Depressive Disorders: Treatment

The treatment of depressive disorders is based on the symptoms of the patient and the severity of the symptoms. Important components are psychotherapy and pharmacotherapy. Depending on the symptoms also complementary methods such as light therapy, sleep deprivation, or sports and exercise therapy are used.

For some patients and their families participating in a support group or group therapy may be helpful.

In very severe, treatment-resistant depression may brain stimulation techniques such as electroconvulsive therapy (ECT), repetitive transcranial magnetic stimulation, transcranial magnetic stimulation, vagus nerve stimulation or deep brain stimulation be an therapeutic option.


Mild depressive episode

In an initial, mild depressive episode it is an option - when it is likely that the symptoms subside without specific therapy due to the surrounding conditions and the resources of the patient - to await the further course for a few days. If the symptoms persist after two weeks or continue to worsen, a treatment should be initiated.

Psychotherapy is often the preferred treatment method. Pharmacotherapy for mild depressive episodes is only recommended, if it is the particular desire of the patient, if the patient has responded well to a history of drug treatment, if the symptoms continue after other interventions or if the patient has a history of episodes of moderate or severe depression (cf. APA 2010, DGPPN 2009, NICE 2010).


Moderate depressive episode

For the treatment of acute moderately severe depressive episodes psychotherapy OR pharmacotherapy is recommended. Psychotherapeutic approaches include cognitive-behavioral therapy (“behavior therapy”) and psychodynamic therapy (cf. APA 2010, DGPPN 2009, NICE 2010).


Major depressive episode

For the treatment of major depressive episodes the combination of psychotherapy AND pharmacotherapy is recommended. Psychotherapeutic approaches include cognitive-behavioral therapy (“behavior therapy”) and psychodynamic therapy (cf. APA 2010, DGPPN 2009, NICE 2010).


Very severe, treatment-resistant depression

In the case of a very severe, treatment-resistant depression, who has not responded to treatment with psychotherapy and psychotropic drugs, electroconvulsive therapy may be helpful. Since the electroconvulsive therapy is performed under general anesthesia, the contraindications for anesthesia have to be considered (cf. APA 2010, DGPPN 2009, NICE 2010).