There are optimal practices to integrate drug and nondrug treatments for depression. The following points can facilitate understanding of the goals and procedure for this combined treatment.
- Psychotherapy should be considered for all patients being evaluated for antidepressant medication, either as an alternative to medication or as an augmenting tool.
- “Watchful waiting” works: A period of evaluation and symptom exploration prior to the prescription of a medication can help confirm diagnosis and treatment options.
- A careful history is essential prior to starting an antidepressant. Past histories of response to medication(s) or psychotherapy often dictate best options.
- Patients started on medication should be afforded a course of psychotherapy. CBT and Interpersonal Therapy have the largest evidence base.
- Clinicians should establish in advance a list of target symptoms for medication (e.g., energy levels, appetite, sleep patterns) and target symptoms for psychotherapy (e.g., despair/hopelessness, suicidal ideation, distorted cognitions, social withdrawal).
- These target symptoms should comprise elements of informed consent and should be charted throughout the treatment course to determine response to treatment and outcome goals.
- The response to medication is often more rapid than response to psychotherapy; psychotherapeutic effects often tend to persist after active treatment ends.
- For patients with new onset depression, remission (return to a depression-free state) is the overall target. For patients with chronic, relapsing depression, response to an agreed on set of key symptoms is often the target.
- Non-prescribing psychologists should make arrangements with prescribers in advance to coordinate care at critical points: Periods when medication is initiated and discontinued often require more intensive monitoring or intervention.
- Treatment adherence is highest when patients receive the treatment they prefer, so accurate informed consent is essential.
Sammons, M. T. (Presenter), & National Register of Health Service Psychologists (Producer). (2018, July). Combined treatments for depression: Evidence and interventions [Webinar].