Treatment Guidelines for Depression

Treatment guidelines for depression address the basic steps that clinicians should take when evaluating a patient with depression. Although their purpose is to standardize treatment, many psychiatrists will use guidelines to form the foundation of an overall treatment plan but will tailor treatment to each individual. Depression guidelines focus on treatment recommendations, make suggestions for how to form and implement a treatment plan, and identify factors that may affect a treatment plan.

Treatment recommendations

• Guidelines for depression give clinicians an overall process for deciding how best to help a patient. The process begins by deciding what kind of therapy will best help a specific patient: medicine, talk therapy or both. In cases of severe depression, doctors can also choose to prescribe shock therapy. In most cases of mild to moderate depression, some combination of drugs and talk therapy are used.

  The choice of drug is the next decision a physician must make--some have unpleasant side effects, some require changes to the patient's diet and some don't interact well with other drugs that the patient might be taking for other conditions. Because of the recent popularity of alternative therapies, most guideline documents address the use of St. John's wort in addition to standard antidepressants, including its interaction with other medications.
  Deciding on type of talk therapy is an important consideration. The doctor will need to think about whether the patient will be most responsive to cognitive behavioral therapy, which links feelings to thoughts; interpersonal therapy, which links feelings to life events; or psychodynamic therapy, which emphasizes transference as a therapeutic tool. Determining the frequency of talk therapy--in combination with dosage for the medicine--is part of the overall treatment plan.

  The final step in treatment recommendations is assessing the patient's response to the treatments and adjusting the treatment as needed.

Considerations for building a treatment plan

• Guidelines assign specific questions and tools to doctors to help assess how the treatment is working, and to adjust the treatment once the patient no longer has symptoms of depression. Most treatment plans will include a plan to help reduce the chances that the patient will suffer from depression again. Doctors may choose to continue a particular treatment as a maintenance therapy once depression symptoms subside--for example, continuing talk therapy but less frequently, or reducing the dosage of antidepressant drugs.

Other factors or considerations

• Most guidelines for depression also take into consideration whether the patient is suffering from other depression-related symptoms--such as psychosis or suicidal urges--as well as other conditions, which could include pregnancy, heart disease or cancer, and alcoholism or drug addiction. Identifying an appropriate treatment plan must take into consideration these issues, ultimately evaluating the safety of the patient and the risk to himself or those around him.