Major depressive disorder (MDD) is a mental health condition often characterized by low mood and motivation, lethargy, and loss of interest in usual activities. There are many effective treatment options, including several types of psychotherapy and medications.
Psychotherapy is a form of treatment where patients work closely with their mental health providers to learn about their symptoms and how to overcome them.
While many types of psychotherapy are available to treat major depressive disorder, some are more effective than others. Several medications are also effective. A combination of antidepressant medication and psychotherapy is recommended for moderate to severe depression, or for people who have only partial or no response to any single treatment. This web page provides basic information about the treatments available in the Military Health System.
Cognitive Behavioral Therapy
Depression can be associated with negative patterns of thinking and behavior. Therapists use cognitive behavioral therapy (CBT) to help patients recognize these patterns and change unhelpful thoughts through a process called cognitive restructuring. Providers may also teach mindfulness and relaxation techniques, and other skills to help patients cope with negative feelings. This type of therapy often requires the patient to complete homework assignments. The purpose of the homework is to help patients increase activity levels, monitor thoughts and mood, and practice interpersonal skills learned during therapy sessions.
- How much time does it take? A usual course of CBT for depression lasts 16 to 20 sessions, depending on the severity of the depression
- Who does this therapy? Mental health providers trained in CBT
- Who does it work for? CBT is an effective treatment for adults with MDD
Interpersonal therapy (IPT) is a short-term therapy based on the idea that people may experience depression because of problematic relationships. The goal of interpersonal therapy is to help patients identify and solve current interpersonal problems, such as relationships with their family members, friends, or co-workers. Therapists work with patients to improve their communication and problem-solving skills to help resolve conflicts faster and improve their relationships with others. Improved relationships are thought to help reduce symptoms associated with depression. During this therapy, patients also learn how to appropriately respond to situations that may result in feelings of depression.
- How much time does it take? A usual course of IPT lasts 16 to 20 sessions
- Who does this therapy? This type of therapy should be conducted by a trained mental health provider and is usually available at mental health clinics
- Who does it work for? IPT is an effective treatment in adults with mild to moderate MDD
Problem Solving Therapy
Problem solving therapy (PST) is based on the idea that depression is caused, in part, by the everyday problems that lead patients to feel overwhelmed. Patients and providers work together to learn problem-solving techniques that can help them now, and in the future. During this therapy, patients gain an increased sense of control over their problems and experience a decrease in their levels of depression.
- How much time does it take? A course of PST usually lasts about six sessions and is delivered during a three-month period
- Who does this therapy? PST is used most frequently in primary care settings and can be delivered by primary care managers, mental health providers or nurses who have training in the therapy
- Who does it work for? PST is an effective treatment in adults with mild to moderate MDD
Antidepressant medications correct chemical imbalances in the brain that occur when a person is depressed. Many types of antidepressants are proven to improve depression. The PDF: Management of Major Depressive Disorder PDF recommend selective serotonin reuptake inhibitors and serotonin and norepinephrine reuptake inhibitors as first-line medications for MDD. These types of medications are effective in relieving symptoms and have relatively few side effects. Although antidepressant medications are not addictive, you should not stop taking them suddenly without the advice of your prescriber -- doing so may cause serious side effects, to include headaches, nausea and increased risk of suicide.
- How much time does it take? Medications require two to four weeks to take effect and should be taken for four to nine months after resolution of depression.
- Who prescribes antidepressant medications? Anti-depressants can be prescribed by your primary care manager or a psychiatrist in a mental health clinic.
- Who does it work for? Antidepressants are an effective treatment in adults with MDD.
Reference: Management of MDD Working Group, Department of Veterans Affairs & Department of Defense. (2009). VA/DoD clinical practice guideline of major depressive disorder (MDD) (Version 2.0-2008). Retrieved from: PDF: Management of Major Depressive Disorder