Psychodynamic Psychotherapy

The goal is to understand the disorders that are present in adulthood as function of the development deficit or conflict that occurred during the life cycle from earliest childhood and onwards (3,4). It focuses on conflicts that are due to guilt, shame, anxiety and interpersonal relationships and repressed impulses (3,4). It may be as effect as CBT in treatment of depression, but may have longer term duration than other psychotherapies (3,4). Basically, it deals with the underlying psychological factors that render the patient susceptible to the development of MDD and could be valuable in increasing adherence to medications (3,4). A systematic review of six studies that compared the efficacy of psychodynamic psychotherapy and CBT found that both were equally effective in terms of decreasing the depressive symptoms and improving social functioning (3,4).

Electroconvulsive Therapy

Electroconvulsive therapy (ECT) is safe and effective for MDD (1,2). It is indicated for patients that need rapid response, where the risk of other treatments outweigh the potential benefits, history of poor response to antidepressants, history of good response to ECT and preference to ECT (1,2). Psychosis, and suicidality are also indications for ECT (1,2). A course of ECT consists of unilateral or bilateral ECT that is administered two or three times on a weekly basis for a total of 6-12 treatments (1,2). There has been a rapid therapeutic response of 10 to 14 days that have been reported (1,2). Increased intracranial pressure, bleeding, recent MI, cerebral lesions may put patients at risk of adverse effects from using ECT (1,2). ECT results in rapid antidepressant effects and has the highest rate of response among the antidepressant treatments (1,2). 60 to 80% of MDD patients show improvement (1,2). There is also a rapid reduction in suicide (1,2). Bright light therapy may also be considered. In this therapy, patients will gaze into a 10,000 lux intensity light box that is slanted downward toward the patient’s face for approximately 30 minutes per day (1,2). It is effective in seasonal affective disorder and is adjunctively used for MDD with seasonal exacerbations (1,2). This treatment s well tolerated, minor visual complaints are the most common side effect (1,2). The combination of such therapy and an antidepressant therapy may be more beneficial than either approach alone (1,2). Lifestyle changes and preventative measures include identifying and addressing certain sources of psychosocial stress, avoiding alcohol, treating substance abuse, exercising daily, prayer or mediation and dietary modifications including foods that are rich in omega 3 fatty acids and vitamin B (1,2).

References

  1. DiPiro JT, Talbert RL, Yee GC, Matzke GR, Wells BG, Posey LM, editors. Pharmacotherapy: a pathophysiologic approach. 7th ed. Toronto: McGraw-Hill; 2007. p. 1123
  2. Chisholm-Burns MA, Wells BG, Schwinghammer TL, Malone PM, Kolesar JM, Rotschafer JC, Dipiro JT. Pharmacotherapy: Principles and Practice. McGraw-Hill: 2008. p. 569.
  3. Josifescu DV, Sudak D. Depression in Adults. MD Consult [online]. Maryland Heights MO: Elsevier Inc. 2011 [cited 2012 Mar 3]. Available from: www.mdconsult.com
  4. Oei T, Dingle G. The effectiveness of group cognitive behavior therapy for unipolar depressive disorder. J Affect Disord. 2008:107(1):5-21.

Disclaimer

This information is presented for informational purposes only and is not meant to be a substitute for advice provided by qualified health care professionals. You should contact your qualified health care provider if you have or suspect any health problems. This article is not intended to provide medical advice for its readers


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