Research has shown that the best form of treatment is a combination of psychotherapy and pharmacotherapy. There are several different types of psychotherapy, which may differ in the techniques used based on the psychological 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.
Here are some of the common types:
Cognitive Behavioural Therapy (originally developed by Aaron Beck)
This is a short-term structured therapy using active collaboration between patient and therapist in order to reach the therapeutic goals. This treatment approach is based on the theory that one’s feelings and behaviour are controlled by how one thinks and perceives one's world.
Those who become depressed tend to see themselves negatively, believe that others see them in a similar light, except to fail or experience continued difficulties, feel hopeless and have negative expectations of life and the future. The therapist uses various techniques to identify and demonstrate the negative thought processes, which are then challenged, and together, patient and therapist work on changing negative thought patterns and beliefs so that a more realistic and positive mindset may develop. Overall therapy is relatively short, lasting up to 25 weeks.
Interpersonal psychotherapy (developed by Gerald Klerman)
The underlying hypothesis in this therapy is that disturbed social or personal relationships may cause or precipitate a depressive episode. The depression, in turn impacts negatively on the relationships, which then further exacerbates the illness. Therapy deals with one or two current interpersonal problems and helps the patient understand how depression and interpersonal conflicts are related. The interpersonal therapy programme usually consists of 12 – 16 weekly sessions.
Psychodynamic psychotherapy (developed by Freud, Kohut, Jacobson and Abraham)
This therapy is based on the idea that current behaviour and life experience is influenced by earlier experiences, hereditary traits and present reality. It takes into account the effects that emotions and unconscious material can have on human behaviour. This is usually a long-term open-ended therapy which may continue for years and is often less interactive.
This is not usually a primary therapy for the treatment of a MDD, but helping to identify negative interactions within a family can help to reduce stress and thereby decrease relapse. Family therapy examines the role of the mood–disordered member in the overall psychological well being of the whole family. It also examines the role of the entire family in maintaining the patient’s symptoms. Family therapy may also provide emotional support for the family of a sufferer.
(Dr Tanya Timmerman, psychiatrist, updated 2011)