Current Approaches to Treatment

Possible interactions with Amitriptyline Diazepam Antipsychotics Astemizole 

There are several prerequisites to the initiation of treatment for depression. The diagnosis of depression must be firmly established, and any comorbid psychiatric or medical illnesses that may affect the treatment should be identified. Medical causes for the depression must also be ruled out. Finally, the diagnosis, its long-term prognosis, and treatment options should be discussed with the patient. Only then can well-informed treatment begin. 

The first decision when beginning acute phase treatment is choosing the primary treatment modality psychotherapy, medication, or both. Several short-term therapies including CBT, IPT, brief psychodynamic therapy, and marital therapy are effective treatments in mild-to-moderate cases of depression without added antidepressant treatment. This is a viable alternative that many patients may prefer. 

For moderate-to-severe depression, antidepressants, with or without combined psychotherapy, must be considered. When depression is so severe that hospitalization is warranted or psychotic or catatonic features are present, psychotherapy should be withheld temporarily and medication (or ECT) is required. 

Antidepressants have been shown effective in the treatment of major depression with response rates at approximately 60-70%. The only treatment for depression consistently shown to be more effective is ECT with response rates of 80-90%. There is no definitive means of predicting which medication will work best for a given patient nevertheless, the choice of a medication should not be made capriciously. Several factors can guide medication selection and thereby maximize the likelihood of a successful response. 

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The initial therapeutic modality selected depends in part on the patient s age, risk of psychiatric adverse effects, and degree of physical impairment. The current approach to treatment is to delay medication therapy until the symptoms begin to interfere with the patient s ability to function or impact their QOL. 

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