treatment
Treating depression is not only to relieve the suffering of the patient, but also to reduce the burden on the family and society after the patient can return to society.
The treatment of depression mainly includes medication, psychotherapy and physical therapy.
Treatment goals: improve the clinical cure rate, improve the quality of life, restore social function, and prevent recurrence.
Treatment principles: the principle of whole-course treatment, the principle of individualized rational drug use, the principle of quantitative evaluation, the principle of single use of antidepressants, the principle of alliance therapy, etc.
The whole course of treatment of depression can be divided into three stages, namely acute treatment, consolidation treatment and maintenance treatment.
medical treatement
Due to the large individual differences, there is no absolute best, fastest, and most effective medication. In addition to commonly used over-the-counter drugs, the most appropriate drug should be selected under the guidance of a doctor in full consideration of personal circumstances.
Drugs are the main treatment method for depression. It is recommended to select antidepressants with good efficacy and high safety. It should be noted that psychotropic drugs should be taken under the guidance of a doctor and strictly in accordance with the doctor's advice.
Currently, the clinically recommended antidepressants include selective serotonin reuptake inhibitors (SSRIs), selective serotonin and norepinephrine reuptake inhibitors (SNRIs), norepinephrine and specific 5- Serotonergic reuptake inhibitors (NaSSAs), norepinephrine and dopamine reuptake inhibitors (NDRIs), etc.
SSRIs: Representative drugs include fluoxetine, sertraline, paroxetine, fluvoxamine, citalopram, escitalopram, etc. Common adverse reactions are nausea, vomiting, diarrhea, restlessness, loss of libido, headache, etc.
SNRIs: Representative drugs include venlafaxine and duloxetine. Common adverse reactions are nausea, vomiting, agitation, and sexual dysfunction.
NaSSAs: The representative drug is mirtazapine. Common adverse reactions are dry mouth, sedation and weight gain.
NDRIs: The representative drug is bupropion. Common adverse reactions include headache, tremor, convulsions, agitation, insomnia, and gastrointestinal discomfort.
Acute treatment
The purpose of acute treatment is to control the symptoms and try to make the patient clinically healed (symptoms disappear completely).
Antidepressants generally start to work in 2 to 4 weeks.
If the medication is ineffective for 6 to 8 weeks, you can switch to another drug of the same kind or another drug with a different mechanism of action.
Consolidation treatment
The purpose is to prevent patients from recurring symptoms due to early drug reduction or drug withdrawal after partial relief of symptoms in the acute phase.
Patients in the consolidation phase are unstable and have a greater risk of re-ignition, and they need to be treated continuously for at least 4 to 6 months. It is necessary to emphasize that the treatment plan, dosage, and method of use are the same as those in the acute phase.
Maintenance treatment
In order to reduce the risk of recurrence, maintenance treatment should be performed after the end of the consolidation period.
Studies on the duration of maintenance treatment are not yet sufficient. Generally, if there are more than two recurrences, especially in patients with onset of adolescents, psychiatric symptoms, severe illness, high risk of suicide, or family genetic history, the duration of maintenance treatment should be At least 2 to 3 years; patients with multiple relapses (3 times or more) advocate long-term maintenance treatment.
Generally, the acute treatment dose is used as the dose of maintenance treatment, which can effectively prevent recurrence.
After the maintenance treatment is over and the condition is stable, the drug can be reduced slowly (several weeks) until the treatment is terminated. At the same time, the early signs of recurrence should be closely monitored. Once it appears, the original therapeutic dose should be quickly restored.
Other treatments
Psychotherapy
Psychotherapy mainly refers to treatment through talking and communicating with doctors. According to different problems, it can be divided into supportive psychotherapy, cognitive behavioral therapy, psychodynamic therapy, interpersonal psychotherapy and marriage and family therapy.
Psychotherapy is often combined with medication.
The effect of psychotherapy on mild and moderate depression is similar to that of antidepressants.
It should be noted that for severe or endogenous depression, psychotherapy is often not used alone, and it needs to be used in combination on a drug basis.
Physiotherapy
Clinically, modified electroconvulsive therapy (MECT) and repetitive transcranial magnetic stimulation (rTMS) can also be used in combination with adjuvant therapy. Among them, MECT can quickly and effectively treat depression and significantly reduce the suicide mortality of patients.
Account not verified