In mental health treatment programmes for depression, most doctors prescribe drugs, usually antidepressants, such as selective serotonin re-uptake inhibitors or selective nor-adrenaline uptake inhibitors. They may also recommend Cognitive Behavioural Therapy (CBT).
Tranquillisers and sleeping tablets – both often benzodiazepines – may also be prescribed if there is a dual diagnosis of depression and anxiety. Mood-stabilisers, such as prescribed for bipolar disorder (manic depression), may be considered helpful in some cases.
However, controlled studies show little effectiveness for medications such as antidepressants over and above the placebo effect. Even so, general medical practitioners and psychiatrists continue to prescribe them in vast quantities. This is partly because they have been trained in pharmacological approaches and partly because generally they have little or no training in therapeutic methods that do not involve pharmaceutical drugs.
Psychologists and other mental health professionals commonly use specific therapies, such as CBT, Gestalt, Transactional Analysis, EMDR (Eye-Movement Desensitization and Re-processing), Psychodrama, Mindfulness, Cognitive Dialectical Therapy, Analytical Psychotherapy or whatever other clinical approach they believe to be most effective.
Rehabilitation services for depressive illness will vary according to the clinical therapeutic philosophy of each establishment. Some will prescribe antidepressants as a matter of course, perhaps in order to ensure cover by medical insurance companies who are fearful of suicide – or other untoward events – being blamed on inadequate therapeutic care.
Doctor Robert Lefever’s Real Recovery Rehab Services provides confidential rehab in the form of private residential inpatient or outpatient treatment, as may be appropriate for each individual patient.
Detoxification in a safe environment, gradually reducing a patient’s dependency upon mood-altering substances (especially for pharmaceutical drugs) can take many weeks and is therefore best carried out on an outpatient basis. Towards the end of the detox process, when patients tend to become more anxious over how they will cope without their chemical fix from prescription medication, the therapeutic sessions can be increased so as to provide the necessary psychological support.
Where social circumstances have contributed to the depression, these should be discussed, assessed and – if possible – alleviated or, at any rate accommodated as best they can be.
Rehab for depression should include a full clinical assessment for physical illnesses or nutritional deficiencies. A psycho-social assessment for the possibility of an underlying addictive tendency should also be made. The involutional melancholia – the deep sense of inner emptiness that affects people who have an addictive nature and which drives them to use mood-altering substances and processes – should be fully assessed. The Lefever Cross-Addiction Questionnaire differentiates addicts from the non-addictive population and shows the full range of an individual’s addictive outlets. All of these, including any tendency to use prescription drugs addictively, will need to be assessed. Depression and alcoholism commonly co-exist and they may be accompanied by drug addiction, eating disorders, love addiction, sex addiction, behavioural disorders, codependency and other forms of emotional challenge or mental illness.
Previous psychological trauma should be assessed and treated. Current stress and psycho-social difficulties should be evaluated and resolved wherever possible.
Family therapy in a specialist family programme may be very helpful and should be a part of any effective therapeutic intervention.
Relapse prevention programmes are as necessary in depression treatment as in addiction treatment of any kind in order to reduce the risk of long-term suffering.
Depression can be healed rather than drugged into submission or accepted as an inevitable part of future life. Appropriate diagnosis and proper treatments can lead to lasting recovery.