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Therapeutic Treatments
| Classification | Therapy | Goal | Effectiveness |
|---|---|---|---|
| Behavioral Therapies | Cognitive Behavioral Therapy (CBT) | Focuses on developing personal strategies for coping with current issues involving thoughts, feelings, attitudes, behaviors, and emotional regulation.[1][2] It it a problem-focused and action-oriented, emphasizing skill learning and practice.[3] | Can be effective in less severe cases when used alone, however can be more effective when paired with psychotropic medications.[1] More recent research shows that it can be equally as effective.[4] A systematic review of data comparing low-intensity CBT (such as guided self-help by means of written materials and limited professional support, and website-based interventions) with usual care found that patients who initially had more severe depression benefited from low-intensity interventions at least as much as less-depressed patients.[5] |
| Dialectical Behavior Therapy (DBT) | Works towards helping people increase their emotional and cognitive regulation by learning about the triggers that lead to reactive states and helping to assess which coping skills to apply in the sequence of events, thoughts, feelings, and behaviors to help avoid undesired reactions. Assumes that people are doing their best but lack the skills needed to succeed, or are influenced by positive reinforcement or negative reinforcement that interferes with their ability to function appropriately.[6] | A Duke University study of compared treatment of depression by antidepressant medication to treatment by antidepressants and dialectical behavior therapy. A total of 34 chronically depressed individuals over age 60 were treated for 28 weeks. Six months after treatment, statistically-significant differences were noted in remission rates between groups, with a greater percentage of patients treated with antidepressants and dialectical behavior therapy in remission.[7] | |
| Psychoanalytic Therapies | Psychoanalysis | A school of thought founded by Sigmund Freud that emphasizes the resolution of unconscious mental conflicts. Is used by its practitioners to treat clients presenting with major depression. (24) | Duration is long-term and frequent; up to 4-5 sessions per week. This allows for a deeper relationship between therapist and patient and helps develop personal treatment strategies from the root of the issue. [8] Effective in treating depression; In 2011, the American Psychological Association made 103 comparisons between psychodynamic treatment and a non-dynamic competitor and found that 6 were superior, 5 were inferior, 28 had no difference and 63 were adequate. The study found that this could be used as a basis "to make psychodynamic psychotherapy an 'empirically validated' treatment." [9] |
| Psychodynamic Psychotherapy (PPT) | Loosely based on psychoanalysis and has an additional social and interpersonal focus. (25) | In a meta-analysis of three controlled trials, psychodynamic psychotherapy was found to be as effective as medication for mild to moderate depression. (26) | |
| Social Therapies | Interpersonal Psychotherapy (IPT) | Focuses on the social and interpersonal triggers that may cause depression. Here, the therapy takes a structured course with a set number of weekly sessions (often 12) as in the case of CBT; however, the focus is on relationships with others. (22) | There is evidence that it is an effective treatment for depression. Therapy can be used to help a person develop or improve interpersonal skills in order to allow him or her to communicate more effectively and reduce stress.(22) |
| Mindfulness | Acceptance and Commitment Therapy (ACT) | A form of CBT where pairing acceptance and mindfulness strategies is used as a technique to change behaviors and commitments and increase psychological flexibility.[10] | Similar effects to CBT when it comes to treatment efficacy, however not a lot of research is there to support this therapy as a treatment. It has scored higher than placebo in trials.[11] With its roots in behavioral analysis, it can be effective such as other like-therapies. (18) (19) (20) |
| Mindfulness-Based Cognitive Therapy (MBCT) | A mindfulness form of CBT designed to improve retention rates. Very similar to CBT, but focuses on changing behaviors and cognitions through mindful strategies and coping mechanisms. Mixes Eastern meditation methodology with CBT framework.[12] | Can be effective for patients Major Depressive Disorder.[13] The emphasis on depressive thoughts and strategies when using meditation methods of awareness help alleviate depressive symptoms. A review of four studies on the effectiveness of suggests that MBCT may have an additive effect when provided with the usual care in patients who have had three or more depressive episodes, although the usual care did not include antidepressant treatment or any psychotherapy, and the improvement observed may have reflected non-specific or placebo effects. (21) | |
| Other Options | Expressive Therapies | ||
| Mental Health Counselor | Shared Care | Art Therapy | |
| Social Worker | Group Therapy | Music Therapy | |
Medical Devices
| Type/Device | Method | Variations | Duration | Purpose | Effectiveness | Side Effects |
|---|---|---|---|---|---|---|
| Electroconvulsive Therapy (ECT) | Under general anesthesia; seizures that are electrically induced in patients to provide relief from psychiatric illnesses; used with Informed Consent as a last line of intervention. (75)(77) | Frequency of courses; electrode placement; electrical waveform of stimulus (77) | 2-3 times/week, as needed (83) | Anticonvulsant effect mostly in frontal lobes; neurotrophic effects in the medial temporal lobe (84) | Effective for 50% of patients with treatment-resistant MDD; 50% of long-term follow ups relapse (79) | Most common are confusion and memory loss; side effects of general anesthesia |
| Deep Brain Stimulation | Electrodes implanted in a specific region of the brain, which is then continuously stimulated. (86) | -- | Not FDA approved in the United States (88) | Electrically stimulating brain regions for treatment-resistant MDD. | About half of the patients who receive it do find dramatic improvement (87) | Generally trivial for younger patient population (as opposed to movement disorders) (87) |
| Repetitive Transcranial Magnetic Stimulation (TMS) | Noninvasive way of stimulating regions of the brain; magnetic field generator, or "coil" is placed near the head of the patient; coil produces small electric currents in the region just under it; coil is connected to pulse generator for electric current. (89)(90) | Number of TMS sessions | -- | Electrically stimulating specific small brain regions for treatment-resistant MDD. (89) | Clinical evidence has shown effectiveness for tSt John's worttant major depressive disorder.[14][15][16]Has been endorsed by The American Psychiatric Association,[17] Canadian Network for Mood and Anxiety Disorders,[18] and the Royal Australia and New Zealand College of Psychiatrists.[19] | Fainting or induced seizures.[20] |
| Vagus Nerve Stimulation (VNS) | Uses an implanted electrode and generator to deliver electrical pulses to the vagus nerve, one of the primary nerves emanating from the brain. | -- | May take longer than other types to see benefit. (85) | -- | It is an approved therapy for treatment-resistant depression in the EU and US and is sometimes used as an adjunct to existing antidepressant treatment. The support for this method comes mainly from open-label trials. (85)The only large double-blind trial conducted lasted only 10 weeks and yielded inconclusive results; the study did not yield definitive evidence of short-term efficacy for adjunctive VNS in treatment-resistant depression."(97) | -- |
| Cranial Electrotherapy Stimulation | -- | -- | -- | -- | A 2014 Cochrane review found insufficient evidence to determine whether or not Cranial electrotherapy stimulation with alternating current is safe and effective for treating depression. (98) | -- |
- ^ a b Beck JS (2011), Cognitive behavior therapy: Basics and beyond (2nd ed.), New York, NY: The Guilford Press, pp. 19–20
- ^ Benjamin CL, Puleo CM, Settipani CA, et al. (2011), "History of cognitive-behavioral therapy in youth", Child and Adolescent Psychiatric Clinics of North America, 20 (2): 179–189, doi:10.1016/j.chc.2011.01.011, PMC 3077930 , PMID 21440849
- ^ Schacter DL, Gilbert DT, Wegner DM (2010), Psychology (2nd ed.), New York: Worth Pub, p. 600
- ^ Roth, Anthony; Fonagy, Peter (2006). "Cognitive-Behavioral Therapy Alone and in Combination with medication: University of Minnesota and University of Pennsylvania–Vanderbilt University Studies". What Works for Whom?: A Critical Review of Psychotherapy Research(2nd ed.). Guilford Press. pp. 76–8. ISBN 978-1-59385-272-6.
- ^ Bower, Peter; Kontopantelis, Evangelos; Sutton, Alex; Kendrick, Tony; Richards, David A; Gilbody, Simon; Knowles, Sarah; Cuijpers, Pim; Andersson, Gerhard; Christensen, Helen; Meyer, Björn; Huibers, Marcus; Smit, Filip; van Straten, Annemieke; Warmerdam, Lisanne; Barkham, Michael; Bilich, Linda; Lovell, Karina; Liu, Emily Tung-Hsueh (2013). "Influence of initial severity of depression on effectiveness of low intensity interventions: Meta-analysis of individual patient data". BMJ. 346: f540. doi:10.1136/bmj.f540. PMC 3582703 . PMID 23444423.
- ^ "An Overview of Dialectical Behavior Therapy - Psych Central". 17 May 2016. Retrieved 2015-01-19.
- ^ Lynch, Thomas (January–February 2003). "Dialectical Behavior Therapy for Depressed Older Adults: A Randomized Pilot Study". The American Journal of Geriatric Psychiatry. 11 (1): 33-45. doi:10.1097/00019442-200301000-00006. Retrieved 16 November 2017.
- ^ For session length, Thompson, M. Guy. The Ethic of Honesty: The Fundamental Rule of Psychoanalysis, Rodopi, 2004, 75. For session frequency, Hinshelwood, Robert D. "Surveying the Maze", in Serge Frisch, Robert D. Hinshelwood, and Jean-Marie Gauthier (eds.). Psychoanalysis and Psychotherapy: The Controversies and the Future, Karnac Books, 2001, 128.
- ^ Gerber AJ, Kocsis JH, Milrod BL, Roose SP, Barber JP, Thase ME, Perkins P, Leon AC: A quality-based review of randomized controlled trials of psychodynamic psychotherapy" Am J Psychiatry 2011 Jan;168(1) 19-28. Epub 2010 Sep 15.
- ^ Hayes, Steven. "Acceptance & Commitment Therapy (ACT)". ContextualPsychology.org.
- ^ A-Tjak, JG; Davis, ML; Morina, N; Powers, MB; Smits, JA; Emmelkamp, PM (2015). "A meta-analysis of the efficacy of acceptance and commitment therapy for clinically relevant mental and physical health problems". Psychotherapy and psychosomatics. 84 (1): 30–6. doi:10.1159/000365764. PMID 25547522.
- ^ Manicavasgar, V.; Parker, G.; Perich, T. (2011). "Mindfulness-Based Cognitive Therapy Vs. Cognitive Behaviour Therapy as a Treatment for Non-Melancholic Depression". Journal of Affective Disorders. 130 (1–2): 138–144. doi:10.1016/j.jad.2010.09.027. PMID 21093925.
- ^ Piet, J.; Hougaard, E. (2011). "The Effect of Mindfulness-Based Cognitive Therapy for Prevention of Relapse in Recurrent Major Depressive Disorder: a Systematic Review and Meta-Analysis". Clinical Psychology Review. 31 (6): 1032–1040. doi:10.1016/j.cpr.2011.05.002.
- ^ Melkerson, MN (2008-12-16). "Special Premarket 510(k) Notification for NeuroStar® TMS Therapy System for Major Depressive Disorder" (pdf). Food and Drug Administration. Retrieved 2010-07-16.
- ^ Lefaucheur, JP; et al. (2014). "Evidence-based guidelines on the therapeutic use of repetitive transcranial magnetic stimulation (rTMS)". Clinical Neurophysiology. 125: 2150–2206. doi:10.1016/j.clinph.2014.05.021. PMID 25034472.
- ^ George, MS; Post, RM (2011). "Daily Left Prefrontal Repetitive Transcranial Magnetic Stimulation for Acute Treatment of Medication-Resistant Depression". American Journal of Psychiatry. 168 (4): 356–364. doi:10.1176/appi.ajp.2010.10060864. PMID 21474597.
- ^ American Psychiatric Association (2010). (eds: Gelenberg, AJ, Freeman, MP, Markowitz, JC, Rosenbaum, JF, Thase, ME, Trivedi, MH, Van Rhoads, RS). Practice Guidelines for the Treatment of Patients with Major Depressive Disorder, 3rd Edition
- ^ Kennedy SH, et al. (2009). "Canadian Network for Mood and Anxiety Treatments (CANMAT) Clinical guidelines for the management of major depressive disorder in adults. IV. Neurostimulation therapies" (PDF). J Aff Disorders. 117: S44–S53. doi:10.1016/j.jad.2009.06.043. PMID 19682750.
- ^ The Royal Australian and New Zealand College of Psychiatrists. (2013) Position Statement 79. Repetitive Transcranial Magnetic Stimulation. Practice and Partnerships Committee
- ^ Rossi S, et al. (Dec 2009). "Safety, ethical considerations, and application guidelines for the use of transcranial magnetic stimulation in clinical practice and research". Clin Neurophysiol. 120 (12): 2008–39. doi:10.1016/j.clinph.2009.08.016. PMC 3260536 . PMID 19833552.