Treatments

The environment surrounding a person suffering from depression is essential to their rehabilitation. The understanding and affection of family and friends are important, as is patience, since patients’ lack of desire and motivation can cause despair. Suggesting and not ordering activities and proposing and not imposing conversations are basic supports for therapy imposed by professionals. One of the most important problems this group presents is the abandonment of therapies, so it is essential to induce them to continue the treatment until the end.

There are two types of treatment for depression: pharmacological and psychotherapy.

Depending on the problem, one or the other may be necessary, or a combination of the two. When the cases are serious, there is another type: electroconvulsive therapy. In general, pharmacological treatment is necessary. In the first phase, the patient is intensely medicated to ensure that the symptoms disappear and the patient’s recovery can begin. In the second phase, drugs are administered to prevent the manifestation of the disease.

• Drug treatment with antidepressants: Antidepressants are used to correct imbalances in the levels of chemicals in the brain, especially serotonin, a brain chemical that transmits messages in the area of ​​the brain that controls emotions, body temperature, appetite, hormone levels, sleep and blood pressure. Antidepressants work by increasing serotonin levels in brain cells.
• Each class of antidepressants does this differently. They do not usually cause dependency and take effect three to six weeks after starting treatment. If no improvement has been made during this time, the doctor usually chooses to change the treatment, adding more doses or opting for another antidepressant. The most common side effects are insomnia, nervousness, sexual dysfunction, nausea, dizziness or weight gain.

• Psychotherapy:  According to the European Association for Psychotherapy (EAP), psychotherapy could be a comprehensive, deliberate and planned treatment or therapeutic intervention based on broad and specific training in behavioural disorders, illnesses or broader personal development needs related to causes and psychosocial and psychosomatic factors.
• To do this, it uses scientific psychotherapeutic methods in the interaction of one or more individuals with one or more psychotherapists, intending to mitigate or eliminate symptoms, change attitudes and altered behaviour patterns, and favouring a process of maturity, development, mental health and wellness.
• Different models of psychotherapy vary in aspects, such as their theoretical foundation and the level of the formal development of their techniques. In recent decades, research in psychotherapy has been increasing. In parallel, clinical practice guidelines on depression consistently recommend its use, especially those interventions explicitly developed for the treatment of depression. Depression.
• Electroconvulsive therapy: It is used when the patient cannot take medication or does not improve with it, when the risk of committing suicide is high or if there is debilitation from another physical illness. 

Electroconvulsive therapy consists of causing a generalised seizure through electrical stimulation of the central nervous system. Different studies have shown that it is effective in severe depressive episodes and resistant depression and could be considered a first-line treatment in acute situations of suicide risk or patients with severe organic deterioration. However, although it has been used in clinical practice for more than 70 years, it is still a controversial technique. Thus, it is perceived by many professionals as a safe and effective form of treatment for severe depression, while others, similarly some groups of patients, consider it an obsolete and potentially harmful technique.

It does not have absolute contraindications, although it does have relative risk situations: the presence of space-occupying brain lesions (tumours or haemorrhages) or any other situation in which intracranial pressure is elevated, recent serious cardiovascular diseases, treatment with MAOIs or lithium, and the risks typical of general anaesthesia.

Side effects can be immediate (confusional symptoms, amnesia and headache) or long-term (fundamentally cognitive alterations) and depend on the previous conditions of the patient, their susceptibility, the technique used (bi or unilateral), the number of sessions used and the frequency of administration.

Regarding the effectiveness and safety of electroconvulsive therapy:

• It is an effective treatment for severe major depression in adults, being more effective than the simulated one. 
• Bilateral application is more effective than unilateral.
• It presents the risk of short-term appearance of cognitive-type side effects.
• It is more effective than short-term treatment with some antidepressants.
• The combination of this therapy with pharmacotherapy has not been shown to have a greater short-term effect than electroconsultation therapy alone. 
• Preliminary studies show greater effectiveness than repetitive transcranial magnetic stimulation. 

In patients who have responded to electroconvulsive therapy, continuation treatment with tricyclic antidepressants and/or lithium reduces the relapse rate compared with placebo. In the case of pregnant patients, the NICE guideline for antenatal and postnatal mental health recommends electroconvulsive therapy in severe depression and when the physical health of the mother or fetus is at risk.