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Treatment of depression

What are the treatment options once one is diagnosed with depressive disorder ?

PSYCHOTHERAPY

A number of  psychotherapeutic measures ( talking therapies ) are available in the treatment of depressive illness. One of the most studied among he psychotherapies is cognitive behavioral therapy. CBT works on the principle that thoughts arise from beleifs and  that thoughts lead to actions. Abberant beleifs can thus lead to dysfunctional thoughts and actions. In CBT these abberant thoughts are restructured with a combination of didactic discussions and behavioral experiments.Read about the common cognitive errors in depression here. CBT has robust efficacy and has been proven to change abberant neural circuits.

Other psychotherapeutic measures such as psychodynamic psychotherapy, family therapy and group therapy are helpful in specific patient populations. Psychotherapeutic measures have proven efficacy in mild to moderate depressive states.

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MEDICATIONS

Medications are indicated in those with moderate to severe depression and those with mild depression not amenable to psychotherapy. Around 10 classes of antidepressants exist, each with seperate indications, contraidications and side effect profiles. Your psychiatrist will able to choose one with the best risk benefit ratio, i.e the drug that can give maximum releif with the least risk of adverse events. 
Other than antidepressants, a number of other drugs including hormones, eugeroics ( wakefulness promoters ) , sleep promoting agents and mood stabilizers are helpful in the management of depression. 
In severe depression and in bipolar depression, antipsychotics with antidepressant properties are an effective treatment option.

Exercise and behavioral activation have proven efficacy in the management of mild to moderate depression.
Management of depression has transformed over the years and multiple safe modalities are available for effective treatment. Stigma seems to be a bigger challenge than the disorder itself, leading to denial of care even to those who suffer the most.

BRAIN STIMULATION TECHNIQUES

Repetitive Transcranial Magnetic Stimulation or rTMS is a technique wherein a magnetic impulse is used to stimulate areas of the brain that are implicated in depression.

Transcranial direct current stimulation, involes stimulation of certain areas of the brain via small electric currents passed via the scalp. TDCS devices are gaining popularity secondary to their ease of use and cost effectiveness.

Electroconvulsive therapy is very effective in the management of severe depression, suicidal intent , catatonic depression (depression with disabling motor symptoms like mutism, negativism or a coma like state). Current ECT practices are safe and painless, contrary to what is often seen in the movies.

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Psychiatry is a medical speciality, like surgery, general medicine and paediatrics. It involves the study, diagnosis and management of mental illnesses and distressing conditons, pertaining to both the mind and body. Misconceptions about psychiatric illness and treatment have some how prevented help seeking behaviour in those who need it the most. This Wall has to go, wherin visiting a psychiatrist should no longer be taboo, and people should be able to openly and freely discuss mental health issues. 


Dr Vikas Prabhav is a psychiatrist in chennai, he runs The Vivid Mind  mental wellness clinic in Anna Nagar. We aim at providing holistic, multimodal care for those suffering from mental illnesses and adjustment issues. We offer effective management strategies for depression, anxiety, unexplained physical symptoms, addictions, child/adolescent problems and other behavioural issues.The information provided in this website does not substitute for a medical consult.