Clinical depression medical therapy

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

The treatment of depression is highly individualized to the patient, based on the patient's unique combination of biological, psychological and social health factors and the severity of their condition.[1] The three most conventional treatments for depression include medication, psychotherapy, and Electroconvulsive therapy, however new treatments and less conventional options are also available, including self help, life style changes, and vagus nerve stimulation.[1] If there is an imminent threat of suicide or the patient is a danger to others, hospitalization is employed as an intervention method to keep at-risk individuals safe until they cease to be a danger to themselves or others. At-risk individuals may also be placed in a partial hospitalization therapy, in which the patient sleeps at home but spends most of the day in a psychiatric hospital setting. This intensive treatment usually involves group therapy, individual therapy, medication management, and is used often in the case of children and adolescents.

Medical Therapy

Pharmacologic medical therapies for Major Depressive Disorder include:

Serotonin reuptake inhibitors

  • Fluoxetine
  • Fluvoxamine
  • Paroxetine
  • Sertraline
  • Citalopram
  • Escitalopram

Serotonin-norepinephrine reuptake inhibitors

  • Duloxetine
  • Venlafaxine
  • Desvenlafaxine
  • Milnacipran
  • Levomilnacipran

Tricyclic antidepressants

  • Amitriptyline
  • Nortriptyline
  • Imipramine
  • Desipramine
  • Clomiprramine
  • Doxepine
  • Amoxepine

Monoamine oxidase inhibitors

  • Phenelzine
  • Tranylcipromine


Atypical antidepressants

Treatment failure

Stopping medications

Patients are generally advised not to stop taking an antidepressant suddenly and to continue its use for at least four to months to prevent the chance of recurrence.[2] For patients that have chronic depression, medication may need to be continued for the remainder of their life.


Patients should be treated indefinitely if they have "three or more prior major depressive episodes or who have chronic major depressive disorder should proceed to the maintenance phase of treatment after completing the continuation phase."[2]

Antidepressant discontinuation syndrome

References

  1. 1.0 1.1 Mayo Clinic Staff (2006-03-06). "Depression Treatment Guide". Mayo Clinic. Retrieved 2007-10-20.
  2. 2.0 2.1 American Psychiatric Association (APA). Practice guideline for the treatment of patients with major depressive disorder. 3rd ed. Arlington (VA): American Psychiatric Association (APA); 2010 Oct. 152 p. [1170 references]

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