Treatment of depression
Almost 20% of people will experience a depression in their lifetime. To improve the quality of (mental) healthcare, clinical practices are increasingly being based on guidelines that are drafted at the direct or indirect initiative of national authorities. These guidelines tend to be widely encouraged and supported by the professions, often in consultation with patient/client associations and interest groups.
In the multidisciplinary evidence-based guidelines for depression (see the Trimbos Institute website www.ggzrichtlijnen.nl ), treatments are prescribed in order of preference based on the severity of symptoms, which results in so-called stepped-care protocols. Stepped care entails that people with a milder depression are to be offered low-intensity interventions first and those with a (more) severe depression more extensive treatments, where symptom severity needs to be regularly monitored (e.g. by self-report questionnaires) to allow a timely transition to a next, more intensive treatment step in case of insufficient response or recovery.
Four such symptom-based depression treatment protocols have been formulated that consider whether the current depression concerns a first-time or a recurrent episode (relapse) as well as symptom duration:
- First mild depressive episode lasting shorter than three months:Treatment is not indicated but psychoeducation and possibly self-management activities may be recommended as well as follow-up contact to monitor improvement.
- First or recurrent mild depressive episode lasting longer than three months: Again, psychoeducation and self-management activities are recommended as well as short-term psychological treatment (possibly online counselling). In case of a relapse, it is suggested to start the treatment that was effective in treating the first episode.
- First severe depressive episode: In addition to psychoeducation and self-management activities, depression-specific psychotherapy (e.g. cognitive-behavioural therapy or interpersonal therapy) or antidepressant medication is recommended.
- Recurrent severe depressive episode: In addition to psychoeducation and self-management activities, depression-specific psychotherapy (e.g. cognitive-behavioural therapy or interpersonal therapy) possibly in combination with antidepressant medication is recommended.
Specialised outpatient treatment of depression typically consists of combination therapy comprising both psychological and psychopharmacological treatment. The multidisciplinary guidelines consider cognitive-behavioural therapy or interpersonal therapy the treatments of first choice, while a stepped-care approach is recommended when it comes to antidepressants. If psychotherapy appears unfeasible due to the presence of too many disruptive stressors or when current treatment motivation is low, a brief sociopsychiatric treatment may be offered first.