TREATMENT DEPENDENT ON DEPRESSION SEVERITY
Healthcare providers approach the treatment of depression differently depending on its severity. The following descriptions explain how the different severity levels are defined.
Mild to moderate depression — People with mild to moderate depression have the following characteristics:
●They do NOT have thoughts of or plans for suicide or homicide.
●They do NOT have psychotic symptoms, such as delusions or hallucinations.
●They have little to no aggressiveness.
●Their judgement is intact.
People with mild to moderate depression can generally be treated during routine visits with a healthcare provider; they do not typically need to be hospitalized.
Severe depression — People with severe major depression have one or more of the following characteristics:
●They DO have thoughts of and plans for suicide or homicide.
●They DO have psychotic symptoms, such as delusions or hallucinations.
●They have a condition called catatonia, which involves being unable to move or talk normally.
●Their judgement is impaired such that people (including themselves) may be at risk for harm.
●Their normal functioning is impaired. For example, they may refuse to eat or drink which may lead to malnourished or dehydration.
People with severe major depression usually need to be seen by a psychiatrist and sometimes need to be hospitalized.
TREATMENT FOR MILD TO MODERATE DEPRESSION
For the initial treatment, we suggest a combination of antidepressant medication and psychotherapy. Well-designed studies have shown that combination treatment is more effective than either treatment on its own. Nevertheless, either treatment can also be given alone, as studies have also shown that each is effective and comparable to the other.
Despite being comparably effective, one advantage of psychotherapy is that some of its benefits often persist even after active treatment ends. Psychotherapy may help people develop new coping skills as well as more adaptive ways of thinking about life problems. The same is not necessarily true of antidepressants; many who take antidepressants alone relapse after stopping them.
Treatment diagnosis however first starts with a call to our admissions. Please call 877-959-9392 Today.
TREATMENT FOR SEVERE MAJOR DEPRESSION
For people with severe, we suggest a combination of antidepressant medication and psychotherapy. It’s also reasonable to try antidepressants alone. (Psychotherapy is generally not used alone for patients with severe depression.) Another reasonable treatment for is electroconvulsive therapy (ECT), particularly in people who are actively thinking about suicide and who may be in danger of following through on their plans. ECT is discussed at elsewhere.
Choosing an antidepressant — For the initial treatment of severe depression, we use serotonin-norepinephrine reuptake inhibitors (SNRIs) or selective serotonin reuptake inhibitors (SSRIs). In people who have other symptoms, additional medications such as atypical antipsychotics may be appropriate.
Some healthcare providers start with SNRIs because studies suggest that these medications are more likely than SSRIs to alleviate severe depression. A reasonable alternative to SNRIs or SSRIs is a medication called mirtazapine (brand name: Remeron). It, too, has been shown to be effective in treating severe depression.
Tricyclic antidepressants are another reasonable alternative for severe depression. However, tricyclics can be dangerous and cause serious side effects, so some healthcare providers prefer to avoid prescribing them until safer alternatives have been tried.