Psychological therapies depression

Compare the use of pharmacotherapy alone, psychological therapy alone, and both therapies together, in the treatment of either schizophrenia or major depression. 

Not all therapies are available locally, so check local provision, waiting times, and referral routes/practicalities of referral. Cognitive Behaviour Therapy (CBT) is most widely available, and some of your teammates may have specialist training, enabling them to offer therapy to CMHT/ward patients. The Improving Access to Psychological Therapies (lAPT) service is a national initiative, providing swift access to CBT for depression and anxiety (self or GP referral). 

Monitor mood and suicidality. Alcohol s depressant effects take a while to lift (NICE su ests waiting 3-4 weeks before considering an antidepressant). Abstinence is the most powerfid antidepressant, but consider medication or psychological therapy, where appropriate. 

Hall SM, Reus VI, Munoz RF, et al Nortriptyline and cognitive-behavioral therapy in the treatment of cigarette smoking. Arch Gen Psychiatry 55 683-690, 1998 Hall SM, Humfleet GL, Reus VI, et al Psychological intervention and antidepressant treatment in smoking cessation. Arch Gen Psychiatry 59 930-936, 2002 Hayford KE, Patten CA, Rummans TA, et al Efficacy of bupropion for smoking cessation in smokers with a former history of major depression or alcoholism. Br J Psychiatry 174 173-178, 1999... 

Although it has received the most attention, CBT is not the only form of psychotherapy that is effective for depression. Other psychological treatments include interpersonal psychotherapy, short-term psychodynamic therapy and non-directive supportive therapy. Interpersonal psychotherapy focuses on problems that arise in interpersonal relationships, such as marital conflict, the loss of a loved one and social isolation.20 Short-term psychodynamic therapy focuses on acquiring insight and understanding of unresolved conflicts arising from the person s childhood. It is based on Freud s psychoanalytic theory, but requires only months, rather than the years it takes for a full psychoanalysis.21 Non-directive supportive therapy provides a warm, supportive atmosphere in which the depressed person can explore life issues... 

Teasdale, John D., Psychological Treatments for Depression How Do They Work , Behaviour Research and Therapy 23 (1985) 157-65... 

The American Psychological Association (APA) has established stringent criteria for determining whether a therapy is empirically supported or validated. Since those guidelines were developed, the committee researching this area has been working for several years to determine the best practices to use when treating certain disorders, such as depression or anxiety. Insurance companies and... 

Monitor the patient for adverse CNS and psychological effects, such as abnormal dreams, dizziness, impaired concentration, insomnia, severe acute depression (including suicidal ideation or attempts), and somnolence. Be aware that insomnia may begin during the first or second day of therapy and generally resolves in 2-4 wk... 

A major indication for antidepressants is endogenous depression, which, by definition, has its origin neither in a physical cause nor in a psychologically traceable development or cause. In the case of so-called psychogenic depression or depression mostly due to situational factors, on the other hand, antidepressants are of only secondary importance in such cases therapy should begin with psychotherapeutic procedures and then, if not responsive, be extended to medications. 

Scott, J., Teasdale, J.D., Paykal, E.S., et aL Effects of cognitive therapy on psychological symptoms and social functioning in residual depression. Br. J. 

Bernstein, S. Kaufman, M. R. 1960, A psychological analysis of apparent depression following Rauwolfia therapy, Journal of Mount Sinai Hospital, vol. 27, pp. 525-530. 

Boyle, G. (1986, November). Concussion of the brain with electroconvulsive shock therapy (ECT) An appropriate treatment for depression and suicidal ideation Australian Clinical Psychology, 21—27. 

Karon, B. (2005). Recurrent psychotic depression is treatable by psychoanalytic therapy without medication. Ethical Human Psychology and Psychiatry, 7, 45-56. 

In addition to antidepressant drugs, some forms of psychological treatments have been shown effec tive for treatment of major depressive disorder. These include cognitive behavioral psychotherapy and interpersonal psychotherapy (Weissman, 1979). These therapies differ from traditional psychoanalytically oriented methods in that the therapist takes an active role, the patient is expected to do homework, and the treatment is time limited, usually for about six months. Little data are available regarding whether the combination of medications and psychotherapy is more effective than either treatment alone, but data are suggestive of an additive effect. 

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