Treat Depression By Subtype
Depression has become so prevalent that it's now the fourth most common complaint among patients seen by their primary care physicians. That means that around one in every primary care patients presents with symptoms of depression. But the diagnosis is only the beginning.
Choosing the right treatment for the individual patient can be very tricky. Primary care physicians tend to turn to medication as the first line of treatment. There's a good reason for this course of action, since 70% of those patients respond well to the first medication they try.
Serotonin reuptake inhibitors (SSRI's) tend to be well-tolerated by patients and there is little chance that patients can succumb to an overdose. That makes them a popular choice as a first-line treatment. However, if the SSRI's fail to achieve a reduction in symptoms, doctors often have a hard time figuring out what to try next.
One way for the physician to maximize the chances that he will choose the right treatment for the patient is to categorize treatments according to specific depressive symptoms and subtypes. Such treatment recommendations are still being refined.
Research on the topic is not very dependable. That's because even though most of the studies have been well-designed, they tend to involve only a small number of participants and are performed over a short time span. Also, studies need to be replicated by other studies and this has not been done with research on treatments for depression. An additional issue is that the use of some of the treatments being researched is still considered off-label for depression.
It's important to stress that depression will manifest in different ways from patient to patient. Identifying the different features of depression will help to clarify a patient's treatment options. Separating depression into subtypes isn't an easy act. The categories are separated not only by symptoms but by severity and time frames. The physician is served well by identifying specific symptoms associated with known subtypes of depression such as catatonic, atypical, hormonal, melancholic, or seasonal depression.
In brief, catatonic depression responds best to electroconvulsive therapy (ECT), melancholic depression responds best to tricyclic antidepressants (TCA), while atypical depression, Seasonal Affectation Disorder (SAD), and hormonal depressions such as postpartum or premenstrual dysphoric syndrome are all served well by treatment with SSRI's. Bipolar depression responds well to mood stabilizers as the first line of treatment, with lithium being the most common choice.
This is a very general outline for treatment and individual contraindications may force the physician to try a different medication as the first-line of treatment. It may take some time to find the ideal method of treatment for the individual suffering from depression.