Treatment

1. Treatment goals

The treatment of depressive episodes must achieve three goals: ① Improve the clinical cure rate and minimize the disability rate and suicide The key is to completely eliminate clinical symptoms; ② improve the quality of life and restore social functions; ③ prevent recurrence.

2. Treatment principles

① Individualized treatment; ② Gradually increase the dose, using the smallest effective dose as much as possible to minimize adverse reactions and improve medication compliance; ③ Sufficient Use a sufficient amount of treatment; ④ Try to use a single drug as much as possible. If the effect is not good, you can consider switching treatment, synergistic treatment or combined treatment, but you need to pay attention to drug interactions; ⑤ Inform before treatment; ⑥ Closely observe changes in the condition and adverse reactions during treatment. And deal with it in time; 7. It can be combined with psychological treatment to increase the efficacy; 8. Actively treat other physical diseases, substance dependence, anxiety disorders, etc. related to depression and depression.

3. Medication treatment

Drug treatment is the main treatment for moderate or above depressive episodes. The first-line antidepressants currently in clinical use mainly include selective serotonin reuptake inhibitors (SSRIs, representing the drugs fluoxetine, paroxetine, sertraline, fluvoxamine, citalopram and escitalopram) , serotonin and norepinephrine reuptake inhibitors (SNRIs, representing the drugs venlafaxine and duloxetine), norepinephrine, and specific serotonergic antidepressants (NaSSA, representing the drugs mirtazone equality. The use of traditional tricyclic and tetracyclic antidepressants and monoamine oxidase inhibitors has been significantly reduced due to their serious adverse reactions.

4. Psychological treatment

For patients with depression who have obvious psychosocial factors, psychological treatment is often required along with drug treatment. Commonly used psychotherapy methods include supportive psychotherapy, cognitive behavioral therapy, interpersonal therapy, marriage and family therapy, psychodynamic therapy, etc. Among them, the efficacy of cognitive behavioral therapy on depressive episodes has been recognized.

5. Physical therapy

Modified electroconvulsive (MECT) therapy can be used for patients with severe passive suicide attempts and patients who are ineffective in treatment with antidepressants. After electroconvulsive treatment, maintenance medication is still required. In recent years, a new physical therapy method has emerged—repetitive transcranial magnetic stimulation (rTMS) therapy, which is mainly suitable for mild to moderate depressive episodes.

Prevention

A study that followed patients with depression for 10 years found that 75% to 80% of patients relapsed multiple times, so patients with depression need preventive treatment. If the disease occurs more than 3 times, long-term treatment should be carried out, and even lifelong medication should be taken. Most scholars believe that the dose of maintenance therapy drugs should be the same as the treatment dose, and regular outpatient follow-up observations should be performed. Psychotherapy and social support systems also play a very important role in preventing the recurrence of the disease. They should relieve or reduce the excessive psychological burden and pressure of patients as much as possible, help patients solve practical difficulties and problems in life and work, and improve patients' coping ability. And actively create a good environment for them to prevent recurrence.