Sunday, 18 January 2015

DEPRESSION & TREATMENT

Depression:-

A possible fourth type of depression is
Why is this important? We believe that, as with any illness, the person suffering from it can’t be properly treated unless the specifics of their illness are understood.
We therefore believe that people who are depressed should receive a sophisticated assessment identifying their particular type of depression and its broad causes, whether biological, psychological or other.

Treatments should be selected according to the specific type of depression experienced by an individual, and its causes.
A description of the different types of depression follows.

Melancholic depression

Melancholic depression is the classic form of biological depression. Its defining features are:
  • a more severe depression than is the case with non-melancholic depression, with a lack of pleasure and difficulty in being cheered up
  • psychomotor disturbance (e.g. low energy, poor concentration, slowed or agitated movements)
Melancholic depression is a relatively uncommon type of depression. It affects less than 10 per cent of people presenting with a depression diagnosis. The numbers affected are roughly the same for men and women.
Melancholic depression has a low spontaneous remission rate. It responds best to physical treatments (for example antidepressant drugs) and only minimally (at best) to non-physical treatments such as counselling or psychotherapy.

Non-melancholic depression

‘Non-melancholic depression’ essentially means that the depression is not melancholic, or, put simply, not primarily biological. Instead, it has to do with psychological causes, and is very often linked to stressful events in a person’s life, alone, or in conjunction with the individual’s personality style.
Non-melancholic depression is the most common of the three sub-types of depression. It accounts for up to 90% of cases of depression seen in clinical practice.
Non-melancholic depression can be hard to accurately diagnose because it lacks the defining characteristics of the other 2 depressive sub-ypes (namely psychomotor disturbance or psychotic features). Also in contrast to the other 2 depressive sub-types, people with non-melancholic depression can usually be cheered up to some degree.

People with non-melancholic depression experience
  • a depressed mood for more than two weeks
  • social impairment (for example, difficulty in dealing with work or relationships).
In contrast to the other sub-types of depression, non-melancholic depression has a high rate of spontaneous remission. This is because it is often linked to stressful events in a person’s life, which, when resolved, tend to assist the depression to lift.
Non-melancholic depression responds well to different sorts of psychological treatments as a first step (such as psychotherapies and counselling), and the treatment selected should respect the cause and maintenance of that depressive episode (e.g. stress, personality style). Antidepressant medications can also be used to treat non-melancholic depression.

Psychotic depression

Psychotic depression is a less common type of depression than either melancholic or non-melancholic depression.
The defining features of psychotic depression are:
  • an even more severely depressed mood , than is the case with either melancholic or non-melancholic depression
  • more severe psychomotor disturbance than is the case with melancholic depression
  • psychotic symptoms (either delusions or hallucinations, with delusions being more common) and over-valued guilt ruminations.
Psychotic depression has a very low spontaneous remission rate. It responds only to physical treatments (such as antidepressant drugs).

Atypical depression

Atypical depression is a name that has been given to expressions of depression that contrast with the usual characteristics of depression. For example, rather than experiencing appetite loss the person instead experiences appetite increase; and sleepiness rather than insomnia. Someone with atypical depression is also likely to have a personality style of interpersonal hypersensitivity ( expecting others not to like or approve of them).
The features of atypical depression include:
  • Being able to be cheered up by pleasant events
  • Significant weight gain or increase in appetite (especially to comfort foods)
  • Excessive sleeping (hypersomnia)
  • Heaviness in the arms and legs
  • A long-standing sensitivity to interpersonal rejection —the individual is quick to feel that others are rejecting of them.
  • There are a wide range of psychological treatments for depression.
    Some of the main ones are:
    Psychological treatments provide either an alternative to medication or work alongside medication. As always, a thorough assessment of the person is needed in order to decide on the best set of approaches.

    Cognitive Behaviour Therapy (CBT)

    People suffering from depression - particularly 'non-melancholic depression' - will often have an ongoing negative view about themselves and the world around them. This negative way of thinking is often not confined to depression, but is an ongoing part of how the person thinks about life. Many or all of their experiences are distorted through a negative filter and their thinking patterns become so entrenched that they don't even notice the errors of judgement caused by thinking irrationally.
    Cognitive behaviour therapy aims to show people how their thinking affects their mood and to teach them to think in a less negative way about life and themselves. It is based on the understanding that thinking negatively is a habit, and, like any other bad habit, can be broken.
    CBT is conducted by trained therapists either in one-on-one therapy sessions or in small groups. People are trained to look logically at the evidence for their negative thoughts, and to adjust the way they view the world around them. The therapist will provide 'homework' for between sessions. Between 6-10 sessions can be required but the number will vary from person to person. More recently, a number of online programs have been developed to deliver CBT to people in their own homes.
    CBT can be very beneficial for some individuals who have depression but there will be others for whom it is irrelevant.

    Interpersonal Therapy (IPT)

    The causes of depression, or our vulnerabilities to developing depression, can often be traced to aspects of social functioning (work, relationships, social roles) and personality .
    Therefore, the underlying assumption with interpersonal therapy is that depression and interpersonal problems are interrelated.
    The goal of interpersonal therapy is to help a person understand how these factors are operating in their current life situation to lead them to become depressed and put them at risk for future depression.
    Therapy occurs in three main phases:
    • an evaluation of the patient's history
    • an exploration of the patient's interpersonal problem areas and the development of a treatment contract
    • recognition and consolidation by the patient of what has been learnt and developing ways of identifying and countering depressive symptoms in the future.
    Usually 12-16 sessions of IPT will be required.

    Mindfulness-Based Cognitive Therapy

    Mindfulness-based Cognitive Therapy is a relatively new form of treatment for depression. This approach was developed by Segal, Williams and Teasdale (adapted from the work of Jon Kabat-Zin) in order to prevent relapse for those who had previously experienced an episode of depression.

    Mindfulness is a form of self-awareness training that has been taken from mindfulness meditation. Mindfulness is about being aware of what is happening in the present on a moment by moment basis, while not making judgements about whether we like or don’t like what we find.
    Generally Mindfulness-based Cognitive Therapy is undertaken in an 8-week group program format, however often psychologists use these techniques in one-on-one therapy sessions depending on their training and experience.
    Other mindfulness-based approaches have also been developed that may be used for depression (eg. MiCBT) and therapies such as Dialectical Behaviour Therapy and Acceptance and Commitment Therapy also use components of mindfulness in their approach.
    See our handout for tips and techniques on how to use mindfulness in everyday life.

    Positive Psychology

    Positive Psychology is a new area of psychology that focuses on the conditions that contribute to flourishing or optimal functioning.
    "Positive Psychology is founded on the belief that people want more than an end to suffering. People want to lead meaningful and fulfilling lives, to cultivate what is best within themselves, to enhance their experiences of love, work, and play. We have the opportunity to create a science and a profession that not only heals psychological damage but also builds strengths to enable people to achieve the best things in life." Professor Martin Seligman, founder of Positive Psychology.
    Positive Psychology researchers have identified many everyday activities that improve wellbeing. These include; keeping a gratitude diary, performing small acts of kindness, learning to savour enjoyable moments and varying pleasant experiences to avoid routine. 

    Psychotherapies

    Psychotherapy is an extended treatment (months to years) in which a relationship is built up between the therapist and the patient. The relationship is then used to explore aspects of a person's past in great depth and to show how these have led to the current depression. Understanding this link between past and present - insight - is thought to resolve the depression and to make a person less vulnerable to becoming depressed again.

    Counselling

    Counselling encompasses a broad set of approaches and goals that are essentially aimed at helping an individual with problem solving - solving long-standing problems in the family or at work; or solving sudden major problems (crisis counselling).

    Narrative Therapy

    Narrative Therapy is a form of counselling based on understanding the 'stories' that people use to describe their lives. The therapist listens to how people describe their problems as stories and helps the person to consider how the stories may restrict them from overcoming their present difficulties. It sees problems as being separate from people and assists individuals to recognise the range of skills, beliefs and abilities that they already have (but may not recognise) and that they can apply to problems in their lives.
    Narrative Therapy differs from many therapies in that it puts a major emphasis on identifying people's strengths, particularly as they have mastered situations in the past and therefore seeks to build resilience rather than focus on their shortcomings.
  • medication treatment :-
  •   psychotic & anxiolytic drugs .
  • 1.carbanmezapin group
  • 2.tricyclic anti depresent drugs (TCADs)
  • 3.MOA  drugs .
  • social factors :-
  • 1.economically weakness problems .
  • 2.environmental changing /societies 
  • 3.food 
  • 4.self medication .




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