Depression: Psychosocial treatment
In mild to moderate cases of depression, evidence-based psychotherapy is as effective as medication. Combining psychotherapy with medication does not work better than either alone except for patients with chronic, severe or refractory depression, or when comorbidity (e.g., anxiety, personality disorder) is present.
The choice of psychotherapy depends on the availability of local resources.
Evidence-based psychotherapy approaches include:
- Problem-solving therapy: Four to six weekly sessions with a focus on identifying problems and simple problem-solving techniques, useful in primary care.
- Cognitive-behavioural therapy: 12 to 16 weekly sessions with a focus on identifying negative cognitions and behaviours, substituting more realistic thinking and behavioural activation.
- Interpersonal therapy: 14 to 16 weekly sessions with a focus on identifying and dealing with interpersonal conflicts and problems.
- Always include patient education (e.g., patient information handouts).
- Involve patients in managing their illness by actively collaborating with them in diagnosis and treatment planning.
- Employ self- management manuals and workbooks (based on cognitive-behavioural techniques).
Work and occupational function
Work and occupation are important domains for treatment and psychosocial functioning.
- The patient may not need to take time off work. Help the patient consider the benefits of staying at work (social interaction, regular schedule, sense of accomplishment) against the risks (accidents, reduced productivity, interpersonal conflict).
- Address work stress with the patient using cognitive techniques and self-management. Note that avoiding stress is often counterproductive in dealing with depression.
- Exercise and activity are beneficial for depression. "Prescribe" at least one brisk walk daily.
- Light therapy (exposure to bright light using a fluorescent light box) is effective for seasonal affective disorder (recurrent winter depressive episodes).
Major depressive disorder in adults: Diagnosis and management (BC Guidelines, 2013)
Depression in adults: Recognition and management (Nice guideline CG 90, 2009)
Depression in adults with chronic physical health problems: Recognition and management (NICE guideline CG91, 2009)
Depression in children and young people: Identification and management (NICE guideline CG28, 2005)