Non-drug treatment
- Electro convulsive Therapy [ECT]
- Psychosurgery
- Phototherapy
- Psychological treatments
- Supportive psychotherapy
- Cognitive therapy
- Interpersonal psychotherapy
- Relationship counselling
- Dynamic psychotherapy
- Social interventions
Electro convulsive Therapy [ECT]
ECT entails administrating an electric charge to the head of a patient under a general anaesthetic in order to produce a generalised convulsion. A normal course is 6–12 treatments at a rate of 2 per week.
ECT is reserved for cases of resistant depressive illness unresponsive to drug treatment, especially those with psychotic symptoms.
ECT produces a more rapid resolution of depressive illness compared to antidepressant medication and may be lifesaving in severe depressive illness. However antidepressant medication should be continued following a successful course of ECT.
Psychosurgery
In extremely rare cases of chronic disabling depressive illness, when all other treatments have failed, the extreme option of psychosurgery may be considered. About 50 operations are performed each year in the UK, [radioactive implants in the brain].
Phototherapy
For those people with Seasonal Affective Disorder, where the onset of depressive illness is in the autumn or winter months, treatment with high-intensity light is possible given at home in the morning and evening, artificially extending daylight.
Psychological treatments
There are a variety of psychological treatments used in the management of depressive illness.
Counselling services are delivered by either: -
- Voluntary organisations e.g. Compass, or Relate [Relationship counselling]
- Primary care [Increasing trend for GPs to employ practice based counsellors]
- Secondary Care.
The effectiveness of psychological treatments have been less well studied than antidepressant therapy, but based on current evidence, the most structured treatments appear to be the most effective i.e. cognitive therapy and interpersonal psychotherapy.
The following treatments are available:
Supportive psychotherapy
Used to relieve distress or help a person cope with difficulties
Relies on active listening, provision of information and advice and active encouragement.
Cognitive therapy [or cognitive behavioural therapy CBT]
Cognitive therapy explores how thoughts can alter feelings and behaviour. Therapy consists of identifying automatic negative thought patterns [such as over-generalisations or catastrophising] and teaching the patient to recognise and challenge them. The aim is to enable the patient to counter the negative thoughts with alternative rational thoughts.
A full course of cognitive therapy consists of 10-20 one-hour sessions with an appropriately trained cognitive behaviour therapist and so is an expensive alternative to antidepressants.
Interpersonal psychotherapy
This is a structured treatment that considers interpersonal problems, such as interpersonal deficits e.g. loneliness or role disputes. Problems are considered by reference to specific situations and alternative ways of coping are evaluated. Clear goals are set and progress towards them is monitored. New coping strategies are tried out in the homework assignments.
Relationship counselling and family therapy
This helps couples or families to talk constructively about problems in their relationships and focuses on the need for each person to understand the view, needs and feelings of the other person. Reciprocal negotiation and reframing the problem are commonly used techniques.
Dynamic psychotherapy
This reconstructs the origins of a psychiatric disorder in early life experience and looks for unconscious factors that account for the abnormal thinking, emotions and behaviour.
There are 2 main types:
- Brief – aims to produce limited but worthwhile changes within a year
- Psychoanalytical – takes place over a prolonged period
Social interventions
The following agencies or individuals can be involved.
- Voluntary agencies e.g. Depressive Alliance, provide support and practical help with a variety of problems [e.g. by befriending].
- The Citizen's Advice Bureau or a Social Worker can provide advice regarding managing debts.
- The prime function of Occupational Therapists is to maximise the independence of patients assessing their needs and prompting the restoration of the maximum use of function. In mental health conditions, they prepare patients to return to as full a life as possible in the community. This may involve psychology or behavioural programmes including group work, for example, desensitisation programmes for agoraphobia or social skills training for people with long-term mental disorders.
- Sheltered employment programmes provide a useful stepping-stone back to mainstream work.
- Psychiatric rehabilitation services aim to teach people the skills they need to cope outside hospital; then gradually to reintroduce them to life in the community.
