Treatment of Depression 1

TOPIC: TREATMENT OF DEPRESSION

By

Aqsa Saeed

Bushra Khan

Hafsa Irfan

Kainat Fayyaz

Laiba Ijaz

Muniba Iqbal

Samia

Sanah Sabir
 Treatment of Depression 2

Treatment

Medications and psychotherapy are effective for most people with depression. Your primary
care doctor or psychiatrist can prescribe medications to relieve symptoms. However, many
people with depression also benefit from seeing a psychiatrist, psychologist or other mental
health professional.

If you have severe depression, you may need a hospital stay, or you may need to participate in an
outpatient treatment program until your symptoms improve.

Medications

Many types of antidepressants are available, including those below. Be sure to discuss possible
major side effects with your doctor or pharmacist.

• Selective serotonin reuptake inhibitors (SSRIs). Doctors often start by prescribing an

SSRI. These drugs are considered safer and generally cause fewer bothersome side effects
than other types of antidepressants. SSRIs include citalopram (Celexa), escitalopram
(Lexapro), fluoxetine (Prozac), paroxetine (Paxil, Pexeva), sertraline (Zoloft) and
vilazodone (Viibryd).

• Serotonin-norepinephrine reuptake inhibitors (SNRIs). Examples of SNRIs include

duloxetine (Cymbalta), venlafaxine (Effexor XR), desvenlafaxine (Pristiq, Khedezla) and
levomilnacipran (Fetzima).

• Atypical antidepressants. These medications don't fit neatly into any of the other
antidepressant categories. They include bupropion (Wellbutrin XL, Wellbutrin SR,
Aplenzin, Forfivo XL), mirtazapine (Remeron), nefazodone, trazodone and vortioxetine
(Trintellix).

• Tricyclic antidepressants. These drugs — such as imipramine (Tofranil), nortriptyline

 Treatment of Depression 3

(Pamelor), amitriptyline, doxepin, trimipramine (Surmontil), desipramine (Norpramin) and

protriptyline (Vivactil) — can be very effective, but tend to cause more-severe side effects than
newer antidepressants. So tricyclics generally aren't prescribed unless you've tried an SSRI first
without improvement.

• Monoamine oxidase inhibitors (MAOIs). MAOIs — such as tranylcypromine (Parnate),

phenelzine (Nardil) and isocarboxazid (Marplan) — may be prescribed, typically when
other drugs haven't worked, because they can have serious side effects. Using MAOIs
requires a strict diet because of dangerous (or even deadly) interactions with foods ― such
as certain cheeses, pickles and wines ― and some medications and herbal supplements.
Selegiline (Emsam), a newer MAOI that sticks on the skin as a patch, may cause fewer side
effects than other MAOIs do. These medications can't be combined with SSRIs.

• Other medications. Other medications may be added to an antidepressant to enhance

antidepressant effects. Your doctor may recommend combining two antidepressants or
adding medications such as mood stabilizers or antipsychotics. Anti-anxiety and stimulant
medications also may be added for short-term use.

Psychotherapy

Psychotherapy is a general term for treating depression by talking about your condition and
related issues with a mental health professional. Psychotherapy is also known as talk therapy or
psychological therapy. Psychotherapy can help you:

• Adjust to a crisis or other current difficulty

• Identify negative beliefs and behaviors and replace them with healthy, positive ones

Explore relationships and experiences, and develop positive interactions with others

• Find better ways to cope and solve problems

• Identify issues that contribute to your depression and change behaviors that make it worse

• Regain a sense of satisfaction and control in your life and help ease depression symptoms,
such as hopelessness and anger
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• Learn to set realistic goals for your life

• Develop the ability to tolerate and accept distress using healthier behaviors

Types of Psychotherapy:

Different types of psychotherapy can be effective for depression, such as cognitive

behavioral therapy or interpersonal therapy. Your mental health professional may also
recommend other types of therapies.

1. Cognitive – Behavioral therapy:

CBT works on the basis that the way we think and interpret life's events affects how we
behave and, ultimately, how we feel. Studies have shown that it is useful in many situations.
More specifically, CBT is a problem-specific, goal-oriented approach that needs the individual's
active involvement to succeed. It focuses on their present-day challenges, thoughts, and
behaviors. During a course of CBT, a person can learn to:

• Identify problems more clearly

• Develop an awareness of automatic thoughts

• Challenge underlying assumptions that may be wrong

• Distinguish between facts and irrational thoughts

• Understand how past experience can affect present feelings and beliefs

• Stop fearing the worst

• See a situation from a different perspective

• Better understand other people's actions and motivations

• Develop a more positive way of thinking and seeing situations

• Become more aware of their own mood

• Establish attainable goals

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• Avoid generalizations and all-or-nothing thinking

• Stop taking the blame for everything

• Focus on how things are rather than how they think they should be

• Face their fears rather than avoid them

• Describe, accept, and understand rather than judge themselves or others

2. Interpersonal therapy

Interpersonal therapy (IPT) is a method of treating depression. IPT is a form of

psychotherapy that focuses on you and your relationships with other people. It‟s based on the
idea that personal relationships are at the center of psychological problems. Treatment usually
begins with your therapist conducting an interview. Based on the problems you describe, they
can identify goals and create a treatment. IPT is not about finding an unconscious origin of your
current feelings and behavior. In this way, it is unlike other forms of psychotherapy. IPT instead
focuses on the current reality of your depression. It looks at how more immediate difficulties are
contributing to symptoms. Feelings of depression often follow a major change in your life. These
changes fall into one of four categories:

• Complicated bereavement — the death of a loved one or unresolved grief

• Role transition — the beginning or ending of a relationship or marriage or diagnosis of a

disease

• Role dispute — a struggle in a relationship

• Interpersonal deficit — the absence of a major life event

The therapist will attempt to identify events in your life that lead to your depression.
They will try to equip you with the skills you need to direct difficult emotions in positive ways.
You may be encouraged to take part in social activities that you found stressful or painful in the
past. This can be a way of practicing new coping techniques.
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3. Brain – Stimulation Therapies

For some people, other procedures, sometimes called brain stimulation therapies, may be
suggested:

• Electroconvulsive therapy (ECT). In ECT, electrical currents are passed through the brain
to impact the function and effect of neurotransmitters in your brain to relieve depression.
ECT is usually used for people who don't get better with medications, can't take
antidepressants for health reasons or are at high risk of suicide.

• Trans – cranial magnetic stimulation (TMS). TMS may be an option for those who
haven't responded to antidepressants. During TMS, a treatment coil placed against your
scalp sends brief magnetic pulses to stimulate nerve cells in your brain that are involved in
mood regulation and depression.

4. Holistic Therapies

Integrative medicine practitioners believe the mind and body must be in harmony for you to
stay healthy. Examples of mind-body techniques that may be helpful for depression include:

• Acupuncture

• Relaxation techniques such as yoga or tai chi

• Meditation

• Guided imagery

• Massage therapy

• Music or art therapy

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• Spirituality

• Aerobic exercise

Relying solely on these therapies is generally not enough to treat depression. They may be
helpful when used in addition to medication and psychotherapy.

5. Mastery and Pleasure Technique

The mastery and pleasure technique is a method of cognitive behavioral therapy for the
treatment of depression. Aaron T. Beck described this technique first. The technique is useful
when patients are active, but have no pleasure. The patients shall rate on a 5-point-scale (or a
10point-scale) how much pleasure they have and how successful they are when they do
something. The patients record this hourly.

• The patients shall learn "to recognize partial successes and small degrees of pleasure"
because depressive patients tend to the cognitive distortion of all-or-nothing thinking.
• The patients can also learn that Mastery and Pleasure are independent. By the combination of
rating mastery and pleasure unrealistic ideas like "Life should be all fun" or "The only thing
worth spending time on is work to accomplish things." can be challenged.
• Lewinsohn has the theory that patients need reinforcers to feel good. The idea is that patients
can get reinforcers from activities, but they "want to wait for their mood to lighten before
engaging in activities." So Beck asks clients to perform activities as a behavioral experiment.
The patients can then increase systematically the activities with higher ratings of mastery and
pleasure and look for new activities.

6. Behavior activation (aka scheduling pleasant activities)

This strategy is at once so simple yet so powerful. Pleasurable activities are among the first

to go when people are faced with adversity. Intentionally taking part in activities that are

enjoyable, helps to reduce negative thinking and promotes more positive emotions and feelings

of wellbeing. This technique is particularly helpful for clients with depression.

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7. Automatic Thought Record

An important a part of CBT is retaining Automatic Thought Records. An Automatic

Thought report (see below) is a one-page chart that permits you to seize key pieces of facts to
which you could practice CBT strategies. The motive of maintaining this report is that it will help
you capture your automatic thoughts, understand the emotions that go together with them,
and work on balancing out your thinking in the direction of modifying your temper.

The Automatic Thought Record has six columns within that you are requested to go
into certain facts along with Date and Time, the Situation, your Automatic Thoughts, and so forth.
Doing this takes some patience and practice, but if you stay with it you will be very
pleasantly amazed on the results you may get. It is common for people to initially express doubt that
this technique will work for them. They may also say things like, "How can this probable help me
to feel better?" or they otherwise specific disbelief that it's far feasible to change their moods at all.
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However, those who work with this method get to the factor in which they grow to be pretty adept at
catching their Automatic Thoughts, responding to them, and enhancing their temper without even
needing to apply the record any longer.
Notice on the top which you are prompted to fill one out whilst you notice that
your temper has become worse. When you do, its helpful to ask yourself, "What am I wondering and
feeling right now?" You want to capture what goes via your thoughts simply as quickly as you
may and get it down onto paper. If you wait hours or days to fill out your Automatic Thought
Record, you may lose precious records as the info of the moment will virtually fade away.

8. Challenging Dysfunctional beliefs

i. Socratic Questioning
It is a therapist stance for wondering maladaptive mind and beliefs. This process entails
asking a sequence of open-ended, short questions that guide the affected person to discover his/her
idiosyncratic thoughts, feelings, or behaviors associated with a particular situation. Socratic
questioning is non – judgmental but is based totally on the therapist’s insight that
the original premise of an idea or notion can be untrue; therefore, the questions are designed to
reveal the dysfunctional thought or notion so that it is able to be challenged.
ii. Dysfunctional Thought Record (DTR)

The Dysfunctional Thought Record (DTR) is the staple of cognitive paintings in Brief CBT.
The first three columns are used for identifying troubling conditions and the
accompanying emotions and dysfunctional thoughts. These 3 columns are used alongside
Module 8, in that after the situation → thought → feeling triangle is unfolded, it forms the
first 3 columns of a DTR.

Situation Thoughts Feelings

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9. The ‘Pie’ technique

Based on the simple pie chart, the „pie‟ technique lets clients see their goals and ideas in
graph form. The pie‟ technique can help with things like setting goals and determining
responsibility for outcomes. Simply have the client place each idea or goal into a pie chart, divided
according to importance as they see fit. This process can be done as part of a homework assignment
or as part of the ongoing therapist-client dialogue.

Hospital and residential treatment

Partial hospitalization or day treatment programs also may help some people. These
programs provide the outpatient support and counseling needed to get symptoms under control.