From the Guidelines
The first line of treatment for depression typically involves a combination of psychotherapy and medication, particularly selective serotonin reuptake inhibitors (SSRIs) or cognitive behavioral therapy (CBT), as recommended by the American College of Physicians 1.
Key Considerations
- The treatment of depression can be characterized by three phases: acute, continuation, and maintenance, with the goal of achieving remission and preventing relapse 1.
- Cognitive Behavioral Therapy (CBT) is a highly effective psychotherapy approach, typically involving weekly sessions for 12-16 weeks, which helps identify and change negative thought patterns that contribute to depression.
- Selective serotonin reuptake inhibitors (SSRIs) are commonly used medications, including fluoxetine (Prozac), sertraline (Zoloft), and escitalopram (Lexapro), which work by increasing serotonin levels in the brain to regulate mood.
- Lifestyle modifications, such as regular physical exercise, consistent sleep patterns, reduced alcohol consumption, and building social connections, are also important for managing depression.
Recommendations
- Clinicians should select between either cognitive behavioral therapy or second-generation antidepressants to treat patients with major depressive disorder after discussing treatment effects, adverse effect profiles, cost, accessibility, and preferences with the patient 1.
- Treatment should continue for at least 6-12 months after symptom improvement to prevent relapse.
- Regular monitoring of patient status, therapeutic response, and adverse effects of antidepressant therapy is crucial, beginning within 1 to 2 weeks of initiation of therapy 1.
From the FDA Drug Label
The efficacy of sertraline in the treatment of a major depressive episode was established in six to eight week controlled trials of adult outpatients whose diagnoses corresponded most closely to the DSM-III category of major depressive disorder Sertraline treatment should be administered at a dose of 50 mg once daily. A major depressive episode implies a prominent and relatively persistent depressed or dysphoric mood that usually interferes with daily functioning (nearly every day for at least 2 weeks); it should include at least 4 of the following 8 symptoms: change in appetite, change in sleep, psychomotor agitation or retardation, loss of interest in usual activities or decrease in sexual drive, increased fatigue, feelings of guilt or worthlessness, slowed thinking or impaired concentration, and a suicide attempt or suicidal ideation.
The first line of treatment for individuals experiencing symptoms of depression is sertraline at a dose of 50 mg once daily 2.
- Key symptoms of a major depressive episode include:
- Change in appetite
- Change in sleep
- Psychomotor agitation or retardation
- Loss of interest in usual activities or decrease in sexual drive
- Increased fatigue
- Feelings of guilt or worthlessness
- Slowed thinking or impaired concentration
- A suicide attempt or suicidal ideation
- Initial treatment should be administered at a dose of 50 mg once daily.
- Patients not responding to a 50 mg dose may benefit from dose increases up to a maximum of 200 mg/day 2.
From the Research
First Line Treatment for Depression
The first line of treatment for individuals experiencing symptoms of depression includes:
- Specific psychotherapies, such as cognitive behavioral therapy (CBT), interpersonal psychotherapy (IPT), psychodynamic psychotherapy (PDP), and problem-solving therapy (PST) 3
- Antidepressant medications, with second-generation antidepressants being the preferred first-line therapy 4
- A combination of medication and psychotherapy, which may be preferred for more severe or chronic depression 5, 6
Benefits of Combined Treatment
Combined treatment with medication and psychotherapy can:
- Improve response rates compared to monotherapy 5, 6
- Enhance the breadth and stability of treatment outcomes 5
- Reduce the risk of symptom return and improve interpersonal functioning 5, 3
Considerations for Treatment Selection
When selecting a treatment, considerations should include: