significant interpersonal loss. By contrast, in a major depressive episode, there is a more generalized depressed mood that is not specifically related to the loss. It should be noted that both prolonged grief disorder and major depressive disorder should Depending on the information gathered during the assessment phase, the treatment approaches may be biological (e.g., medication, brain stimulation therapies), psychological (e.g., psychotherapy), and social (e.g., Treatment Planning Clinicians should always try to implement evidence-based treatment practices when possible. Treatment for major depressive disorder includes biological, psychological, and social interventions. Clients may also be encouraged to exercise, as exercise has been shown to improve mild depressive symptoms and decrease mortality (Murri et al., 2019). Treatment for depression typically focuses on symptom reduction; however, clients often view returning to their previous functioning level as a primary concern (APA, 2019). Clinicians can help clients understand that, with time, treatment approaches can be helpful in reducing the symptoms that led to functional impairments in the first place. They should talk with clients about what the clients themselves would like to happen as a result of treatment and include those goals in treatment interventions (APA, 2019).
be diagnosed if the criteria for both are met.” https://www.psychiatry.org/getmedia/304e9a98- ca5c-4e04-97d7-30b4756705eb/APA-DSM5TR- Update-September-2022.pdf(American Psychiatric Association, 2022, p. 7)
TREATMENT
community support systems). Once an assessment is completed and a diagnosis is determined, the next step in the therapeutic process is individualized, evidence-based treatment planning. The National Institute of Mental Health (NIMH, 2023) reports that the most common forms of treatment for depression are psychopharmacology, electroconvulsive therapy (ECT), and psychotherapies such as CBT and interpersonal therapy (IPT). When medication and psychotherapy fail to relieve depressive symptoms, ECT may be effective (Li et al., 2020). When depressive symptoms are relatively mild, a client may seek psychotherapy alone to treat symptoms (NIMH, 2023). Although social therapies are not specifically mentioned by NIMH, social factors and struggles with social systems (as previously identified) may contribute to an individual client’s depressed mood. Helping clients to build a support network can help to prevent relapse or help to locate treatment early when symptoms first occur (Cruwys et al., 2013). Additionally, advocacy and other actions directed at alleviating other social stressors may be of direct benefit to clients, their families, and communities (Cruwys et al., 2013). obtain the most current information available, readers are encouraged to regularly check product information provided by the manufacturer of each drug and available from such sources as the U.S. Food and Drug Administration (https:// www.fda.gov/; Table 4). FDA-approved medications for the treatment of MDD are equally effective, though their side- effect profiles differ.
Biological Treatments Psychopharmacology
Psychopharmacology helps to balance brain chemistry by affecting neurotransmitters and is a common and effective treatment for depressive symptoms (Jones, 2023). References are made here to various medications used in the treatment of depression. Psychopharmacology treatments are frequently evaluated, changed, or discontinued, and new medications are introduced. To
Table 4: FDA-Approved Medications Antidepressant/Medication Class
Trade Names
Notes
Selective serotonin reuptake inhibitors (SSRIs)
fluoxetine, sertraline, citalopram, escitalopram, paroxetine, and fluvoxamine venlafaxine, duloxetine, desvenlafaxine, levomilnacipran, and milnacipran trazodone, vilazodone, and vortioxetine
First line treatment Most prescribed antidepressant class Used with comorbid pain disorders
Serotonin–norepinephrine reuptake inhibitors (SNRIs)
Serotonin modulators Atypical antidepressants
bupropion and mirtazapine
May augment SSRIs or SNRIs for patients who develop sexual side- effects Sedating effects may be helpful with sleep Limited use High incidence of side-effects Risk of lethality in overdose Used to enhance the effect of antidepressant • Nasal spray • Second-line treatment • Used to enhance the effects of antidepressant
Tricyclic antidepressants (TCAs)
amitriptyline, imipramine, clomipramine, doxepin, nortriptyline, and desipramine tranylcypromine, phenelzine, selegiline, and isocarboxazid
Monoamine oxidase inhibitors (MAOIs)
Other medications include mood stabilizers, antipsychotics
Esketamine
spravato
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