Treatment plans for depression

Treatment Plan Overviews Depression

Part of our behavioral health resources, this is a broad overview of our treatment plan for the treatment of depression. Age- and gender-specific resources are available for adults and juveniles (males and females). For more information, feel free to contact us or fill out our phone consultation form.

  • Major Goals
    • 1. Increased understanding of depressive feelings
    • 2. Address issues underlying depressive feelings
    • 3. Participate actively in individual and group counseling
    • 4. Correct irrational thinking which leads to depression
    • 5. Address issues of dependence, helplessness, and hopelessness
    • 6. Decrease extreme symptoms of depression through improved coping
  • See Also

Major Goals

1. Increased understanding of depressive feelings

Objectives/treatment focus:

  • Develop vocabulary to describe depression Identify cues and symptoms.
  • Identify cues and symptoms
  • Identify areas of vulnerability which underlie depression
  • Identify triggers to these areas
  • Identify antecedents, triggers, and consequences to acting out on depression

2. Address issues underlying depressive feelings

Objectives/treatment focus:

  • Accept that their depression is causing problems
  • Link cues and symptoms of depression with triggers and with harmful coping behaviors (i.e. alcohol and other drug abuse)
  • Identify issues contributing to depression

3. Participate actively in individual and group counseling

Use the support of counselor and others — and reduce isolation and avoidance

4. Correct irrational thinking which leads to depression

Objectives/treatment focus:

  • Identify specific areas of cognitive distortion (“Stinking thinking”). challenge irrational thoughts with reality
  • Develop appropriate substitute self-statements for irrational ones

5. Address issues of dependence, helplessness, and hopelessness

It’s common for people to experience their feelings more honestly as they progress in their recovery. Without chemicals or other dependency-related “coping” behaviors, they may experience more anxiety, confusion, worry, depression, sadness, as well as feelings of helplessness or hopelessness.

6. Decrease extreme symptoms of depression through improved coping

Objectives/treatment focus:

  • Learn coping techniques to reduce depression.
  • Identify appropriate responses to feelings of depression.
  • Learn relaxation techniques to reduce depression.
  • Develop alternative responses to substitute for past “coping” choices.

See Also

The following pages may also be helpful:

Behavioral Health and Dual Diagnosis — specific behavioral health and dual diagnosis treatment planning and program resources for more than 20 DSM-IV diagnoses and issues, including anxiety disorders, depression, PTSD, ADHD, etc. Behavioral health resources include counselors’ tools, model treatment plans, and client workbooks.

Phone Consultation Form — fill out this form if you are interested in purchasing our treatment programs.

In individuals with late-life depression, identification of co-occurring general medical conditions is essential, as these disorders may mimic depression or affect choice or dosing of medications . Older individuals may also be particularly sensitive to medication side effects (e.g., hypotension, anticholinergic effects) and require adjustment of medication doses for hepatic or renal dysfunction . In other respects, treatment for depression should parallel that used in younger age groups .

The assessment and treatment of major depressive disorder should consider the impact of language barriers, as well as cultural variables that may influence symptom presentation, treatment preferences, and the degree to which psychiatric illness is stigmatized . When antidepressants are prescribed, the psychiatrist should recognize that ethnic groups may differ in their metabolism and response to medications .

Issues relating to the family situation and family history, including mood disorders and suicide, can also affect treatment planning and are an important element of the initial evaluation . A family history of bipolar disorder or acute psychosis suggests a need for increased attention to possible signs of bipolar illness in the patient (e.g., with antidepressant treatment) . A family history of recurrent major depressive disorder increases the likelihood of recurrent episodes in the patient and supports a need for maintenance treatment . Family history of a response to a particular antidepressant may sometimes help in choosing a specific antidepressant for the patient . Because problems within the family may become an ongoing stressor that hampers the patient’s response to treatment, and because depression in a family is a major stress in itself, such factors should be identified and strong consideration given to educating the family about the nature of the illness, enlisting the family’s support, and providing family therapy, when indicated .

For patients who have experienced a recent bereavement, psychotherapy or antidepressant treatment should be used when the reaction to a loss is particularly prolonged or accompanied by significant psychopathology and functional impairment . Support groups may be helpful for some bereaved individuals .

Co-occurring General Medical Conditions

In patients with major depressive disorder, it is important to recognize and address the potential interplay between major depressive disorder and any co-occurring general medical conditions . Communication with other clinicians who are providing treatment for general medical conditions is recommended . The clinical assessment should include identifying any potential interactions between medications used to treat depression and those used to treat general medical conditions . Assessment of pain is also important as it can contribute to and co-occur with depression . In addition, the psychiatrist should consider the effects of prescribed psychotropic medications on the patient’s general medical conditions, as well as the effects of interventions for such disorders on the patient’s psychiatric condition .

In patients with preexisting hypertension or cardiac conditions, treatment with specific antidepressant agents may suggest a need for monitoring of vital signs or cardiac rhythm (e.g., electrocardiogram with TCA treatment; heart rate and blood pressure assessment with SNRIs and TCAs) . When using antidepressant medications with anticholinergic side effects, it is important to consider the potential for increases in heart rate in individuals with cardiac disease, worsening cognition in individuals with dementia, development of bladder outlet obstruction in men with prostatic hypertrophy, and precipitation or worsening of narrow angle glaucoma . Some antidepressant drugs (e.g., bupropion, clomipramine, maprotiline) reduce the seizure threshold and should be used with caution in individuals with preexisting seizure disorders . In individuals with Parkinson’s disease, the choice of an antidepressant should consider that serotonergic agents may worsen symptoms of the disease , that bupropion has potential dopamine agonist effects (benefitting symptoms of Parkinson’s disease but potentially worsening psychosis) , and that selegiline has antiparkinsonian and antidepressant effects but may interact with L-dopa and with other antidepressant agents . In treating the depressive syndrome that commonly occurs following a stroke, consideration should be given to the potential for interactions between antidepressants and anticoagulating (including antiplatelet) medications . Given the health risks associated with obesity and the tendency of some antidepressant medications to contribute to weight gain, longitudinal monitoring of weight (either by direct measurement or patient report) is recommended , as well as calculation of body mass index (BMI) . If significant increases are noted in the patient’s weight or BMI, the clinician and patient should discuss potential approaches to weight control such as diet, exercise, change in medication, nutrition consultation, or collaboration with the patient’s primary care physician . In patients who have undergone bariatric surgery to treat obesity, adjustment of medication formulations or doses may be required because of altered medication absorption . For diabetic patients, it is useful to collaborate with the patient’s primary care physician in monitoring diabetic control when initiating antidepressant therapy or making significant dosing adjustments . Clinicians should be alert to the possibility of sleep apnea in patients with depression, particularly those who present with daytime sleepiness, fatigue, or treatment-resistant symptoms . In patients with known sleep apnea, treatment choice should consider the sedative side effects of medication, with minimally sedating options chosen whenever possible . Given the significant numbers of individuals with unrecognized human immunodeficiency virus (HIV) infection and the availability of effective treatment, consideration should be given to HIV risk assessment and screening . For patients with HIV infection who are receiving antiretroviral therapy, the potential for drug-drug interactions needs to be assessed before initiating any psychotropic medications . Patients who are being treated with antiretroviral medications should be cautioned about drug-drug interactions with St. John’s wort that can reduce the effectiveness of HIV treatments . In patients with hepatitis C infection, interferon can exacerbate depressive symptoms, making it important to monitor patients carefully for worsening depressive symptoms during the course of interferon treatment . Because tamoxifen requires active 2D6 enzyme function to be clinically efficacious, patients who receive tamoxifen for breast cancer or other indications should generally be treated with an antidepressant (e.g., citalopram, escitalopram, venlafaxine, desvenlafaxine) that has minimal effect on metabolism through the cytochrome P450 2D6 isoenzyme . When depression occurs in the context of chronic pain, SNRIs and TCAs may be preferable to other antidepressive agents . When ECT is used to treat major depressive disorder in an individual with a co-occurring general medical condition, the evaluation should identify conditions that could require modifications in ECT technique (e.g., cardiac conditions, hypertension, central nervous system lesions) ; these should be addressed insofar as possible and discussed with the patient as part of the informed consent process .

Definitions:

Categories of Endorsement

Recommended with substantial clinical confidence.

Recommended with moderate clinical confidence.

May be recommended on the basis of individual circumstances.

How to Create a Depression Treatment Plan

Dealing with depression means more than just finding the right medication. Since depression can be caused by physical, emotional, and social problems, a complete treatment plan has to take all these causes into consideration.

No two people with depression are the same, and what works well for another person may not work for you. In most cases, the best treatment plan involves a combination of professional help, self-help, and lifestyle changes.

How to Get Medical Help for Depression

Depression may be caused by an imbalance of chemicals in your brain called neurotransmitters.

Research shows that the brains of people with depression look different when viewed with magnetic resonance imaging (MRI).

If your depression has a medical cause, there are many reasons why a medical doctor is the right professional to help you conquer depression. A treatment plan for overcoming depression encompasses:

  • Treating depression and any other diseases. Depression may be caused or made worse by other diseases such as heart disease, diabetes, Parkinson’s disease, or thyroid disease. Medications, such as beta-blockers, oral contraceptives, sedatives, sleep aids, and even antibiotics, may also have side effects that act like depression. Before moving on to treating your depression, you need a good medical evaluation — that’s one that rules out common medical problems that could be affecting your mood, such as thyroid problems, cardiovascular issues, immune system disorders, and neurological conditions, among others.
  • Antidepressant medications. If your family doctor thinks your depression could be helped by antidepressants, he or she may prescribe them for you, or refer you to a psychiatrist. Selective serotonin reuptake inhibitors (SSRIs) are the most common antidepressants prescribed and include Zoloft (sertraline) and Prozac (fluoxetine), but there are other classes of drugs your doctor may recommend. To get the best results, be open with your doctor about how the medication is working and any side effects you may be experiencing.
  • Brain stimulation therapy. Electroconvulsive therapy (ECT), also known as shock therapy, is the delivery of an electric shock that causes a seizure and changes the way the brain’s nerves communicate. There are some types of severe depression for which ECT therapy can provide relief to people who don’t respond to other types of therapy. ECT, which is the most studied type of brain stimulation therapy, can only be administered under medical supervision. Another type of the therapy, repetitive transcranial magnetic stimulation, involves using magnets to send electromagnetic pulses to areas of the brain that affect mood.
  • Supplements. The herb St. John’s wort is commonly taken by people in Europe to help treat depression, but it can be life-threatening when combined with an antidepressant and may affect other prescription medications. If it’s something you’re considering taking, discuss it with a doctor before beginning the treatment. Omega-3 fatty acids, or fish oil supplements, have also been shown to help with depression. In a 2014 meta-analysis, the supplements were effective for people with depression symptoms and major depressive disorder. The National Institutes of Health advises caution when taking omega-3s with oral contraceptives and blood pressure medications.

Finding the Right Psychological Help

Psychological stress is a contributor in many cases of depression. If you have experienced a stressful life event such as a financial problem, relationship problem, or loss of a loved one, it can trigger a severe depression. In most cases, a complete treatment plan for dealing with depression includes psychotherapy, also called “talk therapy.” The therapist, a psychiatrist, psychologist, or other mental health professional, can help you overcome depression by providing:

  • Diagnosis of other psychological problems that contribute to depression. The Anxiety and Depression Association of America (ADAA) says that almost half of those with depression also have an anxiety disorder. In addition, alcohol or other drug problems, post-traumatic stress disorder (PTSD), and sexual abuse can cause depression and can be diagnosed by a mental health professional. The ADAA estimates that about 20 percent of people with depression or anxiety abuse alcohol or drugs, and the National Center for PTSD states that depression is three to five times more common among people with PTSD.
  • Behavioral therapy. Cognitive, interpersonal, exposure, acceptance and commitment, and group therapies are types of talk therapy that teach you new ways of thinking and dealing with your emotions. You may learn how to identify and change negative coping styles and avoid behaviors that contribute to depression. A 2012 review of meta-analyses found strong evidence that cognitive behavioral therapy, a mix of cognitive and behavioral therapies, was effective.
  • Couples and family therapy. A mental health professional can also meet with you and your loved ones at the same time. This is often an effective way of dealing with emotional family and relationship issues that contribute to depression. Getting family members involved in therapy can also strengthen your support system.
  • Animal-assisted therapy. Research has found that pets help people feel calm. In one study published in 2014, 80 women watched a traumatic movie clip. Those who watched the clip with a dog had lower anxiety and negative feelings than those who watched it alone or with a stuffed animal.
  • Alternative therapies. A mental health professional may introduce you to therapies for stress relief such as biofeedback, in which you practice controlling your body’s responses such as heart rate and muscle tension; progressive relaxation, where you tighten and relax your muscles; or guided imagery meditations, which involves visualizing positive images in place of negative feelings.

Your Role in Overcoming Depression

The first thing you need to do if you are dealing with depression is ask for help. Taking that first step can be hard; statistics show that many people never seek help for depression. Other ways you can work to overcome your depression include:

  • Support. Spend time with people who support you. Many people with depression get help from joining a support group. Many also get great support from spiritual practices or religious affiliations. Another option is to go to online message boards and chat rooms to connect with other people who understand what you’re going through. The important thing is not to isolate yourself.
  • Exercise. Many studies show that regular physical activity is a great way to stay fit and fight depression, and experts are beginning to learn why. In a study published in 2014 in the journal Cell, Swedish researchers found that building muscle through exercise creates changes that help rid the body of substances that build up from stress and can lead to depression. Seek out activities that you enjoy and that you can share with others.
  • Relaxation. Give yourself permission to take time for relaxation. Learn and use relaxation strategies regularly. You can also relax by just making time to do things you enjoy like going to a movie or a ballgame.
  • Stay healthy. Eat a balanced diet, get enough sleep, avoid using alcohol and caffeine to excess, and take regular stress breaks by doing something you enjoy, such as watching a comedy, getting a massage, dancing to music, or volunteering.

Depression treatment can work. A good treatment plan will involve a medical evaluation, a psychological evaluation, and one or more types of therapy. The most common treatment plan for severe depression is a combination of medication and talk therapy.

But remember, you can’t overcome depression until you take that first step and seek out the treatment you need. You can find a therapist through the psychologist locator of the American Psychological Association. Learn about support groups in your area or join an online support group through the Depression and Bipolar Support Alliance, the Anxiety and Depression Association of America, or the online community Project Beyond Blue.

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