The first aim of treatment is to
ensure the safety of the patient for whom hospitalisation may be required.
Secondly, a complete diagnostic evaluation must be carried out. Thirdly, a depression treatment plan has to be formulated which would include medication,
psychotherapy, life-style changes and the addressing of stressors.
The vast majority of people respond to
treatment (between 80-90%) and almost all
sufferers who are appropriately treated will experience at least some symptom
relief (yet over 70% of South Africans don’t get assistance or treatment). Medical treatment
with anti-depressants may take up to 7 weeks to start being effective so it is
strongly advised that all patients go for psychotherapy – which helps to
empower the patient in case of future setbacks.
The first aim of treatment is to ensure
the safety of the patient for which hospitalisation may be required (i.e.
suicidal/unable to care for self). Secondly, a complete diagnostic evaluation
must be carried out. This includes a full personal and family history as well
as a history of illnesses, medication and recreational drugs/alcohol used,
activities, personality type and support system.
A physical examination may also be
required to evaluate underlying physical illness, which may cause or worsen
depression e.g. thyroid illness. It is important to detect medical problems, as
these require separate, appropriate treatment.
Thirdly, a treatment plan has to be
formulated which takes into account both immediate symptoms and the patient’s
future well being. This would include medication, psychotherapy, life-style
changes and the addressing of stressors. Stressful life events are associated
with an increased relapse rate in mood disorder sufferers.
Psychotherapy Psychotherapy is also known as “talking therapy” and involves a verbal
interaction between a trained mental health professional and a patient who may
be experiencing emotional or behavioural problems. There are several different
types of psychotherapy, which may differ in the techniques used on the
principles emphasised, but the
underlying aim is to enable the patient to gain insight into him or herself and
thereby change maladaptive thoughts, feelings and behaviour.
Research has shown that some forms of
psychotherapy are as effective as medication in treating mild to moderate
depression. Medication tends to bring about results more rapidly, but the
benefits of psychotherapy may be more enduring. It is generally agreed that the
best form of treatment is a combination of pharmacotherapy or psychotherapy.
Pharmacotherapy for depressive disorders has advanced considerably over the
past twenty years and there are now a large number of drugs to choose from. All
anti-depressants are equally effective providing an adequate dosage is taken
for a sufficiently long time. Different drugs may be prescribed for different
individuals, depending on the symptoms presented. Some anti-depressants are
more energising, while others may cause weight loss or gain.
A decision regarding which drug to use
is often made on the basis of tolerability of potential side effects.
Anti-depressants do not act rapidly. A
certain dosage and concentration has to be reached before they become
effective. This usually takes about a month, but may take six to eight weeks in
the elderly. It is important to persevere and to use the prescribed drug at the
correct dosage for long enough.
Patients often feel significantly
better after two to three months on anti-depressants, but it is important that
medication be continued for as long as your doctor advises. For a first episode
of depression this usually means taking medication six to nine months on
optimal dosage after symptom relief has been achieved, two to five years for a
subsequent episode and possibly life-long if episodes recur frequently and are
severe. Stopping medication too soon increases the likelihood of relapse and
the development of a chronic recurring illness.
What is depression?
Symptoms of depression
Types of depression
Reviewed by Zane Wilson, South African
Depression and Anxiety Group (SADAG), March 2015.
(Previously reviewed by Dr Stefanie van
Vuuren, Psychiatrist, MB ChB (Stell), M Med (Psig) (Stell), FC (Psych) SA, May