When do doctors feel most depressed?
There are basically three levels of treatment for depression. First, psychiatrists and psychotherapists treat within the framework of the Acute therapy the worst symptoms, such as suicidality.
In step two, the Maintenance therapy, try to treat the depressive episode to the extent that the affected person is fine again and maybe even healthy.
The third step that Relapse prevention, finally, focuses on ensuring that the patient does not relapse. Sometimes this is not possible, and doctors try to at least delay the time between two depressive episodes as long as possible.
For depression, there are several approaches that doctors use to manage an episode of depression. The two main routes of treatment are medication and psychotherapy. What psychiatrists and psychotherapists use of this depends on the circumstances and the severity of the illness. Sometimes patients get both.
For mild depression, studies have shown that medication does not work any better than a placebo. Because of the possible side effects, most psychiatrists and psychotherapists therefore rely on psychotherapy. In moderate depressive episodes, on average, both forms of therapy have proven to be equally effective. In severe depression, medication and psychotherapy are usually combined.
Unfortunately, doctors can hardly predict which of the two methods will work best for a particular patient. Sometimes people with depression respond very well to medication, but psychotherapy doesn't work at all. Sometimes it is exactly the other way around and the psychotropic drugs do not help, but psychotherapy does. Even if an initial attempt at treatment may not be successful, it may still work to overcome depression at a later point in time.
The drugs that psychiatrists use to treat depression are called Antidepressants. They aim to compensate for a lack of special messenger substances in the space between the nerve cells in the brain. This should ensure that the nerve cells can send their signals on again better.
So far, almost all antidepressants approved in Germany are based on this mechanism of action. Different antidepressants try to compensate for the deficiency in different ways.
Overview of different classes of antidepressants:
- Tricyclic (and tetracyclic) antidepressants (TCAs) or non-selective monoamine reuptake inhibitors (NSMRI)
- Selective Serotonin Reuptake Inhibitors (SSRI)
- Monoamine Oxidase (MAO) Inhibitors (MAOI)
- Selective Serotonin / Norepinephrine Reuptake Inhibitors (SSNRI)
- Alpha2 receptor antagonists
- Selective Norepinephrine Dopamine Reuptake Inhibitors (Bupropion)
- Melatonin receptor agonists (MT1 / MT) and serotonin 5-HT2C receptor antagonists (agomelatine)
There are also other, unclassified antidepressants. They include lithium salts or St. John's wort.
In addition to medication, psychotherapy is an effective therapy in the treatment of depression. According to the national treatment guidelines, psychotherapy should focus on the following points:
- Active, flexible and supportive approach, conveying encouragement and hope
- Empathic contact, building a trusting relationship
- Exploration of the subjective disease model, clarification of current motivations and the patient's therapy expectations
- Conveying an understanding of the symptoms, their treatability and their prognosis, teaching a "biopsychosocial disease model" to relieve the patient of feelings of guilt, self-reproach and feelings of failure
- Clarification of current external problem situations, relief from currently overwhelming duties and demands at work and in the family situation
- Prevention of depression-related wishes for hasty changes in life situation, support in formulating and achieving concrete, achievable goals to regain success (positive reinforcement)
- Providing insight into the individual need for adequate therapies (e.g. antidepressants, guideline psychotherapy)
- Involvement of relatives, strengths of resources
- Addressing suicidal thoughts and impulses, developing crisis management
If depression is treated on an outpatient basis, the health insurance companies reimburse the costs of psychotherapy if it is behavioral therapy or analytical psychotherapy based on depth psychology. If, on the other hand, a patient is treated as an inpatient in a clinic, doctors can use behavioral, conversational, psychodynamic, modified analytical and systemic (family) therapeutic procedures as well as interpersonal psychotherapy.
In addition, there are a number of other methods that can help against depression. If neither psychotherapy nor antidepressants are effective, electroconvulsive therapy (ECT) has proven to be an effective method. Patients receive a brief electrical shock to the brain under anesthesia.
In addition, potentially helpful therapies:
- Wake Therapy: The patient is not allowed to sleep for half a night or a full night. This method can provide a short-term antidepressant effect on the same day.
- Light therapy: Patients are irradiated by a specific lamp. Can especially help with mild and seasonally dependent depression.
- Ketamine Treatment: Relatively new procedure in which patients receive ketamine in several sessions (intravenous or intranasal). Can help if neither other antidepressants nor psychotherapy help.
- Move: Exercise is an effective remedy for depression.
- Meditation: Unsuitable as a sole therapy. But it can also help and is used as mindfulness-based meditation, especially in mindfulness-based cognitive therapy.
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