Does the type of depression I have determine the type of treatment I need?

Treatments for depression work for all types; typically, the specific type of depression does not change the treatment approach drastically. It does, however, inform as to certain patterns of response to treatments as well as to the degree of intervention that may be necessary. For example, an individual with major depression with psychotic features is more apt to require hospitalization than an individual with dysthymic disorder. Some subtypes of depression have evidence of better response to certain treatments. For example, an atypical depression has classically been considered more responsive to a specific medication class, called the MAOIs. Depression with melancholic features (that is depression with poor sleep, appetite, and energy) may respond better to tricycle antidepressants (TCAs). Seasonal depression responds best to a treatment called light therapy. The presence of bipolar disorder usually means that a mood stabilizer is a necessary part of the treatment, because the use of an antidepressant without a mood stabilizer in a bipolar individual puts the person at risk for the development of a manic episode.

What are the different types of talk therapies, and what do they do?

Once you receive a consultation, the clinician will make recommendations as to the most appropriate treatment or therapeutic approach for your circumstances. He or she may be able to use that approach or can refer you to persons who specialize in a specific approach. Many therapists use a combination of therapeutic approaches in their work. Some of the different approaches are as follows.

Psychodynamic therapy assumes the depression is due to unresolved, unconscious conflicts from childhood. It is based on the classic psychoanalytic approach that Sigmund Freud developed. The therapist uses the concepts of transference, counter transference, resistance[1], free association, and dreams to help the patient develop insight into patterns in their relationships that can then effect change. It is a nondirective therapy. Although classic analytical therapy can last for years, with sessions 4 to 5 days per week, psychodynamic therapy may be shorter in duration, with sessions one to three times per week. Controlled research studies examining the efficacy of this type of therapy are minimal because of the nature of this type of therapy. It is often a helpful treatment approach for those with chronic coping difficulties or with some personality disorders.

Interpersonal therapy[2] conceptualizes depression in a patient with the three components of symptom formation, social functioning, and personality factors. It focuses on the patient's social, or interpersonal, functioning, with expected improvement in symptoms. The goal is to improve communication skills and self-esteem. It is a brief and highly structured, manual-based psychotherapy. Areas of social functioning that may be addressed are interpersonal disputes, role transitions, grief, and interpersonal deficits. Therapy is focused and brief in duration, typically lasting 12 to 16 sessions. Research studies have shown it to be an effective treatment for depression.

Cognitive-behavioral therapy[3] assumes the depression is due to a pattern of negative thinking. It works to help patients identify and change inaccurate perceptions of themselves and situations. It also is brief in duration and manually based, typically lasting for 10 to 20 sessions. It typically involves the use of homework assignments between sessions. Research studies have shown it to be an effective treatment for depression and some anxiety disorders (see Question 39 for further discussion on cognitive-behavioral therapy).

  • [1] the tendency to avoid treatment interventions, often unconsciously (e.g., missed appointments, arriving late, forgetting medication).
  • [2] a form of therapy. Unlike insight-oriented or dynamic therapy that focuses on developmental relationships, interpersonal therapy focuses strictly on current relationships and conflicts within them.
  • [3] a combination of cognitive and behavioral approaches in psychotherapy during which the therapist focuses on automatic thoughts and behavior of a self-defeating quality to make one more conscious of them and replace them with more positive thoughts and behaviors.
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