The variety of treatment for unipolar depression is being discussed below:

PSYCHOLOGICAL APPROACHES

in psychological approach there are two types of treatment methods, such as: psychodynamic therapy and cognitive-behavioral therapy.

 

A. PSYCHODYNAMIC THERAPY

Psychodynamic therapists believe that unipolar depression comes from hidden grief over real or imagined losses, along with too much dependence on others. Their goal is to help clients become aware of these hidden issues and deal with them.

Techniques used:

•          Free association

•          Interpreting client's associations

•          Interpreting dreams and resistance

•          Interpretation of transference

•          Helping the client to review past events and feelings

Short-term psychodynamic therapies have performed better than the longer-term approaches, especially when they are combined with psychotropic medications.

 

A. COGNITIVE-BEHAVIORAL THERAPY (CBT)

Cognitive-behavioral therapy combines both behavioral and cognitive methods to treat depression. On the behavioral side, therapists encourage clients to become more active and take part in enjoyable activities. On the cognitive side, they help clients change negative thinking into healthier, more balanced thoughts.

1. Behavioral Activation

Behavioral activation is a method where therapists try to increase the number of positive and rewarding activities in a client’s life.

Therapists usually do three things:

1.        Reintroduce clients to enjoyable events and activities.

2.        Reward healthy, non-depressive behaviors and avoid rewarding depressive behaviors.

3.        Teach clients better social skills.

Behavioral activation alone is only limited helpful, especially in cases of moderate to severe depression. But when it is combined with cognitive techniques, it usually becomes much more effective.

2. Beck’s Cognitive Therapy

Psychologist Aaron Beck created cognitive therapy, which helps clients recognize and change these negative thoughts. The treatment usually takes fewer than 20 sessions and follows four phases:

i.          Increasing Activities and Improving Mood: Therapists use behavioral methods to help clients become more active and confident. Clients make a detailed weekly schedule of activities to lift their mood.

ii.         Challenging Automatic Thoughts: Once clients feel a little better, therapists educate them to record, recognize and challenge their negative automatic thoughts.

iii.        Identifying Negative Thinking and Biases: Therapists show clients how illogical thinking patterns create negative thoughts. Clients learn to recognize and change the style of interpretation.

iv.        Changing Primary Attitudes: Finally, therapists help clients change attitudes that causes depression.

Research over the years shows that cognitive-behavioral approaches are very effective for depression. About 50–60% of people see major improvement or complete recovery.

 

New-Wave Cognitive-Behavioral Therapy

Newer forms of CBT, such as Acceptance and Commitment Therapy (ACT), use mindfulness and other strategies. Instead of changing negative thoughts, clients learn to observe and accept them as passing mental events, not truths that must control their behavior.

 

BIOLOGICAL APPROACHES

Biological treatment, such as antidepressant drugs and brain stimulation bring significant relief to people with unipolar depression.

 

A. Antidepressant Drugs

Four kinds of antidepressant drugs are used for it: 1. Monoamine oxidase (MAO) inhibitors 2. Tricyclics 3. Second-generation antidepressants 4. Ketamine-based drugs.

1. Monoamine oxidase (MAO) inhibitors: These slowed the body’s production of the enzyme monoamine oxidase (MAO). Thus they were called MAO inhibitors. Normally, brain supplies of the enzyme MAO break down the neurotransmitters serotonin and norepinephrine. MAO inhibitors Block the body's production of the enzyme MAO. These increase the activity level of the neurotransmitters serotonin and norepinephrine throughout the brain and, in turn, reduce depressive symptoms.

•          These helps 50% of patients who take it.

•          People who take MAO inhibitor drugs cannot eat foods with tyramine (like cheese, bananas, and some wines), because it can make their blood pressure rise to dangerous levels. So, they must follow a strict diet.

2. Tricyclics: Tricyclics have three rings in their molecular structure. Tricyclics function by blocking serotonin and norepinephrine reuptake, which allows these neurotransmitters to remain in their synapses longer and thus increases their stimulation of receiving neurons.

•          It Helps 50 to 60 percent of patients who take it.

•          After, discontinuing the drugs may result in relapsing.

3. Second-Generation Antidepressants: It is a third group of effective antidepressant drugs. These are structurally different from the MAO inhibitors and tricyclics. Most of these drugs are called selective serotonin reuptake inhibitors (SSRIs) because they increase serotonin activity, without affecting norepinephrine or other neurotransmitters. Other second-generation antidepressants are selective norepinephrine reuptake inhibitors which increase norepinephrine activity only, and serotonin– norepinephrine reuptake inhibitors which increase both serotonin and norepinephrine activity.

•          It Helps 50 to 60 percent of patients who take it.

4. Ketamine-based drugs: The fourth group of antidepressants are ketamine-based drugs. It Increases the activity of the neurotransmitter glutamate. It reduced depression symptoms very quickly and helps people who are unresponsive to other kinds of treatments and combines effectively with other antidepressant drugs and psychotherapies.

•          70 percent of persons with treatment resistant depression showed immediate improvement and their symptoms decreased.

•          Limitations: Short-term impact, addictive, expensive, can produce dizziness, confusion, memory problems, etc.

 

A. Brain Stimulation

Four types of brain stimulation techniques are used for treating unipolar depression. Those are:

1. Electroconvulsive Therapy (ECT):

This is a treatment for depression where electrodes are placed on a person’s head, and a small electric current is passed through the brain to cause a brain seizure.

Some experts think it is safe with few risks, while others worry it can cause memory problems or even brain damage. Despite the debate, ECT is still used often because it works quickly and can be very effective for treating severe depression.

Procedure:  During the procedure, two electrodes are placed on the head, and a brief electric charge (65–140 volts) is given for less than a second. This causes a seizure lasting 15–70 seconds. Usually, 6 to 12 sessions are given over 2 to 4 weeks. After this, most patients feel much less depressed.

ECT is the most effective brain stimulation method. Studies show that 50–80% of patients get better with ECT.

2. Vagus Nerve Stimulation:

A treatment for depression in which an implanted pulse generator sends regular electrical signals to a person’s vagus nerve, the longest nerve in the human body, which stimulates the brain.

3. Transcranial Magnetic Stimulation (TMS)::

A treatment in which an electromagnetic coil, which is placed on or above a patient’s head sends a current into the individual’s brain, in the prefrontal cortex.

4. Deep Brain Stimulation (DBS):

A treatment for depression in which a pacemaker powers electrodes that have been implanted in subgenual cingulate, thus stimulating that brain area.

 

SOCIO-CULTURAL APPROACHES

In this approach two groups of sociocultural treatments are used to treat unipolar depression. Those are:

A. Family Social Treatments:

In this method, Therapists help clients change how they deal with the close relationships in their lives. The most effective family-social approaches are interpersonal psychotherapy and couple therapy

1.        Interpersonal psychotherapy (IPT)

•          It takes any of four interpersonal problem areas may lead to depression and address that. Areas are:

o          interpersonal loss,

o          interpersonal role dispute,

o          interpersonal role transition,

o          interpersonal deficits

IPT and related interpersonal treatments for depression have a success rate similar to cognitive-behavioral therapy.

2.        Couple Therapy

•          It is a therapy format in which the therapist works with two people who share a long-term relationship.

•          Depression can result from marital discord, and recovery from depression is often slower for people who do not receive support from their spouse.

•          Therapists who offer integrative behavioral couples therapy combine cognitive-behavioral and sociocultural techniques.

B. Multicultural Treatments:

Culture-sensitive therapy focuses on the special problems faced by people from minority cultural groups. It looks at things like their cultural values, the stress they face because of their culture, and the prejudices or stereotypes against them.

This type of therapy is often used together with regular psychotherapy to make treatment more effective.