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Treatments for Depression

The following treatment guidelines are meant as a reference tool only, and are not intended as treatment advice or to replace the clinical decision-making process of psychiatrists or other health professionals who administer these treatments. In clinical practice there are often good reasons why treatment approaches differ from what is described here.

 

For the Depressive Disorders, the two main types of treatments available are psychotherapy and medications (along with other biological treatments).  Although these treatments do not cure the disorder, they are effective in helping to resolve an episode and in preventing further episodes from occurring. 

Most studies show that after a 3-month course of a standard treatment for an uncomplicated Major Depressive Episode, about half of all individuals will recover completely, and another 15% will improve substantially with a reduction in their symptoms of at least 50% [ref].  However, these figures also suggest that over a third of individuals will not have adequate improvement from a first trial of treatment and will require additional measures.

Comparing Psychotherapy versus Medications for Depression

Various studies have come to the conclusion that psychotherapy and medications are equally effective for treating most episodes of Major Depression [ref]. Some studies have found that psychotherapy may be more effective than medications when it comes to preventing future episodes of Major Depression [ref].  On the other hand, medications seem to be superior to psychotherapy when it comes to treating Dysthymia [ref, ref], Major Depressive Episodes with psychotic features [ref], and perhaps also chronic Depression [ref].

Combining Psychotherapy with Medications for Depression

The best available evidence to date suggests that combining psychotherapy with medications is superior to using either of these treatments alone for resolving all forms and severities of Major Depression [ref, ref, ref, ref]. The improvement that is found tends to be modest in absolute terms, in the sense that a clear clinical benefit will only be seen in one in every five people who receive combined treatment [ref].

Combining psychotherapy with medications is also superior to using medications alone for preventing individuals from dropping-out of treatment [ref, ref].

However, when it comes to Dysthymia, it seems that a combination treatment is no better than just using medications alone [ref, ref].

Guidelines for Treating Depressive Disorders

Detailed guidelines have been developed to help clinicians decide when to consider using each of the different types of treatments available for the Depressive Disorders [ref, ref, ref, ref, ref], and they are summarized by PsychVisit. These treatment strategies differ depending on the type of Depressive Disorder in question. There are guidelines that exist for treating:

 

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