Medication And Psychotherapy For Depression

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Medication And Psychotherapy For Depression
Medication And Psychotherapy For Depression
Video: Medication And Psychotherapy For Depression
Video: Cognitive Behavioral Therapy (CBT) Interventions for Depression Treatment and Mental Health 2023, February
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Depression: Medication & Psychotherapy

The most common drugs used to treat depression are antidepressants. These work specifically against depression. Psychotherapeutic methods have also proven themselves in the treatment of depression.

In the case of acute severe depression, for example, a combination treatment with drug therapy and psychotherapy makes sense. Psychotherapy and accompanying pharmacological treatment are also useful for dysthymia.

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  • What drugs are used for depression?
  • Antidepressants
  • Other drugs
  • How can psychotherapy help?

What drugs are used for depression?

For drug treatment, it is important that this is well coordinated between the doctor and the patient. The effect and side effects should be explained during an informative discussion. The risk-benefit ratio should always be weighed. It usually takes about four weeks to assess whether the preparation is individually effective. Regular checks are important in order to assess the success of the treatment, as well as any accompanying measures when taking certain medications (if necessary, blood tests to determine the medication level or an EKG). Depending on the drug, blood samples are also taken before therapy (e.g. blood count, liver or kidney values).

The group of antidepressants is also used in combination with so-called antipsychotics - especially for depression with psychotic symptoms (e.g. delusions) or bipolar illness in the depressive phase. Sedatives can also bring short-term relief in certain situations, e.g. if restlessness and fear are the main focus of the depressive symptoms.

All of these drugs intervene in the metabolism of carrier substances in the brain, so-called neurotransmitters. These messenger substances are in balance in healthy people. This balance seems to be disturbed in depression. The neurotransmitters serotonin, noradrenaline and dopamine in particular show reduced activity. They are found in lower concentrations at the junctions between the nerves (synapses).

Antidepressants

Antidepressants are sometimes prescribed for other illnesses - for example anxiety disorders - and influence the brain metabolism. Antidepressants increase the availability of these mood-relevant transmitter substances and mostly attack the following points:

  • Inhibition of the re-uptake of neurotransmitters in the memory of nerve cells,
  • Inhibition of the breakdown of neurotransmitters,
  • increased release of neurotransmitters.

This increases the concentration of these messenger substances and the mood in depressed patients - but only after a longer period of treatment (often only after more than two weeks).

Groups of antidepressants

There are several groups of antidepressants:

  • Selective serotonin reuptake inhibitors (SSRIs): These prevent serotonin from being transported back into its stores. This means that more of it is available.
  • Selective serotonin / noradrenaline reuptake inhibitors (SSNRIs): block the return transport of serotonin and noradrenaline to the nerve cells (neurons).
  • Selective norepinephrine dopamine reuptake inhibitors (NDRI): These antidepressants specifically inhibit the transport of norepinephrine and dopamine back into the nerve cells (neurons).
  • Melatonin receptor agonists (MT1 / MT) and serotonin 5-HT2C receptor antagonists (agomelatine): Melatonin receptor agonists tend to promote sleep. Agomelatine also blocks serotonin 5-HT2C receptors and therefore has antidepressant effects.
  • Alpha2 receptor antagonists: These drugs block the noradrenaline receptors for noradrenaline on the nerve cells and at the same time cause an increase in the release of this messenger substance. They are used for depression, which is mainly characterized by "inner" restlessness or sleep disorders.
  • Non-selective monoamine reuptake inhibitors (NSMRI): These include the so-called tricyclic antidepressants. They are no longer among the drugs of first choice because there are other antidepressants that have a more targeted effect (e.g. selective serotonin reuptake inhibitors (SSRI). If you do not respond to selective drugs or if you have very severe depression, nonselective monoamine reuptake inhibitors are also used to the train.
  • Lithium ions: How exactly lithium works is still controversial to date. If it is administered as long-term medication, it prevents depressive or manic attacks. However, it takes months to take effect. The level of lithium in the blood must be checked at regular intervals, as lithium is a toxic drug which in very high doses can cause serious side effects. Lithium is mainly used in bipolar disorders ("manic-depressive").

Proof of effectiveness

The effect of antidepressants in mild depressive illnesses is not yet adequately supported by high evidence. The effectiveness has been better proven for moderate as well as severe depression. You can find more information at Gesundheitsinformation.de.

When may therapy adjustments be necessary?

If a patient does not respond to therapy with an antidepressant after four weeks, the reasons for this should be clarified or the therapy concept should be adapted. For example, the effect of an antidepressant can be increased by administering another drug that is not an antidepressant (augmentation). Or you can switch from one antidepressant to another (switching). You can also try to take another antidepressant (combination). In addition, psychotherapy - if not already done - can be weighed up. With drug therapy, the doctor pays attention to possible interactions between the various drugs. These should therefore only be taken in the prescribed dose. Otherwise there is a risk of a so-called serotonin syndrome, for example.The medication is discontinued on recovery in a gradually decreasing dose over a period of weeks. However, it may also be necessary to take additional medication to avoid relapses or recurrences.

Note Taking antidepressants can initially increase the risk of suicide. Do not be afraid to get help with thoughts of suicide and, as a relative, watch out for possible signs. You can find more information and emergency numbers on the public suicide prevention portal.

Other drugs

A combination of antidepressants and antipsychotics should be considered in patients with delusional depression. However, according to the current study, it is not yet clear which combination can be particularly promising.

The effectiveness of individual St. John's wort preparations has been proven in mild to moderate depressive episodes and in “autumn-winter depression” (SAD). The effects of St. John's Wort in severe depression have not yet been scientifically proven. Even if St. John's wort is available in lower doses in the pharmacy, a doctor should always be consulted before use. Herbal medicines are considered “gentle”, although they also work according to chemical mechanisms and often trigger allergies. St. John's wort is generally well tolerated, but side effects such as increased sensitivity to light, restlessness, etc. are possible. It can interact with other drugs and thus trigger undesirable drug interactions (e.g.certain anti-coagulants or hormonal contraceptives).

Please note when taking medication: The use of medication should always be agreed with a doctor. Stick to the prescribed therapy plan - even if longer treatment is required. Among other things, you can significantly support your recovery and prevent relapses. Report any side effects to your doctor immediately and tell him or her if you are also taking other medicines (including over-the-counter or "herbal") or hormonal contraceptives, as this can lead to drug interactions.

How can psychotherapy help?

The aim of psychotherapy is to heal or at least alleviate mental suffering with the help of psychotherapeutic methods. The focus of psychotherapy is the so-called therapeutic relationship, the exchange and conversation between the patient and the psychotherapist. Various exercises - depending on the psychotherapeutic method - can support or consolidate this exchange.

Understand and alleviate mental suffering

Psychotherapy is something individual and not pressed into a fixed scheme. The problems of those seeking help are not simply "solved" by the therapist, rather it is a matter of accompanying the patient in his / her development and in the search for a solution or change. Thus, people with mental illness can learn to understand themselves and to help themselves

Psychotherapeutic methods have proven themselves in the treatment of depression. There are a number of proven effective forms of psychotherapy. A combination of psychotherapy and drug therapy is also often used in practice. It is important to also offer the patient psychosocial help, for example involving relatives in therapy and further care.

You can find more information on the individual directions of psychotherapy in the brochure “Psychotherapy - When the soul needs help”.

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