Major depressive disorder Health Article

Treatments

Because MDD can have a devastating impact on a person'slife, the importance of effective treatment cannot be overestimated. Treatment strategies have evolved over the years according to researchers' varying opinions of the underlying causes of depression, but the outpouring of interest in MDD allows treatment providers to select from a variety of tested approaches.

Psychotherapy

Cognitive psychotherapies for depression are based on the belief that depressed people perceive themselves and the world in unrealistically negative ways. Considerable research has been done regarding the cognitive dimension of depression; for example, studies find that depressed people pay more attention to negative events than to positive ones, and that dwelling on unpleasant experiences prolongs and worsens depressive episodes. Cognitive therapists help patients identify the automatic thoughts that lead them to anticipate poor outcomes or to interpret neutral events in negative ways. The patient is also encouraged to challenge negative thoughts by comparing his or her expectations of events with actual outcomes.

Evidence that poor interpersonal relationships may heighten vulnerability to depression, along with findings that depressed adults and depressed children tend to provoke negative reactions from other people, has prompted the use of social skills trainingas a form of treatment. In this type of therapy, patients are trained to recognize actions and attitudes that annoy or distance other people, and to replace these behaviors with more appropriate ones. Social skills training may be particularly helpful to depressed persons who tend to isolate themselves and have lost confidence in their ability to develop healthy relationships. This treatment model promotes the idea that depression is likely to lift when the patient becomes adept at making new friends and establishing rewarding social supports.

Psychodynamic psychotherapyis often effective in treating patients with MDD whose depression is related to unresolved issues from the past, particularly abuse or other painful childhood experiences. The growth of insight into one's emotional patterns, as well as the supportive aspects of this form of therapy, offers considerable relief from emotional pain to many patients.

Medications

The use of medications in the treatment of depression began in the late 1950s with the successful introduction of tricyclic antidepressants and MAO inhibitors. Treatment of depression with medications has greatly increased since the advent of selective serotonin reuptake inhibitors (SSRIs) such as fluoxetine(Prozac) and sertraline(Zoloft). While these medications are no more effective than their predecessors, they have fewer side effects and are much safer for patients who may be likely to overdose. Selecting the optimal antidepressant medication is not always a straightforward process, however, and the patient may have to try out various drugs for a period of weeks or months before finding one that is effective for him or her. In addition, while the SSRIs have comparatively few side effects, such complaints as loss of sexual interest or functioning, nervousness, headaches, gastrointestinal complaints, drowsiness, and insomnia can be significant obstacles to the patient's taking the medication as directed.

Other mainstream approaches

The use of electroconvulsive therapy(ECT), initially introduced in the 1930s, was virtually abandoned as a treatment for MDD for many years, largely as a result of the effectiveness and convenience of psychotropic (mindaltering) medications. Since the 1980s, however, interest in the procedure has renewed; in 1990 the American Psychiatric Association published new guidelines for the use of ECT. Despite media portrayals of ECT as an outdated and cruel form of treatment that causes considerable pain, in actuality the patient is given a sedative and the electrical stimulation is calibrated precisely to produce the maximum therapeutic effects. ECT may be the first line of treatment when a patient cannot tolerate the customary medications or is at high risk of harming themselves; it is more commonly used with patients who fail to respond to drug treatment. In terms of effectiveness, however, ECT actually outperforms medications even among patients who are helped by antidepressants, as well as those who are resistant to drug treatment.

The use of phototherapy (light therapy) has proven to be the treatment of choice for patients diagnosed with seasonal affective disorder. Although the reasons for the effectiveness of phototherapy are not yet clear, treatment involves exposing the eyes to bright (2,500 lux) light for several minutes a day. Currently, however, there is little evidence to suggest that phototherapy is useful in the treatment of other types of MDD.