COMMENTARY

A Guide to Treating Depression

Matt A. Goldenberg, DO

Disclosures

December 08, 2014

In This Article

The Role of Psychotherapy

Psychotherapy is the most common initial treatment tool that I use with my patients who suffer from depression. There are numerous evidence-based therapies for depression. The type of therapy I use is specific to what the patients discuss during their initial evaluation and subsequent follow-up visits. I base the type and intensity of therapy on my patients' stressors, symptoms, and preference for the frequency of follow-up visits.

All of my patients receive supportive therapy. This is a type of therapy that you can easily incorporate into your visits with patients who are suffering from depression. At each appointment, I provide an empathic environment in which they can discuss any number of concerns and stressors in a supportive, nonjudgmental, and noncritical atmosphere. I seek to help my patients make their own connections and discover insights and solutions, while working to move forward through difficult problems and situations.

Some patients may have cognitive distortions that contribute to their depression. Examples include polarized ("black and white") thinking (in which patients feel that they are either perfect or a total failure, with no middle ground) or overgeneralization (in which patients draw general conclusions from a single incident—eg, if something happens once, they expect it to happen again and again).

With patients whose thought distortions are negatively affecting their mood, I use cognitive-behavioral therapy (CBT), which is designed to change these thought processes. If you identify such a patient, you can discuss CBT with them. In some cases, it can be of benefit to simply educate the patient regarding the connection between their thoughts, memories, and experiences and their feelings. In more severe cases, referral to a psychiatrist or a therapist who performs CBT is indicated.

If my patients have a history of trauma, a stressful childhood, or a pattern of poor functioning in a number of similar settings throughout their life, I may use psychodynamic psychotherapy. During these sessions, I work with patients to uncover their less obvious or subconscious beliefs, feelings, and memories. These factors often influence behavior, thoughts, and emotions without our knowledge. By identifying how memories and experiences are contributing to their current patterns of thought and behavior, my patients can better understand why they feel depressed or anxious, as we work to decrease this negative influence.

There are many other types of therapy I utilize, and several others to which I refer my patients in the community. Interpersonal psychotherapy can be very beneficial if relationships and social encounters are the root of stress, anxiety, and mood problems. Eye-movement desensitization and reprocessing can be very helpful for trauma and anxiety associated with depression. Dialectical behavioral therapy can be very useful in patients whose belief systems or patterns of interaction with those around them causes dysfunction of mood and behavior.

There are also intensive outpatient programs for the patients who are most negatively affected by depression and whose functioning is the most severely impaired. These programs meet several times during the week and for several hours each session. I advise that if my patient's depression is severe enough to cause a leave from work or impaired ability to carry out obligations at home, it warrants this more intensive therapy.

If you are the patient's general practitioner, I would not advise you to use these types of therapy unless you are trained to do so. However, now you can begin to educate your patients on how therapy is personalized to their specific needs.

If you are unsure about what type of therapy your patients would most benefit from, a referral to a psychiatrist can assist with recommendations of therapy options. The psychiatrist plays an instrumental role in making a formal diagnosis and formulating the treatment plan. In many cases, I perform therapy in my office; in other cases, I may refer my patient to another psychiatrist, a psychologist, or other therapist who specializes in a specific type of therapy.

The most important factor when selecting who your patient will go to for therapy is fit. They must feel that their therapist understands their concerns and provides a safe and supportive environment for healing. The second most important factor is the type of therapy used. A psychiatrist can be instrumental in helping you and your patients determine what type of therapy will provide them with the most benefit.

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