy may also be effective for other forms of depression [23].

Recent studies have shown that complementary methods, such as sport, yoga and relaxation techniques, can have additional positive effects on the course of depression [24].

New forms of therapy

In the last 20 years, research regarding the efficacy of so-called serotonergic psychedelics and ketamine has become increasingly important in the treatment of depression. Initial research suggests that psychedelic-assisted psychotherapy may represent an alternative treatment modality for people suffering from major depression. However, this form of therapy is still being researched and has not yet been approved in Germany [25, 26].

One alternative and safe option for therapy with altered states of consciousness is the ketamine-augmented psychotherapy [25]. This treatment option is offered at the OVID clinic in a unique way. Learn more about ketamine-augmented psychotherapy for depression.

Ketamine-augmented psychotherapy

Published on 06.04.2022

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[15]  Neuronation. Neurotransmitter: Die Botenstoffe unseres Gehirns.  https://blog.neuronation.com/de/neurotransmitter-die-botenstoffe-unseres-gehirns/#neurotransmitter_bedeutung_f%C3%BCr_die_neuropsychologie (Abgerufen am: 23.03.22)

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