In order to properly
diagnosis an individual with depression, they need a thorough
physical examination completed by a physician. There are medications
as well as certain medical conditions that can mimic or create
the same symptoms as depression; however, this may not be a
depressive syndrome. If a physical cause for the depression
is ruled out, a psychological evaluation should be done, by
the physician or by referral to a psychiatrist or psychologist.
A good diagnostic evaluation will include a complete history
of symptoms, i.e., when they started, how long they have lasted,
how severe they are, whether the patient had them before and,
if so, whether the symptoms were treated and what treatment
was given. The doctor should ask about alcohol and drug use,
and if the patient has thoughts about death or suicide. Further,
a history should include questions about whether other family
members have had a depressive illness and, if treated, what
treatments they may have received and which were effective.
Last, a diagnostic evaluation should include a mental status
examination to determine if speech or thought patterns or memory
have been affected, as sometimes happens in the case of a depressive
or manic-depressive illness. Treatment choice will depend on
the outcome of the evaluation. There are a variety of antidepressant
medications and psychotherapies that can be used to treat depressive
disorders.
Some people with milder forms may do well with psychotherapy
alone. People with moderate to severe depression most often
benefit from antidepressants. Most do best with combined treatment:
medication to gain relatively quick symptom relief and psychotherapy
to learn more effective ways to deal with life's problems, including
depression. Depending on the patient's diagnosis and severity
of symptoms, the therapist may prescribe medication and/or one
of the several forms of psychotherapy that have proven effective
for depression.
Electroconvulsive therapy (ECT) is useful; particularly
for individuals whose depression is severe or life threatening
or who cannot take antidepressant medication. ECT often is effective
in cases where antidepressant medications do not provide sufficient
relief of symptoms. In recent years, ECT has been much improved.
A muscle relaxant is given before treatment, which is done under
brief anesthesia. Electrodes are placed at precise locations
on the head to deliver electrical impulses. The stimulation
causes a brief (about 30 seconds) seizure within the brain.
The person receiving ECT does not consciously experience the
electrical stimulus. For full therapeutic benefit, at least
several sessions of ECT, typically given at the rate of three
per week, are required.
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