Management of depression

This is the title of a recent article in British Medical Journal. It is accurate, precise, and important information not only for professionals but it could also benefit patients. It is not yet free online, you will have to wait another 12 months.

Nevertheless the two most important conclusions to my opinion are about the components of a comprehensive management plan and factors associated with increased risk for recurrence of depression. These are important because this knowledge make patients better prepared and equipped to judge about there own treatment and to discuss different options with their psychiatrists or primary physicians.

Components of a comprehensive management plan for depression. Adapted from American Psychiatric Association and World Federation of Societies of Biological Psychiatry guidelines

  • Determine the pharmacological or psychosocial treatment
  • Determine the treatment setting
  • Establish and maintain a therapeutic alliance
  • Monitor and reassess the patient’s psychiatric status in the course of treatment
  • Monitor the patient’s response to treatment
  • Reassess the adequacy of diagnosis when appropriate
  • Monitor possible side effects and physical condition
  • Enhance treatment adherence
  • Educate patients and their families about the nature of the illness (psychoeducation)

Now these are all important considerations to make by a psychiatrist or primary physician. This is not always shared with their patients but could be important topics to discuss. So go over them slowly and look for yourself if any of these components leaves you with questions regarding your own treatment and discuss it with your doctor.

Factors associated with increased risk for depression recurrence. Adapted from World Federation of Societies of Biological Psychiatry guideline

  • Three or more episodes of major depression
  • High prior frequency of recurrence
  • Previous episode in past year
  • Residual symptoms during continuation phase treatment
  • Severity of episodes (for example, suicidality and psychotic features)
  • Long previous episodes
  • Relapse after drug withdrawal

Now these are all very important risk factors. Continuation therapy is not a go or nogo decisions. It is a balance between several options which might take a while and a lot of discussion before a treatment for the long term is agreed upon by patient and doctor.
Timonen, M., Liukkonen, T. (2008). Management of depression in adults. BMJ, 336(7641), 435-439. DOI: 10.1136/bmj.39478.609097.BE