Treatment Of Depression In Primary Carepart : Principles Of Acute Treatment
Treatment of major depression involves establishing a correct diagnosis and applying clear, evidence-based, and goal-directed principles. Treatment principles include recognizing and treating any coexisting medical conditions, building a therapeutic alliance with patients, choosing an appropriate treatment, and monitoring response. The goals of treatment are to achieve remission of symptoms, improve quality of life, and prevent relapse/recurrence. Antidepressants and time-limited psychotherapies are effective treatments, but each has their own advantages and limitations.
The authors summarize the new Canadian depression treatment guidelines and focus on the principles of acute treatment.
Introduction
Major depressive disorder is a common problem in the primary health care setting. The recognition of depression requires a high index of suspicion, as depression can masquerade as many different problems. Depression also commonly coexists with other medical conditions and can be a side effect of medications.
Recently, evidence-based Canadian guidelines for treating depression have been published. The Canadian Network for Mood and Anxiety Treatments developed Guidelines for the Diagnosis and Pharmacological Treatment of Depression for primary care physicians and, in partnership with the Canadian Psychiatric Association, Clinical Guidelines for the Treatment of Depressive Disorders for specialists .
Assess suicide risk
Nursing Care Plan For Depression 2
Nursing Diagnosis: Impaired Social Interaction related to social isolation secondary to clinical depression as evidenced by withdrawal from group gatherings or social events, anxiety, impaired perception, inability to meet basic needs and role expectations
Desired Outcome: The patient will demonstrate improved social interaction by increased participation in social events.
What Is A Depression Treatment Plan
A depression treatment plan is a detailed, individualized strategy created to help clients reach goals and overcome depression. It’s an essential tool in getting clients engaged with their treatment.
In general, treatment plans follow a simple format and include a client’s goals, measurable objectives and a timeline for progress. They’re a roadmap to provide clients with clear directions on how to get to an improved condition. Treatment plans can also give clients a sense of accomplishment and strengthen the therapeutic relationship.
A depression treatment plan focuses specifically on treating depression and relieving related symptoms. However, since counselors tailor treatment plans to each person under their care, a depression treatment plan might also include goals related to co-occurring disorders, such as anxiety or substance use disorder. The treatment plan must focus on the client’s priorities and immediate areas of need to build trust and increase their motivation. You and your client will collaborate when writing the treatment plan and adjust accordingly as they progress and symptoms change or improve.
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Ethics Approval And Consent To Participate
The study was conducted in accordance with the Declaration of Helsinki and ICH guidelines, and all patients provided written informed consent before participating in the study. The study protocol was approved by the institutional review board at all participating sites on behalf of the Copernicus Group Independent Review Board, a WIRD-Copernicus Group Company .
How Do I Know Which Treatment Is Best For Me
There is a wide consensus among experts that mild depression responds to psychotherapy such as cognitive and behavioral therapy , without drugs. More severe depression responds best to a combination of drugs and psychotherapy. Antidepressant drugs are most effective against depression that is moderate to severe and chronic in nature.
Clinical psychiatrists who are highly experienced in treating depression have a general sense of which symptoms, and which clusters of symptoms, may respond to which antidepressant drugs. Still, more often than not, it takes a trial of one or more agents to find the most effective one, or combination of drugs, and the most effective dose, with the fewest, or most tolerable, side effects.
Sometimes side effectsnausea, weight gain, agitation, insomnia, loss of sex drive, difficulty reaching orgasmare the deciding factors in whether to continue drug treatment. Treatment is successful when there is a complete remission of symptoms and patients can feel that they can function as well as, or better than, before they were sick.
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What Is Samhsa’s National Helpline
SAMHSAs National Helpline, , or TTY: is a confidential, free, 24-hour-a-day, 365-day-a-year, information service, in English and Spanish, for individuals and family members facing mental and/or substance use disorders. This service provides referrals to local treatment facilities, support groups, and community-based organizations.
Also visit the online treatment locator, or send your zip code via text message: 435748 to find help near you. Read more about the HELP4U text messaging service.
Acute Phase Treatment: Severe Major Depression
The goal of acute phase treatment is to induce remission.
For patients with severe major depression, evidence supports either pharmacotherapy alone, or the combination of pharmacotherapy and psychotherapy. There is insufficient evidence that psychotherapy alone is effective for severe depression.
Patients with severe depression should be seen again in the office within 1-2 weeks of starting a new antidepressant medication for re-assessment. The combination of antidepressant medication and psychotherapy may be the initial treatment approach for patients for patients with severe depression in the presence of psychosocial stressors, interpersonal difficulties, intrapsychic conflict, and any personality disorders. Patients with depression and psychotic symptoms, catatonia, or severe impairment may be considered for combination therapy with antidepressants, antipsychotics, and / or electroconvulsive therapy . Patient with severe depression with any of the aforementioned co-morbidities are usually referred for care under a psychiatrist.
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Understanding Goals For Depression Treatment
Since theres more than one type of depression, with symptoms that can vary greatly from one person to the next, theres no one-size-fits-all form of treatment for every person affected by a form of depressive illness.
Several different approaches are used to treat depression, including the use of antidepressant medications, types of therapy such as cognitive behavioral therapy and simple changes to a persons habits and lifestyle.
For many people, a combination of different approaches is the most effective way to bring the symptoms of depression under control.
One key part of the process of treating depression is setting clear treatment goals objectives that define if and when the treatment of depression has been successful.
Mental health professionals use a range of different approaches to assess a persons response to treatment, from clinician and patient-reported rating scales to alternative approaches such as the Goal Attainment Scale .
Goal attainment scaling the basis of GAS involves setting specific, broadly stated goals for depression treatment, then following up to track progress over time. By creating goals, you and your mental health provider can enhance motivation and produce better treatment outcomes.
GAS is used in many different areas of healthcare, including mental health treatment and even personal care for the elderly.
What Are The Major Types Of Brain Stimulation
In transcranial magnetic stimulation , one or two externally placed electromagnetic coils deliver magnetic pulses to generate currents in deep brain tissue implicated in depressions stall-out. The pulses generated are of the same type and, most often, of the same strength as those generated by magnetic resonance imaging machines. No anesthesia is required, and stimulation is applied during a series of sessions in a doctors office. Approximately 60 percent of people who do not benefit from antidepressant medication improve significantly or achieve full remission with TMS treatment.
Transcranial direct current stimulation applies a weak electrical current to brain sites through the scalp from a headset-like device. The goal is to target brain circuits involved in attention, perception, learning, and memory that affect mood.
In deep brain stimulation, reserved for highly treatment-resistant depression, an externally programmable device is implanted in the chest to deliver electrical signals to targeted sites in the brain. It is like a pacemaker for the brain.
Intermittent theta-burst stimulation is a noninvasive form of brain stimulation approved for use in treatment-resistant depression.
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How Cbt Can Help Treat Depression In Adults
CBT can teach people how to differentiate between their thoughts and feelings and regulate their feelings by questioning their assumptions and beliefs. This is done through identifying and labeling the types of negative thinking patterns described in sessions and in the various exercises the individual completes . CBT might also address behavior patterns that contribute to withdrawal and lack of enjoyment with strategies such as helping people identify activities they have enjoyed in the past and planning to engage in them regularly.
What Is A Treatment Plan
For a therapist or counselor to provide effective coping skills when managing anxiety symptoms, they will develop a uniquely tailored treatment plan. Treatment plans are a good way to track progress and ensure that clients are receiving the appropriate care. When a therapist creates a clients treatment plan they will include the goals that you have both discussed and agreed on. Having concrete goals set out at the beginning of your therapy is an important way to help you overcome your mental health conditions and get the most out of your treatment. They give you the chance to actively engage with what you are taught in therapy. Whether you are seeking treatment for anxiety or depression or both, a solid treatment plan will have set goals, measurable objectives, and a reasonable timeline for your progress. The treatment plan will also be tailored to your specific needs and what you are hoping to get out of therapy.
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Introduction To Supportive Therapy
Supportive therapy emphasizes the therapeutic relationship between the person and therapist as the foundation of the treatment of depression in adults. The therapist shows genuine care for the well-being of the person by listening with empathy as well as being flexible in having the person define what successful treatment looks like. Therapists focus on the individuals current stressors and provide affirmation and support for what the person is currently experiencing to facilitate effective coping. In an environment free of judgment and interpretation, the person shares difficult situations and how they felt about them. On average, adults receive four to 20 weekly or bi-weekly sessions of supportive therapy.
Supportive therapy is recommended for the treatment of depression in adults.
Use The Supports You Have
Reach out for encouragement from others while youre working toward your goals. Some people work best with an accountability partner to keep them on track. This way, you have someone to check in with on a regular basis to ensure youre making progress. This also gives you someone to celebrate your successes with.
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Negative Thoughts And Depression
Worrying or thinking negatively is common in people with depression. This affects your ability to focus on getting better and makes you more vulnerable to unhealthy emotions.
Tips to help you control worry and reduce negative thinking include:
- Write down what you are worried about. Go through each concern and think about how realistic your negative thoughts are. Explore alternative thoughts and explanations.
- Try not to focus on the things you cannot change.
- Focus on the present. Accept your thoughts without actively engaging with them.
- Write down your problems and brainstorm solutions. Jot down the pros and cons with each option and choose the one that seems the best. Review whether it worked to overcome the problem.
- Avoid making major decisions about your life at this time.
How To Write A Treatment Plan For Depression
Treatment planning is an essential part of the therapeutic process. Thorough treatment planning provides a clear, achievable direction for your work with clients. Both counselors and clients alike benefit from the assessment process and formulation of a treatment plan catered to the client’s individual needs. Writing a treatment plan for depression that reflects your client’s specific needs begins with a complete biopsychosocial assessment. In the treatment world, we also know this as an “intake.”
During the intake process, counselors can build rapport while gathering pertinent information related to the depression, including personal and family history of medical and mood disorders, ongoing stressors, previous services and medications, and the current presentation of their depression symptoms. Throughout the intake process, clinicians conceptualize the client’s everyday functioning to diagnose depression accurately. A diagnosis of depression will reflect an understanding of the client’s challenges based on duration, frequency or persistence of episodes, and severity of symptoms.
Once the intake and diagnosis are complete, make sure to take advantage of the Wiley Treatment Planner tool integrated directly into our EMR platform to help you formulate your client’s treatment plan for depression.
Wiley Treatment Planners outline plans for treatment using the following criteria:
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Practice Anxiety Management Techniques
For the next month, I will practice two anxiety management techniques every night to decrease my symptoms of anxiety to fewer than three times per week.
S: This statement notes the action the person intends to take and the purpose of that action.
M: Each anxiety management technique practiced acts as one unit of measurement out of two for each night, and symptoms of anxiety will be measured with a goal of three or fewer per week.
A: Depending on where you are in your journey, this is a reasonable goal. The numbers can be adjusted as needed.
R: This goal is relevant to decreasing anxiety.
T: This goal-setter will practice this goal for a month.
Contraindications For Cognitive Behavioral Therapy
There is no absolute contraindication to CBT however, it is often reported that clients with comorbid severe personality disorders such as antisocial personality disorders and subnormal intelligence are difficult to manage through CBT. Special training and expertise may be needed for the treatment of these clients.
Patient with severe depression with psychosis and/or suicidality might be difficult to manage with CBT alone and need medications and other treatment before considering CBT. Organicity should be ruled out using clinical evaluation and relevant investigations, as and when required.
There are many advantages of CBT in depression as given in table 2
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Write Down Positive Interactions
I will increase positive relational interactions to reinforce my support system by writing down at least one positive interaction I have with someone every day for four consecutive weeks.
S: This SMART goal statement shows exactly what the person will do, including the frequency and duration of the activity.
M: This is measured by writing down a positive interaction that occurred that day for four weeks straight.
A: This is a reasonable goal.
R: This goal is relevant because improving relationships can help reduce depression.
T: This goal will be completed in four weeks.
Do Psychedelics Help Depression
Given the large percentage of people for whom standard antidepressants do not workmore than 50 percent, in some studiesthere is renewed scientific interest in psychedelic agents as treatments for depression, especially depression accompanied by suicide ideation. Ongoing clinical trials show that in carefully monitored settings, the substances, which broaden and deepen consciousness, can dramatically boost the effectiveness of psychotherapy for major depression, facilitating self-awareness and speeding behavior change. Psychedelic-assisted psychotherapy actually seems to motivate people to change, and brain imaging studies of treated patients show durable changes in brain connectivity patterns.
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How To Set Goals When Living With Depression
Goal setting is one of the most important elements of success in our professional and personal lives. Empirical research supports the idea that having clear goals can positively impact day-to-day well being, but setting realistic and achievable goals can be challenging under the best of circumstances. If youre living with depression or anxiety, it can feel downright impossible.
But you CAN do it! We have compiled a list of simple and effective steps you can take today to start making positive progress toward your goals.
Does Depression Ever Go Away On Its Own
Depressive episodes may lift on their own, but even in the best-case scenario that can take many months and in the interim do significant damage to both your brain and your life. Experts believe that the inflammation involved in depression can, over time, contribute to neurodegeneration and, in a vicious cycle, accelerate pathologic changes in the brain that make future recovery more elusive. In one study of patients with major depression, 23 percent of untreated cases remitted within three months 32 percent were in remission by six months, and 53 percent within a year. Remission is most likely among children and adolescents.
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Examples Of Mental Health Treatment Plans
There are several examples of mental health treatment plans to be found online, and several are linked below:
This sample treatment plan is for a young Medicaid recipient struggling with symptoms of depression and suicidal thoughts.
This treatment plan is written for the treatment of a man suffering from schizoaffective disorder who is experiencing side effects from his medication.
If youâd like to see more, this website has a ton of useful example treatment plans and templates.
Assessing Life Engagement In Patients With Mdd
The movement in clinical research toward outcomes that focus on the patients perspective has created a need for valid, reliable patient-reported outcome measures5 that assess outcomes valued highly by patients, such as life engagement. Life engagement reflects an outcome that overlaps with, but is not fully captured by, other outcomes in mental health. It entails the improvement of anhedonia and apathy, but these alone do not fully capture aspects of life engagement relating to attention and alertness.6,7 Likewise, quality of life measures do not capture the energy and alertness aspects of life engagement.7 Dr Thase explained,
Dr Correll summarized the importance of developing a measure specific to life engagement: We only recognize what we see, and we only see what we look for, and to look for something we need to conceptualize it. A systematic review7 identified only 2 existing validated measures described by their authors as assessing life engagement: the Engaged Living Scale8 and Life Engagement Test.9 However, these scales do not capture all of the essential areas of life engagement according to a validated framework developed with expert psychiatrists and validated via interviews with patients with MDD.6
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