New APA Guidelines for Treatment of Major Depression
I have loved treatment guidelines for as long as I can remember!
The first week at my first job as a therapist with children who had been abused, I can remember thinking, how has graduate school prepared me for this? I had no idea what I was doing.
Thankfully I had two great supervisors, Kimberly Kreuger and Christine Simpson who helped to teach me everything they know. I also stayed late hours photocopying books and articles that I found on their shelves and in their file cabinets and went to every conference I could.
Knowing the research has always provided me with some extra security that I was doing the right thing. Especially as a young therapist, I needed to feel confident that I had some idea what to do!
Guidelines are important in that they publish the most recent advances in evidence based practice.
This month the APA published the new and improved guidelines for major depressive disorder and it's treatment. Along with medication recommendations, they also suggest interpersonal therapy and cognitive behavioral therapy as effective treatment tools, exercise, and Electro Convulsive (Shock )Therapy.
What is Interpersonal Therapy?
Interpersonal therapy helps clients with delayed or distorted grief reactions and with the acceptance of difficulty emotions. It focuses on difficulties clients may have in relationships, difficulties with changes in roles and finally to bolster skills( such as communication skills or emotional regulation) which they may be lacking.
Interpersonal therapy is a fancy name for what good therapists do to help clients who are depressed. It emphasizes a focus on the present and assists clients to move out of patterns and habits that aren't working for them. Therapists also work to teach clients how to do things differently so perhaps they are less vulnerable to depression in the future. All of this needs to happen in the context of a safe and therapeutic relationship.
The guidelines also focus on Electro Convulsive (Shock) Treatment(ECT.)
I couldn't believe it when I learned a few years ago that ECT was considered a great treatment for resistant depression. I personally have witnessed it help four of my clients who were unresponsive to any other treatment. It can truly be a lifesaver for someone who has tried everything else and can get no relief from their pain.
The problem with exercise is that its really hard to do at the level necessary when you are in a major depression. I tell my clients when they are feeling healthy to make it a part of their schedule, so they can buffer themselves against depression in the future. It's hard to use that as a treatment technique when you can't really even get out of bed. Who wants to go to the gym, when you feel like getting dressed exerts about all the energy you have? I also find it can have a shaming effect on my clients, making them feel if only they would, they would get better.
I am excited for the new 152 page treatment guidelines to put in my file cabinet. Here is the link to the new guidelines!
10/2010 Major Depressive Disorder Guidelines