Depression: options for treatment and prevention of relapse
You don’t just have to watch depression helplessly: there are various treatment options for this mental illness . In acute cases, hospitalization may be necessary , but sometimes a stay in a day care center or a rehabilitation stay can also help. Depending on the situation, treatment focuses on alleviating symptoms or preventing recurrence . Other treatment goals include improving, maintaining or re-engaging in social and work life. During treatment – and especially during acute treatment – the doctor should repeatedly evaluate whether the current treatment is suitable for the patient or whether it needs to be adjusted.
Joint treatment planning
Before starting the treatment itself, the patient should be informed of its planned course and should also participate in the decision-making process regarding treatment measures. Accompanying measures also include psychoeducation , during which the patient learns to better understand his illness and the possibilities for managing it. If it is a mild depressive episode that is unlikely to last long, a psychotherapeutic consultation or a conversation with a doctor may be sufficient, or with a clinical psychologist . In any case, the patient should go to the doctor for regular check-ups, who will assess whether additional treatment measures need to be implemented.
In the case of mild and moderate depressive episodes, psychotherapy or drug treatment can be used , either individually or in combination. For severe depressive episodes, psychotherapy should always be used in combination with drug treatment. The doctor should inform the patient and his relatives about self-help groups, because the involvement of the patient (or his family) in the activities of these groups can significantly contribute to the treatment of depression . Sometimes the doctor may suggest other treatments.
Stages of depression treatment
The treatment of depression can basically be divided into three phases:
- acute treatment ,
- follow-up treatment,
- maintenance ( prophylactic ) treatment – long-term treatment, the aim of which is the prevention of recurrence .
If, after several weeks of acute treatment , depressive symptoms are reduced by approximately 50%, doctors speak of a so-called response to treatment. In the course of the disease, remission , relapse or complete recovery can also occur . “Full recovery” in this case is defined as a period longer than 6 months during which no depressive symptoms occurred. If the symptoms reappear after that, we talk about a relapse.
Treatment goals should generally be as follows:
- alleviation of symptoms, or the disappearance of difficulties,
- preventing possible suicide ,
- re-engagement in social and work life,
- achieving mental balance,
- reducing the likelihood of relapse.
How to prevent relapses?
Depression cannot be cured overnight: treatment needs to be well planned and spread over a longer period of time. As part of the so-called continuation treatment, the patient is still taking medication , although the symptoms of the disease have already disappeared. This phase of treatment should last approximately 4-9 months. At the same time, the patient is taking the same drugs that helped him get rid of depressive symptoms. If the patient were to stop the medication earlier than the doctor recommended, the probability of relapse (return of the disease) will increase. It is necessary for the patient to come for regular check-ups. Discontinuing the medication usually takes place in such a way that the doctor gradually (usually over several weeks) reduces the dose so that the organism gets used to it slowly.
If a depressive episode occurs twice or more, maintenance treatment should be started no later than after the third depressive phase has been cured . However, a doctor may suggest drug maintenance treatment already after the first depressive episode, under the following circumstances:
- positive family history (occurrence of depression in relatives),
- severe depression (long duration, high risk of suicide),
- poor response to previous treatment (i.e. the previous treatment did not work well for the patient in question),
- psychotic symptoms (eg delusions).
Maintenance treatment usually lasts several years, according to expert recommendations it should last at least two years. This can be a significant burden for some patients, but should allow them to live a full life, if possible without recurrence of the disease. After the first depressive episode, recurrence occurs in approximately 50-60% of patients, and the likelihood of recurrence increases with each subsequent episode.
As part of maintenance treatment, psychotherapy or regular exercise can also serve well. In addition, one should pay attention to life circumstances that can have a supportive effect (in relationships, at work, etc.).
Who can I contact?
Similar to other diseases, it is very important to recognize depression early so that the necessary treatment can be started as soon as possible. In case of suspicion, therefore, do not hesitate to seek a doctor, or sensitively alert the affected person to the possible help of a specialist.
If you feel down or suspect that you are suffering from depression, you can contact a general practitioner , psychiatrist , psychotherapist or clinical psychologist.
