Major Depressive Disorder

Treatments

Antidepressant treatment      

Treatment Summary: Patients with Major Depressive Disorder were given antidepressant medications and they were later evaluated on whether they received a follow upvisit. Patients may have had different providers when they were first given their antidepressants. The results revealed that patients who received their first prescription from a psychiatrist were more likely to receive a guideline-concordant follow-up visit than those seen by primary care physicians. 

• Reference: Chen, S., Hanson, R., Farley, J., Gaynes, B., Morrissey, J., & Maciejewski, M. (2010). Follow-up visits by provider specialty for patients with Major Depressive Disorder Initiating Antidepressant Treatment. Psychiatric Services, 61 (1), 81-85. 

• Submitter: Crystal Morris 

Mindfulness-Based Cognitive Therapy 

Summary of Treatment: In the study referenced below, Mindfulness-Based Cognitive Therapy, or MBCT, was described as being a type of therapy that is used to prevent relapse in patients that have overcome depression. MBCT is supposed to change the way patients react to things that would usually cause depression. This involves showing clients how to recognize patterns that have developed in their lives and then by helping them to bypass their automatic reaction of becoming depressed. MBCT lasts 8 sessions. The first 4 sessions involve helping client to gain an understanding of mindfulness practices, while the last 4 sessions focus on helping clients develop skills that will help them avoid negative mood shifts. 

• Reference: Felder, J.N., Dimidjian, S., & Segal, Z. (2012). Collaboration in mindfulness-based cognitive therapy. Journal of Clinical Psychology: In Session, 68(2), 179-186. 

• Submitted by: Kelly Williams 

Pharmacotherapy with/or psychotherapy 

Treatment Summary: The current stand by most clinicians regarding treatment for depression is still solidly in the corner of antidepressant drugs. The most popular of these drugs are as follows: Fluoxetine (Prozac) , Fluvoxamine (Luvox), Sertraline (Zoloft), Paroxetine (Paxil), Escitalopram (Lexapro) Citalopram (Celexa). While there are significant positive results of these drugs, there is a growing movement of clinicians to incorporate psychotherapy into the mix or even as a stand-alone treatment. In fact, the Hagen article even states that psychotherapy and drugs were about equal in how well they work for mild to moderate depression while psychotherapy seems to have the upper hand for those diagnosed with moderate to severe depression 

• Reference: Augmentation strategies for depression: Options include psychotherapy, drugs, and dietary supplements. Harvard Mental Health Letter, 27(6), 1-3 (2010). Retrieved from Psychology and Behavioral Sciences Collection database. Hagen, B., Wong-Wylie, G., & Piji-Zieber, E. (2010). Tablets or Talk? A Critical Review of the Literature Comparing Antidepressants and Counseling for Treatment of Depression. Journal of Mental Health Counseling, 32(2), 102-124. Retrieved from Psychology and Behavioral Sciences Collection database. 

• Submitter: Mark Roberts 

Psychotherapy and Antidepressant Medication 

Treatment Summary: Both psychotherapy and certain antidepressant medications go hand in hand in the treatment of Depression Schizoaffective. The combination of these two has shown to provide the most positive outcome for patients. However, some people may be unable or unwilling to receive medication, and if this is the case, psychotherapy can be a benefit for the patient as well as the institution since it is cost effective. However, the best case treatment usually includes both antidepressant/antipsychotic medication(s) and psychotherapy. 

• Reference: Psychotherapy is worth it: A comprehensive review of its cost-effectiveness. Lazar, Susan G. (Ed.) The Committee on Psychotherapy; pp. 135-173. Arlington, VA, US: American Psychiatric Publishing, Inc., 2010. 

• Submitter: Mark Roberts 

Antidepressant and an antipsychotic drug 

Treatment Summary: Combining either of two antidepressants, paroxetine (Paxil) or sertaline (Zoloft) with the antipsychotic drug, aripiprazole. 

• Reference: Hori, H., Ikenouchi-Sugita, A., Iwata, N., Katsuki, A., Kishi, T., Nakamura, J.Umene-Nakano, W. (2012, July 17). Comparison of the efficacy between paroxetine and sertraline augmented with aripiprazolein patients with refractory major depressive disorder. Progress in Neuro-Psychopharmacology & Biological Psychiatry, 39, 355-357. 

• Submitter: Annettie Janell Cline 

Cognitive-behavioral analysis system of psychotherapy (CBASP) 

Treatment Summary: CBASP was developed by McCullough, (as cited in Constantino et al., 2012) to treat chronic depression. McCullough (as cited in Constantino et al., 2012) argues that the symptoms of chronic depression are a cause and consequence of arrested social development, which are exhibited as “hostile detachment and excessive submissiveness.” The purpose of CBASP is to develop a client’s: awareness of the consequences of her actions, sense of connectedness to her environment, and assertiveness. Two study groups underwent 12 weeks of CBASP therapy, one with, and one without medication (nefazodone). The results supported CBASP as somewhat effective in the reduction of chronic depression and more so when combined with medication 

• Reference: Constantino, M.J., Laws, H. B., Arnow, B. A., Klein, D. N., Rothbaum, B. O., Manber, R. (2012). The Relation Between Changes in Patients’ Interpersonal Impact Messages and Outcome in Treatment for Chronic Depression. Journal Of Consulting and Clinical Psychology, 80(3), 354-364. doi:10.1037/a0028351 

• Submitter: Marlena Del Hierro 

Cognitive-Behavioral Treatment 

Treatment Summary: There are three steps in this treatment plan. First, it is important to establish trust with the client because most people who are depressed have difficulty maintaining intimate relationships. The practitioner also needs to assess the client’s situation and diagnose the type of depression the client has. The second step creates modules for activity. The flexibility of this phase allows the client to be an active participant in his self-improvement. It also allows the client and therapist to quickly fix the simpler problems and spend more time on the complicated problems. This step also enables the practitioner to effectively deal with comorbidity because more than one disorder can be addressed in this phase. The focus of phase two is to not only change the way a person views himself and his world, but it also addresses the way in which he reacts and interacts with that world. The focus is on behavior change and altering cognitive processes. The final stage is relapse prevention. The client and the therapist identify the ways in which the client may relapse. Then the formulate strategies for either avoiding relapse or effectively overcoming the challenges. 

• Reference: Overholser, J. (2003). Cognitive-behavioral treatment of depression: A three-stage model to guide treatment planning. Cognitive and Behavioral Practice, 10(3), 231-239. 

• Submitter: AshleyDawn Sheppard 

Communication Counseling 

Treatment Summary: The typical treatment for depression is the use of antidepressant medication some studies have found that communication focused approaches is the most effective interventions for mild to moderate depression. Behavior therapy goal is to gain confidence in the manner in which you speak in order to get a better response from the interaction with others. Cognitive Behavioral therapy and Rational Emotive Behavior therapy goal is to assist the client in having a positive perception so they are able to interact more with others, for example performing an act that deters negative thought process. Family therapy goal is to work on the dynamics of the family system that builds a positive relationship with an open line of communication. This should also develop expectations of parent and child relationships.Interpersonal Psychotherapy goal is to discuss the functioning of each close relationship of the client. 

• Reference: Puterbaugh, D. (2006). Communication counseling as part of a treatment plan for depression. Journal of Counseling and Development, 84, 373-380. 

• Submitter: Shirley Redd 

Deep transcranial magnetic stimulation 

Summary of Treatment: There was a study conducted for an update of a Meta-Analysis on the clinician outcomes of Deep Transcranial Magnetic Stimulation (DTMS) in major depressive disorder. (Gellersen & Kedzior, 2018) The transcranial magnetic stimulations trigger the frontal hypoactivity of the brain to trigger to reduce depression. This study compares the outcomes and limitations of other previous meta-analysis with mixed samples of unipolar and bipolar major depressive disorder to their current meta-analysis of just unipolar major depressive population 

The study also revealed that DTMS had some amazing results that can be translated into clinical-relevant antidepressants effects. These effects were proven to have a duration of 12 months and without maintenance the effects will decrease tremendously. However, DTMS also showed to have discomfort in the scalp due to the high frequency in the brain and in some cases cause seizures and further studies with lower frequencies and intensities might need to be investigated. 

• Reference: Gellersen, H., & Kedzior, K. (2018). An Update of a Meta-Analysis on the Clinical Outcomes of Deep Transcranial Magnetic Stimulation (DTMS) in Major Depressive Disorder (MDD). Zeitschift fur Psychologie, 226(1), 30-44. https://doi.org/10.1027/2151-2604/a000320 (Links to an external site.)Links to an external site. 

• Submitted by: Eleny Guerrero Pena