II. Management: General Approach
- See Pediatric Depression
- See Antepartum Depression
- See Depression in Athletes
- See Depression in Older Adults
- See Postpartum Major Depression
- Mild to Moderate Depression (PHQ-9 <16)
- Antidepressants (e.g. SSRI) are optional (per patient preference)
- Active monitoring of depression
- Consider Cognitive Behavioral Therapy
- Individual or group therapy
- Group Exercise
- Severe Depression (PHQ-9 >=16)
- Antidepressants (e.g. SSRI, SNRI) AND
- Cognitive Behavioral Therapy
III. Management: Medications
IV. Management: Psychotherapy - Reassurance and listening
- Instill hope
- Reframe depression as an adaptation to a patient's environment and circumstances
- Adaptation reframing destigmatizes depression and may help empower patient self-efficacy
- Think of depression as an alarm, alerting patients that something in their life needs attention
- Schroder (2023) Soc Sci Med 328: 115995 [PubMed]
- Consider Cork Analogy
- Think of self as cork under water
- No matter how much people or events push you under
- Eventually you will pop up
V. Management: Psychotherapy - Reinforce Positive Behaviors
-
Exercise (may increase energy and self esteem)
- Likely effective adjunct, although variable evidence (needs more high quality studies)
- Most effective when given as a formal Exercise Prescription
- Specify the frequency, intensity, duration and Exercise type
- Blumenthal (1999) Arch Intern Med 159:2349-56 [PubMed]
- Cooney (2014) JAMA 311(23): 2432-33 [PubMed]
- Dunn (2005) Am J Prev Med 28:1-8 [PubMed]
- Noetel (2024) BMJ 384:e075847 [PubMed]
- Yoga
- Effective in the treatment of Major Depression
- Cramer (2017) J Affect Disord 213:70-77 [PubMed]
-
Mindfulness Based Interventions
- Effective in the treatment of Major Depression
- Goldberg (2018) Clin Psychol Rev 59: 52-60 [PubMed]
-
Healthy Diet
- High fruit and vegetable intake is associated with decreased depression risk in age >45 years
- Attending Counseling
-
Antidepressant Compliance
- Reassure that these are not habit forming
- Reassure that these are not forever
- Establish a therapeutic alliance
- Schedule pleasurable activities (esp. with people)
- Repair relationships with family and friends
- Consider keeping a journal
VI. Management: Psychotherapy - Discourage Negative Behaviors
- Challenge negative thoughts
- Sleep disturbance
- Stress in relationships and work
- Poor diet or nutrition
- Alcohol use or Alcohol Abuse
- Medications that worsen depression (Beta Blockers)
VII. Management: Psychotherapy - Educate family and patient
- Greatest risk of Suicide is in early treatment
VIII. Management: Cognitive Behavioral Therapy
- Efficacy
- At least as effect as pharmacotherapy
- Wampold (2002) J Affect Disord 68:159-65 [PubMed]
- Summary of Process
- Recognize that some Perceptions of reality are false
- False Perceptions lead to negative thoughts
- Learn to identify negative thoughts as they occur
- Replace distorted thoughts with alternatives
- Reframe central beliefs about world and self-image
- Techniques
- Keep a Thought Journal
- Identify specific stressful situations
- Example: Meeting a new person
- Characterize associated mood and automatic reaction
- Example: I am anxious - they will hate me
- Identify reasons for negative thoughts
- Example: Noone speaks with me at parties
- Identify counter-arguments
- Example: I have close friends who care about me
- Substitute negative thought with alternative
- Example: I am likeable - be myself
- Identify specific stressful situations
- Set goals and activities (example follows)
- Goal: Exercise every day, this improves self-esteem
- Start: Next thursday, before work
- Obstacles: Early wake-up
- Strategies to overcome obstacles
- Be in bed by 10 pm, with clothes set out for AM
- Progress
- Jan 4: Arrived gym 20 minutes late, short jog
- Jan 5: Overslept, missed workout, bad day
- Jan 6: Swam for 40 minutes, feel great
- Keep a Thought Journal
IX. Management: Adjuncts
- Audio tape based Patient Education
- Small British study of "Coping with Depression" tape
- Found to effective adjunct to Depression Management
- Blenkiron (2001) Br J Gen Pract 51:366-70 [PubMed]
- Website based cognitive-behavioral management
- Mood Gym
- Effective in Major Depression
X. Resources
Images: Related links to external sites (from Bing)
Related Studies
| Definition (NCI) | A type of psychotherapy utilized to treat different forms of mental disorders.The treatment involves the identification of unhelpful or destructive patterns of thinking and behaviors and the subsequent replacement with behaviors that are beneficial and constructive. |
| Definition (NCI_NCI-GLOSS) | A type of psychotherapy that helps patients change their behavior by changing the way they think and feel about certain things. It is used to treat mental, emotional, personality, and behavioral disorders. |
| Definition (MSH) | A direct form of psychotherapy based on the interpretation of situations (cognitive structure of experiences) that determine how an individual feels and behaves. It is based on the premise that cognition, the process of acquiring knowledge and forming beliefs, is a primary determinant of mood and behavior. The therapy uses behavioral and verbal techniques to identify and correct negative thinking that is at the root of the aberrant behavior. |
| Definition (PSY) | Directive therapy based on the belief that the way one perceives and structures the world determines one's feelings and behavior. Treatment aims at altering cognitive schema and hence permitting the patient to change his/her distorted self-view and world view. |
| Definition (PSY) | An integrated approach to psychotherapy that combines the techniques of cognitive and behavior therapy. |
| Definition (CSP) | involves identifying and changing specific cognitive processes as they relate to problems of emotions and behavior; based on the premise that cognition, the process of acquiring knowledge and forming beliefs, is a primary determinant of mood and behavior; directed toward learning through practice of specific skills which have direct relevance to the present problem. |
| Definition (NIC) | Interventions to reinforce or promote desirable cognitive functioning or alter undesirable cognitive functioning |
| Concepts | Therapeutic or Preventive Procedure (T061) |
| MSH | D015928 |
| ICD10 | 96101-00 |
| SnomedCT | 228553007, 151618003, 390657008, 389923006, 183383008, 304891004, 228557008 |
| English | Behavior Therapies, Cognitive, Behavior Therapy, Cognitive, Cognition Therapies, Cognition Therapy, Cognitive Behavior Therapies, Cognitive Behavior Therapy, Cognitive Psychotherapies, Cognitive Psychotherapy, Cognitive Therapies, Psychotherapies, Cognitive, Psychotherapy, Cognitive, Therapies, Cognition, Therapies, Cognitive, Therapies, Cognitive Behavior, Therapy, Cognition, Therapy, Cognitive, Therapy, Cognitive Behavior, Cognitive Therapy, COGNITIVE PSYCHOTHER, THER COGNITIVE BEHAVIOR, BEHAVIOR THER COGNITIVE, COGNITIVE THER, THER COGNITION, COGNITION THER, PSYCHOTHER COGNITIVE, THER COGNITIVE, COGNITIVE BEHAVIOR THER, Cognitive-behavior ther appro, Cognitive-behaviour ther appro, CBT-Cognitiv-behavior therapy, Cognitve & behavioral therapy, CBT-Cognitiv-behaviour therapy, Cognitve & behavioural therapy, CT, cognitive behavior modification, cognitive behavioral therapy (treatment), cognitive behavioral therapy, rnox cognition (treatment), rnox cognition, Cognitive behavior therapy, Cognitive behaviour therapy, cognitive therapy, cognitive and behavioral therapy, therapy behavior cognitive, therapy cognitive, behaviour cognitive therapy, cognitive behaviour therapy, cognitive therapies, behavioral cognitive therapy, cognitive behavior therapy, cognitive psychotherapy, Cognitive psychotherapy, Cognitive Behavioral Therapies, Therapies, Cognitive Behavioral, Cognitive Behavioral Therapy, Behavioral Therapies, Cognitive, Behavioral Therapy, Cognitive, Therapy, Cognitive Behavioral, Cognitive - behaviour therapy (regime/therapy), CBT, Psychotherapy - cognitive, Cognitive approach, Cognitive therapy approach, CBT - Cognitive - behavior therapy, Cognitive - behavior therapy, Cognitive and behavioral therapy, CBT - Cognitive - behaviour therapy, Cognitive - behaviour therapy, Cognitive and behavioural therapy, Cognitive therapy, Cognitive-behavioral therapy approach, Cognitive-behavioural therapy approach, Cognitive - behavior therapy (regime/therapy), Cognitive and behavioral therapy (regime/therapy), Cognitive therapy (regime/therapy), Psychotherapy - cognitive (regime/therapy), Cognitive - behavior therapy (procedure), Cognitive and behavioral therapy (procedure), Cognitive therapy (procedure), Psychotherapy - cognitive (procedure), Cognitive-behaviour therapy, cognitive behavioural therapy, Cognitive behavioral therapy, Cognitive behavioural therapy |
| Spanish | psicoterapia cognitiva, Psicoterapia congnitiva, abordaje cognitivo, psicoterapia - cognitiva (régimen/tratamiento), psicoterapia - cognitiva, terapia cognitiva (régimen/tratamiento), terapia cognitiva y conductual (régimen/tratamiento), terapia cognitiva y conductual, terapia cognitiva, tratamiento con terapia cognitivo-conductual (régimen/tratamiento), tratamiento con terapia cognitivo-conductual, Psicoterapia Cognitiva, Terapia Cognitiva, Terapia Conductista Cognitiva |
| Dutch | cognitieve psychotherapie, Cognitieve therapie, Gedragstherapie, cognitieve, Psychotherapie, cognitieve |
| German | kognitive Psychotherapie, Kognitive Therapie, Psychotherapie, kognitive, Verhaltenstherapie, kognitive |
| Portuguese | Psicoterapia cognitiva, Psicoterapia Cognitiva, Terapia Cognitiva, Terapia Comportamental Cognitiva |
| Swedish | Kognitiv terapi |
| Japanese | ﾆﾝﾁｼﾝﾘﾘｮｳﾎｳ, 行動療法-認知, 認知療法, 認知心理療法, 認知行動療法, 心理療法-認知 |
| Finnish | Kognitiivinen psykoterapia |
| Italian | Terapia cognitivo-comportamentale, Terapia della cognizione, Psicoterapia cognitiva, Terapia cognitiva |
| Russian | POVEDENCHESKAIA TERAPIIA KOGNITIVNAIA, KOGNITIVNAIA TERAPIIA, PSIKHOTERAPIIA KOGNITIVNAIA, КОГНИТИВНАЯ ТЕРАПИЯ, ПОВЕДЕНЧЕСКАЯ ТЕРАПИЯ КОГНИТИВНАЯ, ПСИХОТЕРАПИЯ КОГНИТИВНАЯ |
| Czech | Kognitivní psychoterapie, kognitivně behaviorální terapie, kognitivní terapie, kognitivně-behaviorální terapie, KBT |
| Croatian | KOGNITIVNA TERAPIJA |
| Polish | Terapia poznawczo-behawioralna, Psychoterapia poznawcza, Terapia poznawcza, Terapia zachowania |
| Hungarian | Kognitív pszichoterápia |
| Norwegian | Kognitiv atferdsterapi, Atferdsterapi, kognitiv |
| French | TCC (Thérapie Cognitivo-Comportementale), Thérapie cognitivo-comportementale, Thérapie cognito-comportementale, Psychothérapie cognitive, Thérapie cognitive comportementale, Thérapie cognitive |
Ontology: Counseling (C0010210)
| Definition (CCC) | Actions performed to provide advice or instruction to help another |
| Definition (SCTSPA) | Procedimiento psicosocial que implica escuchar, reflexionar, etc., para facilitar el reconocimiento de un curso de acción / solución |
| Definition (SNOMEDCT_US) | Psychosocial procedure that involves listening, reflecting, etc. to facilitate recognition of course of action / solution. |
| Definition (NCI) | The act of receiving professional guidance in resolving personal conflicts and emotional problems. |
| Definition (NCI_NCI-GLOSS) | The process by which a professional counselor helps a person cope with mental or emotional distress, and understand and solve personal problems. |
| Definition (MSH) | The giving of advice and assistance to individuals with educational or personal problems. |
| Definition (PSY) | Conceptually broad term referring to a form of helping process which involves giving advice and information, in order to assist individuals or groups in coping with their problems. Use a more specific term if possible. |
| Definition (CSP) | the use of psychological methods in testing the interests of and giving professional guidance to individuals. |
| Definition (NIC) | Use of an interactive helping process focusing on the needs, problems, or feelings of the patient and significant others to enhance or support coping, problem solving, and interpersonal relationships |
| Concepts | Health Care Activity (T058) |
| MSH | D003376 |
| SnomedCT | 170975000, 170984000, 148198002, 69197005, 360268008, 148199005, 170974001, 148207006, 129441002, 409063005 |
| English | Counseling, Counseling - general, Counseling - general NOS, Counselling - general, Counselling - general NOS, Counselling - general (context-dependent category), Counselling - general NOS (context-dependent category), Counselling - general (situation), Counselling - general NOS (situation), counseling service, rnrx counseling service (treatment), rnrx counseling service, counseling services, counselling, counseling therapy, Counseling Service, counseling, preventive medicine services: counseling, counseling (treatment), Counseling - general (situation), Counselling - general (procedure), Counselling - general NOS (procedure), Counseling - general NOS (situation), Counselling - action (qualifier value), Counseling - action (qualifier value), Counseling - action, Counselling - action, Counselling, Counselling service, Counseling (regime/therapy), Counseling (procedure) |
| Spanish | asesoramiento (procedimiento), asesoramiento (acción), asesoramiento - general, SAI (categoría dependiente del contexto), asesoramiento (régimen/terapia), asesoramiento - general (categoría dependiente del contexto), Consejo, asesoramiento - general (situación), asesoramiento - general, SAI, Counselling - general NOS, asesoramiento - general, asesoramiento - general, SAI (situación), asesoramiento - general, SAI (procedimiento), asesoramiento - acción (calificador), asistencia psicológica (acción), orientación (acción), orientación - acción (calificador), orientación - acción, psicoterapia (acción), asesoramiento |
| Swedish | Rådgivning |
| Czech | poradenství |
| Finnish | Neuvonta |
| Russian | KONSUL'TIROVANIE PO LICHNYM VOPROSAM, КОНСУЛЬТИРОВАНИЕ ПО ЛИЧНЫМ ВОПРОСАМ |
| Japanese | カウンセリング, 相談(心理学) |
| Italian | Counselling, Counseling |
| Polish | Poradnictwo, Poradnictwo psychiatryczne, Telefon zaufania, Poradnictwo psychologiczne |
| Norwegian | Rådgivning |
| Croatian | SAVJETOVANJE |
| Portuguese | Conselho, Aconselhamento |
| French | Conseil |
| German | Beratung, Richtungsweisende Beratung |
| Dutch | Voorlichting en advies, niet gespecificeerd |
Ontology: Psychotherapy (C0033968)
| Definition (NCI) | A method of treating disease, esp. psychic disorders, by mental rather than pharmacological means (e.g., suggestion, re-education, hypnotism, and psychoanalysis). (Taber's) |
| Definition (NCI_NCI-GLOSS) | Treatment of mental, emotional, personality, and behavioral disorders using methods such as discussion, listening, and counseling. |
| Definition (MSH) | A generic term for the treatment of mental illness or emotional disturbances primarily by verbal or nonverbal communication. |
| Definition (CSP) | treatment of emotional, behavioral, personality, and psychiatric disorders based primarily upon verbal or nonverbal communication and interventions with the patient. |
| Concepts | Therapeutic or Preventive Procedure (T061) |
| MSH | D011613 |
| ICD10 | 96099-00 |
| SnomedCT | 151615000, 183380006, 75516001 |
| CPT | 1021137 |
| English | Psychotherapies, PSYCHOTHER, psychotherapeutic technique, psychotherapies, psychotherapy, Psychotherapy Services and Procedures, talk therapy, Psychotherapy (regime/therapy), Psychotherapy, NOS, Psychotherapy (regime/therapy)(procedure), Psychotherapy |
| Japanese | 心理療法, ｼﾝﾘﾘｮｳﾎｳ |
| Swedish | Psykoterapi |
| Czech | psychoterapie, Psychoterapie |
| Finnish | Psykoterapia |
| Russian | PSIKHOTERAPIIA, ПСИХОТЕРАПИЯ |
| Croatian | PSIHOTERAPIJA |
| Polish | Psychoterapia |
| Hungarian | Pszichoterápia |
| Norwegian | Psykoterapi |
| Spanish | psicoterapia (procedimiento), psicoterapia (régimen/tratamiento), psicoterapia, Psicoterapia |
| Dutch | psychotherapie, Psychotherapie |
| French | Psychothérapie |
| German | Psychotherapie |
| Italian | Psicoterapia |
| Portuguese | Psicoterapia |
Ontology: Major Depressive Disorder (C1269683)
| Definition (MSH) | Marked depression appearing in the involution period and characterized by hallucinations, delusions, paranoia, and agitation. |
| Definition (PSY) | Affective disorder marked by dysphoric mood, inactivity, lack of interest, insomnia, feelings of worthlessness, diminished ability to think, and thoughts of suicide. Use DEPRESSION (EMOTION) for nonclinical depression. |
| Definition (CSP) | one or more periods of depression in the absence of history of manic or hypomanic episodes; chronic type lasts 2 or more years; melancholic type is more severe, has vegetative signs, and responds well to somatic therapy. |
| Concepts | Mental or Behavioral Dysfunction (T048) |
| MSH | D003865 |
| ICD10 | F32.9 |
| SnomedCT | 370143000, 35489007 |
| English | Disorder, Major Depressive, Disorders, Major Depressive, Major Depressive Disorders, MDD, MAJOR DEPRESSIVE DISORDER, DEPRESSIVE DIS MAJOR, MAJOR DEPRESSIVE DIS, Major depressive disorder NOS, Major depressive illness, Major depression NOS, Depressive Disorder, Major [Disease/Finding], major depressive illness, major depressive disorder, major depression, Major depressive disorder (diagnosis), Major depression, Major depressive disorder (disorder), Major depressive disorder, Major depression, NOS, Major depressive disorder, NOS, Depressive Disorder, Major, Depressive Disorders, Major, Major Depressive Disorder, Major Depression |
| Dutch | depressieve ziekte, depressieve stoornis NAO, major depression, Depressieve stoornis, ernstige, Ernstige depressieve stoornis, Involutiepsychose, Melancholie, involutionele, Parafrenie, involutionele, Psychose, involutionele, Involutiedepressie, Involutionele depressie |
| French | Syndrome dépressif majeur SAI, Épisode dépressif majeur, Dépression grave, Grave dépression, Dépression majeure, Trouble dépressif majeur |
| German | Major Depression NNB, schwere depressive Krankheit, Endogene Depression, Involutionsdepression, Melancholie, Involutions-, Paraphrenie, Involutions-, Psychose, Involutions-, Depressive Störung, majore, Majore depressive Störung |
| Italian | Depressione maggiore NAS, Malattia depressiva maggiore, Depressione maggiore, Disturbo depressivo maggiore |
| Portuguese | Doença depressiva major, Perturbação depressiva major NE, Depressão grave, Transtorno Depressivo Maior |
| Spanish | Trastorno depresivo mayor NEOM, Enfermedad depresiva mayor, depresión mayor, trastorno depresivo mayor (trastorno), trastorno depresivo mayor, Depresión mayor, Trastorno Depresivo Mayor |
| Japanese | 大うつ病ＮＯＳ, ｵｵｳﾂﾋﾞｮｳ, ﾀﾞｲｳﾂﾋﾞｮｳ, ﾀﾞｲｳﾂﾋﾞｮｳNOS, うつ病-退行期, 大うつ病性障害, 大鬱病, うつ病-更年期, 大うつ病, 初老期うつ病, 更年期うつ病, 更年期鬱病, 精神病-更年期, 退行期うつ病, 退行期パラフレニー, 退行期メランコリア, 退行期精神病, 鬱病-更年期, パラフレニー-退行期, 更年期うつ状態, 更年期メランコリー, 更年期精神病, 更年期鬱状態, 精神病-退行期, 退行期鬱病 |
| Swedish | Involutionsdepression |
| Czech | psychóza involuční, deprese involuční, depresivní porucha unipolární, melancholie involuční, parafrenie involuční, Velké depresivní onemocnění, Velká deprese, Velká depresivní porucha NOS |
| Finnish | Laaja-alainen masentuneisuushäiriö |
| Russian | DEPRESSIVNOE RASSTROISTVO TIAZHELOE, DEPRESSIIA INVOLIUTSIONNAIA, MELANKHOLIIA INVOLIUTSIONNAIA, PSIKHOZ INVOLIUTSIONNYI, PARAFRENIIA INVOLIUTSIONNAIA, ДЕПРЕССИВНОЕ РАССТРОЙСТВО ТЯЖЕЛОЕ, ДЕПРЕССИЯ ИНВОЛЮЦИОННАЯ, МЕЛАНХОЛИЯ ИНВОЛЮЦИОННАЯ, ПАРАФРЕНИЯ ИНВОЛЮЦИОННАЯ, ПСИХОЗ ИНВОЛЮЦИОННЫЙ |
| Polish | Wielkie zaburzenie depresyjne, Zaburzenie depresyjne wielkie, Ciężkie zaburzenie depresyjne, Depresja wielka, Parafrenia inwolucyjna, Depresja głęboka, Epizod depresji dużej, Depresja inwolucyjna |
| Hungarian | Major depressiós betegség, Major depressio, Major depressiós zavar k.m.n. |
| Norwegian | Depresjon, alvorlig, Markert depresjon, Depresjon, markert, Alvorlig depresjon, Markant depressiv forstyrrelse |
