Treatments

Assessments

Severe cases of depressive illnesses can be treated and the earlier the treatment, the greater the success and less likely a chance for recurrence. The first and most important step is to seek medical care. Emergency room doctors can assist with temporary care and further advise where to seek additional treatment. Psychiatrists, social workers, psychologists, community mental health centers, hospital outpatient psychiatry centers, state hospital outpatient clinics, private clinics, local medical and psychiatric societies can each assist in offering care and guidance towards the appropriate treatment based on individual needs.

Consulting a physician is necessary in ruling out potential thyroid conditions, viral infections or previously treated medical conditions creating depressive adverse reactions. Laboratory testing and physical examinations are necessary along with psychological evaluations to determine history of symptoms, duration, severity, alcohol or substance use, thoughts of suicide and/or death. Once an individual is diagnosed, treatment methods such as psychotherapy and medications are typically introduced.

The World Health Organization (WHO) updated its Comprehensive Mental Health Action Plan 2013-2030. The plan encourages partners to promote mental health and well-being for all, to prevent mental health conditions for those at-risk, and to achieve universal coverage for mental health services. While the updated action plan includes new and updated indicators and implementation options, the original four major objectives remain unchanged: more effective leadership and governance for mental health; the provision of comprehensive, integrated mental health and social care services in community-based settings; implementation of strategies for promotion and prevention; and strengthened information systems, evidence and research.¹¹³

Psychotherapy

When mild to moderate depression is diagnosed, psychotherapy has demonstrated successful treatment regimens consisting of short-term (10-20 weeks) cognitive-behavioral therapy (CBT) and/or interpersonal therapy (IPT) based on individual needs. CBT assists in altering behaviors and negative thoughts that potentially contribute towards depression, while IPT focuses on working out difficult relationships triggering depressive symptoms.¹¹² Alternative therapies often recommend a positive state of well-being emphasizing good nutrition, exercise, social support groups, and the avoidance of drugs, cigarettes, and alcohol use are strongly encouraged.¹¹⁴ Complementary and alternative medicine (CAM) therapies are increasing and being tested with increasing scientific rigor, similar to the clinical trials that evaluate modern drugs for depression and other mood disorders. Reliable evidence is emerging about the efficacy of several types of CAM in these conditions. There is even some evidence that nutraceuticals, botanicals, and nutrients could be used alone as first-line treatments in mild-to-moderate mood disorders. However, severe depression, including psychotic depression, bipolar disorder with rapid cycling, and treatment-resistant depression require antidepressants, mood stabilizers, and atypical antipsychotics.¹¹⁴