Depression medication intervention

My husband recognized that he couldn t leave me by myself and he recognized his limitations, so we decided to get some help. I went into a hospital a couple of times. I spent two weeks in a psychiatric unit of a hospital. I needed to separate from what was going on. I wouldn t be here today if I hadn t had some medical intervention. I m very grateful for that resource. And some good counseling has helped me to express my feelings. But I have battled depression off and on. 

The cocaine addict most often presents during withdrawal after a binge of cocaine use. Cocaine withdrawal is not life threatening and does not require medical intervention in the same sense as alcohol or opiate withdrawal. It is, however, associated with a profound depression that can render the addict suicidal for 24-48 hours. The crashing cocaine addict should be assessed for suicide risk and, if indicated, the patient should be monitored in an emergency psychiatric setting or may require a brief 1-2 day inpatient psychiatric admission until the withdrawal resolves and the suicide risk is relieved. 

The first major groups of antidepressant medications are the tricyclics, also known as the TCAs. Discovered in the late 1950s, these drugs are considered the oldest in the treatment of depression and have historically been used as the first line of medication intervention for the treatment of unipolar depression (Austrian, 1995). The side-effect profile that accompanies this group of medications, however, has recently caused them to fall into disfavor. For years, these medications were often considered the first choice for the client who suffers from depressed mood. Today, however, the antidepressant medications known as the selective serotonin inhibitors (SSRIs), and the selective serotonin norepinephrine inhibitors (SSNRIs) are often considered as the first-line medications. 

Some have defined persistent pain as a disease entity unto itself. Persistent post-operative pain has challenged pain management specialists for decades it is only in the past several years that it has received significant attention. The continuation of pain and pain disability beyond the immediate post-operative period often results in medical (interventional and pharmacological), economic (healthcare utilization, loss of productivity) and psychological (depression, anxiety) complications. 

Since early detection and intervention in schizophrenia is important for maximizing outcomes, treatment with antipsychotic medications should begin as soon as psychotic symptoms are recognized. Antipsychotic medications are the cornerstone of therapy for people with schizophrenia, and most patients are on lifelong therapy since non-adherence and discontinuation of antipsychotics are associated with high relapse rates. If other symptoms are present such as depression and anxiety, these symptoms should also be aggressively treated. Additionally, psychosocial treatments should be used concomitantly to improve patient outcomes. 

Lawlor, Debbie A. and Stephen W. Hopker, The Effectiveness of Exercise as an Intervention in the Management of Depression Systematic Review and Metaregression Analysis of Randomised Controlled Trials , British Medical Journal 322 (2001) 1-8 Layard, Richard, The Case for Psychological Treatment Centres , British Medical Journal 332 (2006) 1030-32... 

Once chronic insomnia has developed, it hardly ever spontaneously resolves without treatment or intervention. The toll of chronic insomnia can be very high and the frustration it produces may precipitate a clinical depression or an anxiety disorder. Insomnia is also associated with decreased productivity in the workplace and more frequent use of medical services. Einally, substance abuse problems may result from the inappropriate use of alcohol or sedatives to induce sleep or caffeine and other stimulants to maintain alertness during the day. 

The TCAs, SSRIs, and lithium have been found to be efficacious for the prevention of depressive recurrences in adults (APA, 2000). However, given the noted advantages of the SSRIs and their efficacy in the acute treatment of MDD and dysthymia, this group is considered the first-choice medication for Intervention. 

An adequate trial of antidepressant medication is defined as treatment with therapeutic doses of a drug for a total of 4 weeks. After 4 weeks of antidepressant treatment, patients can be divided into three groups those who have achieved a full response, those who have achieved a partial response, and those who have not responded. In the case of patients who achieve full remission, treatment should continue for a minimum of 4-6 months, or longer if the patient has a history of recurrent depression (see Maintenance Treatment of Major Depression later in this chapter). If a partial response has been achieved by 4 weeks, a full response may be evident within an additional 2 weeks without further intervention. If the symptoms do not respond at all, the dose should be increased, a different antidepressant should be used, or the therapy should be augmented with another medication (see Treatment-Resistant Depression later in this chapter). 

A common mistake is to treat bipolar depression in the same manner that one treats unipolar depression, overlooking the need for a mood stabilizer. In bipolar depression, the first pharmacological intervention should be to start or optimize treatment with a mood stabilizer rather than to start administering an antidepressant medication. In addition, thyroid function should be evaluated, particularly if the patient is taking lithium. Subclinical hypothyroidism, manifested as an increased thyroid-stimulating hormone level and normal triiodothyronine and thyroxine levels, may present as depression in affectively predisposed individuals. In such cases, the addition of thyroid hormones may be beneficial, even if there is no other evidence of hypothyroidism. 

Significant psychosocial stressors that are not addressed and ameliorated are frequently assumed to contribute to persistent depressive symptomatology despite adequate pharmacologic intervention. In such situations, supportive, interpersonal, and cognitive therapy may be necessary adjuncts to medication. 

With drugs that produce a depression after chronic exposure (e.g., alcohol), detoxification is instituted, in addition to supportive care and therapy for substance dependency. Even though most alcoholics will experience depression immediately after the cessation of heavy and prolonged consumption, the majority will remit within several weeks following detoxification and supportive care (see Chapter 14, The Alcoholic Patient ). For those who do not, it is likely there had been a preexisting depressive disorder, which itself can lead to substance dependency, because patients frequently self-medicate before seeking professional intervention. This possibility should be evaluated through a review of the patient s personal medical and psychiatric history, as well as family history. 

For more severe forms of depression, characterized by a rapidly deteriorating course or nonresponsiveness to drug intervention, or in patients with serious concurrent medical disorders, ECT may be the most appropriate alternative (see Chapter 8) (293). 

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