Treating Depression: Hospital Methods And Options

Depression is a serious mood disorder that can affect one's whole body, including mood and thoughts. Treatment for depression typically involves medication or therapy, or a combination of both. In some cases, hospitalisation may be necessary for safety or further care. This could be because the patient is at risk of hurting themselves or others, or is unable to function or take care of themselves. Hospitalisation may also be required for treatments that cannot be provided elsewhere, such as electroconvulsive therapy (ECT). During a hospital stay, patients will usually be seen by psychiatrists or a physician's assistant daily and may take part in group therapy.

Electroconvulsive therapy (ECT)

ECT is considered highly effective for treating severe depression, with clinical evidence indicating substantial improvement in approximately 80% of patients with uncomplicated but severe major depression. It is also used to treat other severe mental illnesses, such as bipolar disorder, schizophrenia, and catatonia. ECT can be especially useful for patients who are suicidal or are not responding to medications or their side effects.

Before undergoing ECT, patients should receive a thorough psychiatric assessment, a medical examination, and sometimes a basic blood test and electrocardiogram (ECG) to check heart health. Informed consent is crucial, and patients must provide written consent before the procedure.

ECT is generally safe, and modern methods use anaesthesia to minimise discomfort. However, it does not prevent the return of depression, and most patients will require maintenance treatment, such as medication, psychotherapy, or ongoing ECT treatments.

While the exact mechanism of ECT is not fully understood, it is believed to cause changes in brain chemistry or repair changes in the brain caused by severe, chronic depression.

Medication

Depression is a serious mood disorder that can affect one's whole body, including mood and thoughts. It is often treated with medicine, therapy, or a combination of both. Antidepressants are one of the most commonly prescribed medications for depression. They are prescription medications that can help treat the symptoms of depression, but they do not always address its causes. There are several types (or classes) of antidepressants, including:

Selective Serotonin Reuptake Inhibitors (SSRIs)

These are the most common type of prescribed antidepressants. They are designed to increase serotonin levels in the brain, which can enhance one's mood.

Serotonin/Norepinephrine Reuptake Inhibitors (SNRIs)

SNRIs work similarly to SSRIs by increasing serotonin levels in the brain, but they also increase norepinephrine levels, which can improve energy and alertness.

Tricyclic Antidepressants (TCAs)

TCAs are an older class of antidepressants that are often reserved for treatment-resistant depression due to increased rates of side effects. They work by blocking the reabsorption of serotonin and norepinephrine in the brain, leading to improved mood and energy.

Atypical Antidepressants

Atypical antidepressants do not fit neatly into other categories and may have unique mechanisms of action. They are often prescribed when other types of antidepressants have proven ineffective or poorly tolerated.

Serotonin Modulators

These medications primarily modulate serotonin receptors in the brain, which can help regulate mood and emotions.

Monoamine Oxidase Inhibitors (MAOIs)

MAOIs are the oldest type of antidepressants and are highly effective, but they are typically a last resort due to potential side effects and dietary restrictions. They work by inhibiting the enzyme monoamine oxidase, increasing the levels of serotonin and norepinephrine in the brain.

It is important to note that while antidepressants can be effective, they may also cause side effects. Patients should not stop taking their medication without consulting their healthcare provider. Additionally, combining certain medications or supplements with antidepressants can lead to unwanted side effects. Therefore, it is crucial to inform your healthcare provider about any other substances you are taking.

Group therapy

There are several types of group therapy, including interpersonal group therapy and psychodynamic group therapy. Interpersonal group therapy centres on the client's desire for secure relationships. Clients maintain parataxic distortions, which are perceptions based on the realities of their past. The therapist's role is to create a safe and supportive environment where these distortions can be explored and understood by the group. Psychodynamic group therapy was first developed by Wilfred Bion, an army psychiatrist during World War II, when there was a shortage of individual therapists.

When establishing a group, the therapist must consider several key factors, including the purpose of the group and how it will help clients. For example, the group may be formed in response to a specific traumatic event, such as a disaster, or to address a specific diagnosis, such as obsessive-compulsive disorder. The group should have enough similarity between members to allow for cohesion, with each member able to identify with at least one other. At the same time, sufficient heterogeneity can help the group function as a microcosm of the outside world.

Crisis counselling

Telephone crisis services, such as 24-hour crisis lines, are often the first point of contact. They offer assessment, screening, triage, preliminary crisis counselling, and referral services. Hotlines like the National Suicide Prevention Lifeline (988 in the US), the Samaritans (116 123 in the UK), or the Shout Crisis Text Line (text "SHOUT" to 85258 in the UK) provide confidential and immediate support.

Walk-in crisis services, including clinics or psychiatric urgent care centres, offer a less intensive setting than hospitals for individuals seeking help. They focus on resolving the crisis and may recommend hospitalization if necessary. Mobile crisis teams, on the other hand, intervene directly at the location of the crisis, often collaborating with police, crisis hotlines, and hospital emergency staff. They may act as gatekeepers for inpatient hospitalization and facilitate connections to community-based programs.

Crisis Stabilization Units (CSUs) are small inpatient facilities for individuals whose mental health needs cannot be safely met in residential settings. CSUs provide a safe and secure environment that is less restrictive than a hospital. They aim to stabilize individuals and reintegrate them into their communities as quickly as possible. Extended observation units (EOUs) are similar but are designed for shorter stays of less than 24 hours.

Long-term treatment programs

If a hospital care team believes that a patient can benefit from a long-term treatment program, they will facilitate their transfer to one. These long-term treatment programs generally last 30 to 45 days and involve working with a psychiatrist to ensure that the patient is taking the correct types and doses of medication to effectively treat their depression. The patient may also take part in electroconvulsive therapy (ECT), which is usually prescribed only when people do not respond to medication and talk therapy, meaning they have treatment-resistant depression. ECT is highly controlled and very safe.

During the discharge process, the patient can involve their family or friends if they want. It is recommended that the patient have a positive and helpful support system in place for their transition to being an outpatient. A social worker will also help the patient come up with a plan for continuing their treatment once they are discharged from the hospital.

Hospitalization is often necessary for safety or further care. Preventing suicide and violence is the most common reason for hospitalization. A stay in the hospital allows patients to get back in control and is especially helpful for people who are unable to function and take care of themselves. Hospitalization also makes sense for people who need observation when trying a new medication.

Frequently asked questions