Treatment of major depressive disorder (MDD) in adults is based on certain protocols, diagnosis, principles and management. Along with psychotherapy and pharmacotherapy, there are several norms and directions, which has to be followed by the therapist for proceeding with anti depression methods.
When an individual faces symptoms of MDD, he/she may be clueless as to what to do next. Here is a list of essentials for depression treatment guidelines best practices. These will help the affected person in understanding the how the route to recovery is devised and followed.
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A proper diagnosis is a key to anti depression. The clinician must know the symptoms, its context in terms with the person’s psychological, social, and biological factors, which formulates a case. Knowledge of psychopathology is also required. Relevant precipitating and problem identifying methods are used to work out the treatment plan, which takes into account the patient’s medical history.
The individual can be asked to undergo quality tests, with physical examination if necessary. If the patient is suffering from multiple diseases, then those ailments are to be monitored along with depression in confirming a concrete diagnosis. If MDD is mild, there is a possibility that the patient can be relieved as soon as a month or two from the treatment.
MDD can have different diagnosis systems. Series of examinations are run to conclude if substance abuse, anxiety disorder is involved or any risk of these developing into other disorders, persist.
The therapy setting may constantly change to accommodate new observations and progress made by the patient. The therapeutic methods may differ as per the person’s altered reactions, consisting of physiotherapies as well (if required), and social interaction.
MDD is now looked upon as recurrent or chronic than as acute illness. This is because; the person may display a pattern of residual symptoms now and then, even after the treatment is deemed successful. The patient’s reaction to therapy includes response, remission, reversion and reappearance. Response is calculated according to the individual’s therapy proceedings and time taken for recovery.
Remission is presence of symptoms or the state of wellness. Reversion is the person’s symptoms returning after remission, generally within 6 months from the end of therapy. Reappearance of depressive state may occur within remission’s 6 months.
There are three phases of treatment: acute phase (person responds to the therapy), continuation phase (steps to prevent reversion), maintenance phase (steps to deal with reappearance). These phases have their own length, as per the patient’s depression severity.
While, these are the general ways for the therapy’s advancement, there may be a shift or interchange of the patient’s reaction or treatment phase. If a person switches from a symptom to another depressive state, additional therapies may be inducted.
Consent of the patient for any anti depression means must be the foremost principle. The person is made aware of therapeutic results and methods incorporated for the treatment. If the patient refuses a treatment, then alternatives must be discussed. Establishing a professional relationship is important, which has to be grounded on collaboration and trust for both the therapist and the patient.
If a participant is being added, then his/her role should be defined. The person’s information is starkly confidential. Clinician cannot discuss the same with anyone else. The communication or point of contact is to be attained for further conversations.
The mode of psychotherapy should underline care, nonjudgmental motives and compassion. Once the individual’s health begins to improve, positive reinforcements have to be introduced to keep the treatment aligned with current scenario.
Jumping from a phase to another is not advisable, until the patient responds erratically and needs emergency intervention of a secondary plan. A good psychiatrist will concentrate on procedure details keeping in mind patient’s emotional feedback as well.
Psychiatrist needs to set a treatment goal, aiming to eliminate unrealistic expectations. The patient must be informed of only the possible effects of relevant therapy. Setting timelines for the therapy can organize a treatment plan. Most of the plans take around 4 to 8 weeks for critical observation.
In the acute phase, the goal of therapy is to reduce depression symptoms, enhance quality of life through reaction and remission. In maintenance phase, the therapist must focus to curb the return of depressive signs, by observing the residual symptoms, if any.
Psychiatric rating scales are implied like Montgomery-Asberg Depression Rating Scale (MADRS), Hamilton Depression Rating Scale (HDRS), Beck Depression Inventory II (BDI- II), etc. These can be utilized to note the change in symptoms. If the response is not satisfactory, then the treatment plan can be altered or switched to other.
To restore social function, rehabilitation services are applied, which entails occupational therapy, psychotherapy, marital/family therapy, career counselling etc. For social function, Global Assessment of Functioning (GAF) scale is quite effective.
The therapist may not always go by the trials, experiments and medication guidelines for anti depression as per the module and recognized manuals. The person may not always be suffering from MDD due to personal or social cause, but there are other repercussions involved. These may follow on financial strain trail to community practices, borderline insanity and criminal mindset etc.
Both quality and quantitative analysis is mandatory. The clinician has the freedom to try cognitive behavioural therapy, interpersonal therapy, hypnosis, talk therapy, interview or group therapy, quality of object relations, supportive and dynamic psychotherapy, and others. Selecting a particular treatment itself is a challenge. These may embrace many limitations, trials and techniques to form an accurate approach in time.
Patients, who have not responded to a treatment within 2 months of initiation, may be at a risk of no response on future assessment. Occasional resistance is sometimes found among people who are attacked by bipolar disorder, central nervous system failure, and other critical diseases.
As the study and goals move ahead, the clinician has to curtail risks to suicide and teach ways of coping with depression in a healthy manner. These can collectively mean the lifestyle, diet, sleep patterns, thought process and familial relations etc.
Apart from other psychological techniques used for anti depression, antidepressants too form a functional part of the therapy. Not always is a person is prescribed a dose of an antidepressant.
But, for moderate and severe cases, the medicines to balance neurotransmission and promote brain function are needed. These may encompass selective serotonin reuptake inhibitors, monoamine oxidise inhibitors, dopamine reuptake inhibitors, serotonin and nor epinephrine inhibitors, trycyclic antidepressants etc.
Pain killers and supportive medicines are often prescribed that cease the side effects of depression medications. Some of these may have slightly sedative consequences, and cause headache, dizziness, drowsiness, stomach upset, nausea, and sexual dysfunction. The implications of medication for depression related to diet, mood etc. must be viewed intricately. Their impact on the individual should be noted for timely contradictory measures.
The therapist may change the dose of medication as per the user’s health and response to the treatment. A person may feel discomfort for the altered or current medication plan. Thus, it is vital on clinician’s role to ask the patient about the pros and cons being countered by his/her patient after a stipulated period (mostly after 4 to 6 weeks of dosage).
If a particular set of antidepressants are not bringing a desired effect, then these should be replaced with other able medicines or therapies. No risk or extreme experiments are necessary that compromise with patient’s wellbeing. A psychiatrist must only prescribe depression medication that the person is not allergic to.