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. 2008 Nov;105(45):782-92.
doi: 10.3238/arztebl.2008.0782. Epub 2008 Nov 7.

Treatment of depressive disorders

Tom Bschor, Mazda Adli

Treatment of depressive disorders

Tom Bschor et al. Dtsch Arztebl Int. 2008 Nov.

Abstract

Introduction: A confusing variety of options are available for the treatment of depressive disorders.

Method: Selective literature review under consideration of current guidelines.

Results: The treatment of depression can be divided into acute, maintenance and prophylactic phases. The basic forms of treatment are pharmacotherapy, psychotherapy, and supportive strategies. The approximately 30 antidepressants currently on the market differ mainly with respect to their side effect profiles. Of the specific types of psychotherapy, cognitive behavioral therapy, psychodynamic therapy, and psychoanalysis are funded by the statutory health insurance providers in Germany. All treatment strategies (except for sleep deprivation) show a latency of onset of several weeks and a nonresponse rate of about 30% to 50%. In clinical practice it is essential to follow a stepwise procedure and to perform a standardized evaluation of response after the latency period. In the event of nonresponse, the next step of treatment should be initiated.

Discussion: Depressive disorders have a good prognosis provided one takes best advantage of the available treatment options. Preconditions are continuation of treatment for an appropriate length of time (for antidepressants ca. 4 to 6 weeks, for psychotherapy ca. 4 to 12 weeks) and standardized evaluation of response thereafter.

Keywords: antidepressants; depression; psychotherapy; stepwise antidepressant treatment; treatment algorithm.

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Figures

Figure
Figure
Algorithm-based flowchart for stepwise treatment of depression. The flowchart shows the three arms of the algorithm study of the German Competence Network on Depression, because neither the result of the study (supported by the German Federal Ministry of Education and Research) nor the relevant literature permits any definite recommendation to be made. Whether the patient goes on to the next step in any of the three algorithms is a function of the decision procedure. The severity of depression is assessed at the end of each step with the Hamilton Depression Rating Scale (HAM-D, 21-item version). T3, triiodothyronine
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