Both medication and therapy work treatments for depression. The treatment choice depends on the severity of the episode. Mild depression is often effectively treated with cognitive-behavioral therapy or interpersonal therapy alone, for example. More severe forms of depression typically require the adjunctive use of medication.
A lot of people just take medication, but research indicates that the mixture of medication with therapy could possibly be the most effective. When taking medication, it is usually better to have some type of therapy at some point during the treatment in order to address the precipitating stressors. This could help develop coping mechanisms and problem-solving abilities and cuts down on the risk of recurrence under stressful circumstances in the future.
The most crucial factor in determining a positive outcome from either modality is that both forms of treatment require commitment to the treatment in order for this to operate. Therapy requires regular attendance to appointments, communication using the therapist throughout the session, and for some types of therapy, work on assignments between sessions. The process of treatments are not easy.
It may be anxiety provoking, and one does not necessarily feel relief after each individual session. Relief comes with time with effort on the issues. It may feel easier to cancel sessions in order to terminate treatment prematurely, but then the treatment isn't given an opportunity to be effective.
For medication, its use requires daily compliance and regular communication with your doctor. It is a hardship on lots of people to consider to consider a medication daily, twice a day, or more. Doses may be skipped. Missing doses regularly results in reduced efficacy from the medication. Sometimes a medicine does not work right away. It becomes frustrating, and also the medication treatment is abandoned prematurely.
Oftentimes, when a person lists "ineffective" medication, many of them didn't get adequate trials. You might wish to try therapy alone first, and depending on progress, consider utilization of medication later. This route may be appropriate for milder cases of depression.
Again, the more severe the depression, the more likely medication may also be necessary, as improvement in symptoms usually occurs more quickly with medication. Persistent, unremitting depression could be unhealthy due to the adverse physical and emotional effects as well as its associated risk for suicide.
Therefore, the choice to initiate or hold off on medication needs to be made cautiously. Again, it is optimal to be in therapy while on medication, as the therapy will give you the skills required to manage stressful situations in the future and can hopefully deter future depressive episodes.
Many myths exist surrounding the use of electroconvulsive therapy (ECT), the industry procedure that induces a seizure in the brain with an application of an electrical current through the scalp. Although ECT is not a first-line treatment (and is typically only offered after several failed medication trials/repeated hospitalizations), it is a very effective treatment. It is very safe and is not painful. The individual is offered anesthesia and a muscle relaxant for that procedure.
For some patients, ECT is safer than medications, particularly for those with serious health conditions for whom medication can be contraindicated and for pregnant woman who might not want to expose the fetus to some certain medication (e.g., lithium). ECT is growing in use in older depressed patients because of higher rates of concurrent medical illness and risks of toxicity from medication.
Psychotic depressions in many cases are refractory to medication, and thus, ECT may be considered early on in the treatment to prevent an extended course of medication trials. The chance of serious complication from ECT is 1 in 1,000. Cardiac complications would be the most common negative effects, which is why a pre-ECT evaluation includes evaluation from the cardiac system. Most potential cardiovascular complications can be avoided by using appropriate medications.
Confusion and/or memory loss will also be often common. Confusion is usually transient. Memory deficits may be for events before or after the procedure. Memory deficits usually resolve over weeks to months after, although occasionally there are more persistent memory difficulties.
Although ECT provides rapid improvement in the signs of depression, there's a high rate of relapse-up to 50% within 6 months-and thus, either continuation/ maintenance ECT or medication is recommended after the treatment course. Continuation ECT is usually provided only if continuation medication has not successfully prevented relapse or recurrence of depression in the past.
ECT is generally done in a hospital setting being an inpatient (outpatient ECT might be provided for maintenance ECT). Medications are typically tapered and discontinued before the treatment, and this process may need to happen in a hospital setting because of the risk for worsening depression and/or suicidality. ECT providers have received specialized training and certification.
Although protocols may vary among states, usually more than one physician needs to evaluate the patient and determine that ECT is clinically appropriate. Unfortunately, due to the media's negative portrayal of ECT over the years, even with the safety features in place, this very effective procedure is extremely stigmatized as well as illegal in some jurisdictions.
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