Depression

Pharmacotherapy remains the mainstay treatment of depression. Treatment should be considered for the majority of depressed patients, especially those who are suicidal, functionally impaired from their depression, or experiencing a recurrent episode, or who have comorbid medical or psychiatric conditions likely to worsen unless their depression is treated (e.g., panic, GAD, chronic pain). Treatment of depression has clearly been shown to prevent relapse, shorten current episodes, decrease psychosocial impairment, decrease risk of suicide, and improve quality of life. Mild depression may be treated with symptomatic intervention alone (e.g., mild sedative for insomnia), although continuing depressive symptoms or inadequate response to purely symptomatic interventions warrants more aggressive treatment of the underlying depression. Patients with psychotic depression typically require treatment with both antidepressant and antipsychotic agents, or they may require electroconvul-sive therapy (ECT). Often, psychotically depressed patients require hospitalization. Patients with psychotic depression should be referred to a psychiatrist, given the severity of illness and complexity of treatment.

Again, the aim of treatment is remission of all depressive symptoms and a return to the patient's previous baseline functioning. Pharmacotherapy combined with psychotherapy has been shown to be superior to either modality alone (de Maat et al., 2008; Thase, 1997); thus referral to a psychotherapist may be helpful, especially for patients with moderate to severe depression. Some patients may choose psychotherapy alone to treat depression; cognitive-behavioral therapy, interpersonal therapy, behavioral activation, and psychodynamic therapy may prove as effective as medication alone.

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