What works for depression? The exact active ingredients in the prevention and treatment of depression are as yet unknown. However, there are a number of points on which there is national and international consensus among researchers.
Prevention of depression
- Cognitive behavioural therapy is the most evidence-based method for preventing and reducing mood problems in children and adolescents. In adolescents, interpersonal therapy can also have a preventive effect.
- Selective and indicated depression prevention programmes generally have better effects than universal programmes.
- Prevention programmes work especially well if they are structured, with concrete goals, trained implementers and a relatively short duration (less than twelve sessions).
- Interactive elements (such as role-plays and group exercises), the involvement of children and young people themselves in the intervention and homework assignments can increase the effectiveness of prevention programmes.
- Programmes seem to be more effective when delivered by professionals (mental health or prevention) than, for example, by teachers.
- Demographic characteristics, such as age and gender, may influence the effects of preventive interventions, but more research is needed to make statements about this.
Treatment of depression
- For children and adolescents with mild depression, supportive treatment (e.g. psycho-education or self-help) should be chosen in the first instance, and this is often sufficient.
- For children and adolescents with moderate to severe depression, psychotherapy is very suitable. Cognitive behavioural therapy and interpersonal therapy are the best researched and most effective psychotherapeutic treatments.
- Activation (stimulating to do pleasurable activities) and the strengthening of problem-solving skills emerge as important elements in the psychotherapeutic treatment of depression. Other elements that often appear in effective treatments are self-monitoring, strengthening of social and communication skills, relaxation, cognitive restructuring and relapse prevention.
- Many demographic characteristics, such as intelligence, ethnicity or gender, do not seem to influence the effectiveness of psychotherapeutic treatment.
However, the severity of the symptoms may have a negative influence on the effectiveness of psychotherapeutic treatment and this may also apply to comorbidity.
- More sessions of cognitive behavioural therapy lead to greater treatment effects and booster sessions can also enhance the effect.
- In the case of severe depression, treatment with antidepressants can also be chosen. To date, the efficacy of only one antidepressant has been convincingly demonstrated, namely fluoxetine, a specific SSRI. It is important to accompany the treatment with medication with psycho-education, exercise activation and proper monitoring of symptoms.
Risk groups for depression
The six risk groups are:
- new mothers giving birth
- young people
- informal carers
- workers in stressful professions
- general practitioner patients
- chronically sick
More in-depth information: Treatment of depression
Depression does not come about at random and the consequences can be serious. Fortunately, however, depression is easy to treat. During the intake phase, we take a good look at your symptoms and the structure of your depression. Once we have an idea of which factors influence your symptoms, we can choose an appropriate treatment.
Treatment always begins with psycho-education. This means that you get an explanation of what depression is and how it is maintained. You, but usually also your family members, partners or friends, will receive advice on how you can deal with your depression. You will be given various lifestyle tips, for example in the area of sleeping, eating and exercising. With this, you can lay the foundation for dealing with your depression.
Treatment interventions for depression
There are various forms of treatment that work well for depression. You can work together with a therapist, but you can also follow treatment in a group. The following therapies are often used:
Cognitive behavioural therapy
During this therapy, you work in two areas: activation and cognitive therapy. Depression often makes you less active in hobbies or social activities because of fatigue and gloominess. While these activities are very important for a good mood! During treatment, you are encouraged to become more active again in small steps. This is not easy, because the depression wants to hold you back. But once you succeed, you will notice that you slowly start to feel better again. You also start to investigate your negative thoughts that cause a depressed mood: are they really true? You will learn to have more realistic and helpful thoughts. You will practise this both in the treatment sessions and at home. As you get a more realistic view of things, your mood will improve.
The KOP model
This model assumes that your depression has to do with the circumstances in your life and how you as a person deal with these circumstances. The latter we call your ‘personal style’. When you have depression, you can think of a personal style of, for example, perfectionism, disaster thinking, difficulty setting boundaries or the tendency to bury your head in the sand. In this treatment, you and your therapist will map out which circumstances and personal style are important in your depression. This will give you a better understanding of your depression and you will feel less powerless. Next, you set goals that can be aimed at the symptoms, circumstances or personal style. The emphasis will be on changing your personal style. It is not about making drastic changes in who you are, but about taking it down a notch. Saying ‘no’ more often or being satisfied with good enough can make you feel a lot less depressed.
Interpersonal therapy (IPT)
Everyone needs good social contacts in order to feel good. IPT assumes that drastic changes in important relationships with others can trigger depression. Examples of such changes are the death of an important loved one, a marriage or work conflict, or a new social role after a divorce or job change. It is also possible that you have difficulty maintaining relationships so that a lack of social contact plays a part in your depression. This therapy focuses on examining how contact with significant others works and how this is related to feelings of depression. Then, we tackle your social problem. By learning, for example, conversation skills, ways of solving conflicts or expanding social contacts, your relationships with others are improved.
Treating depression with medication
In some cases, it is necessary to combine talk therapy with medication, such as antidepressants.
An important part of depression treatment: relapse prevention
At the end of treatment, we pay attention to relapse prevention. Recovering from depression involves trial and error. It is therefore possible that your depressive feelings return after a while. This does not mean that you are back to square one, but that you have to consciously apply the therapy techniques you have learned. If you make a plan for this beforehand, it is the easiest way to deal with your relapse. In the concluding phase of treatment, you learn to recognise the signs of a relapse and how to respond appropriately. In this way, you can conclude your therapy with confidence in the future.
Thank you for reading – Depression treatment and prevention: Expert tips –