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07.01.2015

Major depression treatment goals, ringing in ears meaning someone's talking about you - How to DIY

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Patient information: See related handout on postpartum depression, written by the authors of this article.
Comparative efficacy of cognitive therapy and pharmacotherapy in the treatment of depressed outpatients. Treatment of major depression with psychotherapy or psychotherapy-pharmacotherapy combinations.
Six-year outcome for cognitive behavioral treatment of residual symptoms in major depression. Systematic review of efficacy of cognitive behaviour therapies in childhood and adolescent depressive disorder. If it is determined that you will benefit from antidepressant treatment, your physician should work out a treatment plan with you. Maintenance treatment should continue for at least one year to prevent the return of symptoms, or relapse.. Provided the optimal dose is used, and treatment continues for long enough, about 2 out of 3 people treated with antidepressant medication do well. Adapted from the CANMAT Clinical guidelines for the management of major depressive disorder in adults. Preparation for postpartum care and consideration of prophylactic treatment have been recommended in these women.16 Prophylactic treatment may involve psychotherapy beginning in the third trimester or medication offered immediately postpartum. 34 Psychotherapy can also be used as adjunct therapy with medication in moderate to severe postpartum major depression. Several studies9-11 have shown that cognitive therapy is superior to no treatment or to placebo.
Some women with postpartum major depression may experience suicidal ideation or obsessive thoughts of harming their infants, but they are reluctant to volunteer this information unless asked directly.


Studies have shown that cognitive therapy is an effective treatment for depression and is comparable in effectiveness to antidepressants and interpersonal or psychodynamic therapy. Two comprehensive meta-analyses11,13 showed that cognitive therapy is as effective as interpersonal or brief psychodynamic therapy in managing depression. The combination of cognitive therapy and antidepressants has been shown to effectively manage severe or chronic depression.
CBT should be strongly considered as initial therapy for patients with severe or chronic depression or for adolescents.
In patients with moderate to severe postpartum major depression, psychotherapy may be used as an adjunct to medication.
A meta-analysis12 of four studies, which included 169 patients with major depression, showed similar results for tricyclic antidepressants and CBT.
The Edinbugh Postnatal Depression Scale may be photocopied by individual researchers or clinicians for their own use without seeking permission from the publishers.
Good evidence has shown that cognitive therapy reduces relapse rates in patients with depression, and some evidence has shown that cognitive therapy is effective for adolescents with depression. An important part of CBT for depression is scheduling pleasurable activities, especially with others, that usually give positive reinforcement. The evidence suggests that cognitive therapy is a valid alternative to antidepressants for patients with mild to moderate depression and possibly for patients with more severe depression.
If left untreated, postpartum major depression can lead to poor mother-infant bonding, delays in infant growth and development, and an increased risk of anxiety or depressive symptoms in the infant later in life. The strongest risk factor is a history of postpartum major depression with a previous pregnancy. Decreased energy and disrupted sleep related to infant care may be difficult to differentiate from symptoms of depression.


A meta-analysis17 that included six studies and 595 patients showed that patients with severe depression benefited from the combination of psychotherapy and pharmacotherapy. However, only two trials studied CBT, and patients with less severe depression gained little from the combination.17 A more recent study18 of 681 patients with chronic major depression compared nefazodone (Serzone), CBT, and combination therapy.
Up to 60 percent of women with postpartum major depression have obsessive thoughts focusing on aggression toward the infant.29 These thoughts are intrusive and similar to those in obsessive-compulsive disorder. Physicians should ask about these symptoms as part of the diagnosis of postpartum major depression. Mothers who score above 13 are likely to be suffering from a depressive illness of varying severity.
Two small studies20,21 of 40 patients with unipolar major depression and residual symptoms following antidepressant therapy showed that patients treated with CBT initially had fewer residual symptoms and fewer depressive episodes after six years compared with those treated with clinical therapy.A more recent, larger study19 randomized 158 patients who did not respond to adequate antidepressant therapy to receive cognitive therapy with clinical management or clinical management alone. However, women with mild to moderate postpartum major depression may have passive suicidal ideation, defined as a desire to die but no plan. A meta-analysis22 of six studies with 191 patients showed that CBT was significantly more effective than placebo or inactive interventions in managing adolescent depressive disorder (36 versus 62 percent, NNT = 4).
The scale will not detect mothers with anxiety neuroses, phobias or personality disorders.Women with postpartum depression need not feel alone. However, as depression worsens, she may view herself as a bad mother and believe that her child would be better off without her.



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