Depression and Anxiety Treatment
Many of these women will not actively seek treatment for depression and anxiety symptoms; therefore, it is the responsibility of all concerned to be aware of such outcomes.
Treatment options for patients with mood disorders include psychotherapy, pharmacotherapy, combined psychotherapy and pharmacotherapy, and combination pharmacologic therapy.
1. Psychotherapeutic Options
Of the available psychotherapeutic treatment options, cognitive-behavioural therapy CBT), alone or in combination with pharmacotherapy, has the best evidence in its favour.
2. The Pharmacologic Approach
There is strong evidence for the efficacy of the SSRIs in treating depression and anxiety, but the serotonin- norepinephrine reuptake inhibitors (SNRIs), tricyclic antidepressants (TCAs), and monoamine oxidase inhibitors (MAOIs) are effective as well. Costs are of concern in Fiji, when we consider medication choices.
Getting to Remission
Remission of symptoms is the established goal of acute-phase treatment Chief among the barriers to remission are psychiatric and medical co morbidity, psychosocial stress, inherited vulnerability, and insufficient treatment intensity. Health-care practitioners cannot change factors such as inherited vulnerability and the ability to modify psychosocial stress is limited. Clinicians can, however, modify treatment intensity and some aspects of co morbid conditions, especially psychiatric ones.
Patients need to be educated and clinicians also need to match the patient’s requests for treatment with the interventions that offer the best chances of recovery. Understanding patients’ belief systems, cultural notions, and perceptions of their illness is essential. Attention to a patient’s literacy level is crucial when distributing patient-education materials.
Long Term Approaches
Depression and anxiety are chronic diseases requiring long-term follow-up and treatment. The clinical focus after the acute phase shifts to concerns for long-term care. Goals of longterm treatment of mood disorders include:
- Minimizing relapses and recurrences
- Progressing from response to remission
- Improving treatment adherence with antidepressant therapy and other medical and psychiatric treatments
- Minimizing and managing side effects of medications
- Slowing the progression of psychiatric and medical illnesses.
Depression and anxiety are common in the community. They are frequently un-diagnosed and are a source of morbidity and mortality. Both conditions increase the risk of suicide, increase the use of health-care resources, cause occupational impairment, and often become chronic. With increasing stress in modern day living, we need to support each other and assist in maintaining positive health in the community. A psychiatric condition can present in up to 20% of the population, in some form at some stage of their life.