treatment for major depressive disorder

Family therapy has also been used to treat severe forms of depression associated with medications and hospitalization[91]. Treatment of Major Depressive Episode Among Adults. 2016;2:16065. doi:10.1038/nrdp.2016.65, Kupfer DJ, Frank E, Phillips ML. Exercise and severe major depression: effect on symptom severity and quality of life at discharge in an inpatient cohort. Omori W, Itagaki K, Kajitani N, Abe H, Okada-Tsuchioka M, Okamoto Y, Takebayashi M. Shared preventive factors associated with relapse after a response to electroconvulsive therapy in four major psychiatric disorders. Brief psychotherapy for depression: a systematic review and meta-analysis. Symptoms must cause significant distress or functional impairment. American Psychiatric Association. 2019;36(4):294-304. doi:10.1002/da.22867, Yang L, Zhao Y, Wang Y, et al. These triggers may include losses, social isolation, or difficulties in social interactions. Use of pharmacogenetic testing to guide medication choice does not appear to improve treatment outcomes. Tranylcypromine. This efficacy can be explained by the superiority of TCAs over SSRIs for patients with severe major depressive disorder (MDD) symptoms who require hospitalization[21-24]. Ignoring the symptoms of depression and leaving it untreated can lead to self-harm or death. Verywell Mind's content is for informational and educational purposes only. This type of therapy focuses on intrapsychic conflicts related to shame, repressed impulses, problems in early childhood with ones emotional caretakers that lead to low self-esteem and poor emotional self-regulation[93,95]. However, some TCAs can be more effective than SSRIs when used to treat hospitalized patients[20]. Evidence for ketamine and esketamine (Spravato) is limited to patients with persistent depression. Despite its small effect sizes, PST is comparable to other psychotherapeutic methods used to treat depression[88,90]. Accessibility Twohig MP, Levin ME. CCBT and guided bibliotherapy based on CBT could be considered for self-motivated patients with mild to moderate major depression or as a complementary treatment to pharmacotherapy[25]. Swiatek KM, Jordan K, Coffman J. Copyright 2023 by the American Academy of Family Physicians. These questionnaires are recommended for older adults because of similar sensitivity to geriatric-specific screening tools. Schuch FB, Vasconcelos-Moreno MP, Borowsky C, Zimmermann AB, Rocha NS, Fleck MP. In most systematic reviews and meta-analyses, SSRIs have demonstrated comparable efficacy to TCAs[18,19,29], and there is no significant evidence indicating the superiority of any other class or agent over SSRIs[29-31]. However, studies are still lacking in this domain. Some simple techniques were developed to overcome this issue, especially in primary care management. Nausea and vomiting were the most common reasons for treatment discontinuation; sexual dysfunction, sedation, priapism, and cardiotoxicity were also reported[31,41]. Department of Psychiatry, Moulay Ismal Military Hospital, Faculty of Medicine and Pharmacy, Sidi Mohamed Ben Abdellah University, Fez 30070, Morocco, Department of Psychiatry, Faculty of Medicine, Mohammed VI University of Health Sciences, Casablanca 20000, Morocco, Department of Psychiatry, Moulay Ismal Military Hospital, Faculty of Medicine and Pharmacy, Sidi Mohamed Ben Abdellah University, Fez 30070, Morocco. . IPT, like CBT, is a first-line treatment for mild to moderate major depressive episodes in adults; it is also a well-established intervention for adolescents with depression[25]. Meta-analysis: pharmacologic treatment of obesity. Depression is a common psychiatric disorder and a major contributor to the global burden of diseases. CSF neurochemicals during tryptophan depletion in individuals with remitted depression and healthy controls. Exercise also promotes improvements in ones quality of life in general[105]. They have elicited different tolerance rates and side effects-mostly sexual and digestive (nausea and loss of appetite), as well as irritability, anxiety, insomnia, and headaches[27]. [email protected], Corresponding author: Yassine Otheman, MD, Associate Professor, Chief Doctor, Department of Psychiatry, Moulay Ismal Military Hospital, Faculty of Medicine and Pharmacy, Sidi Mohamed Ben Abdellah University, 1893, Km 2.2 road of Sidi Hrazem, Fez 30070, Morocco. Marital therapy includes both members of the couple, as depression is considered in an interpersonal context in such cases. Trials have demonstrated that MAOIs efficacy is comparable to that of tricyclic antidepressants (TCAs)[10,11]. Studies have shown that eight weeks of MBCT treatment during remission reduces relapse. Li M, Yao X, Sun L, Zhao L, Xu W, Zhao H, Zhao F, Zou X, Cheng Z, Li B, Yang W, Cui R. Effects of Electroconvulsive Therapy on Depression and Its Potential Mechanism. The https:// ensures that you are connecting to the Zakaria Hammani, Department of Psychiatry, Moulay Ismal Military Hospital, Faculty of Medicine and Pharmacy, Sidi Mohamed Ben Abdellah University, Fez 30070, Morocco. Schema therapy is another CBT-derived therapy that can be used in patients who have failed classical CBT, like patients with personality disorder comorbidity. Allen NB. ECT remains the most documented and effective method in this category[151]. Because St. Johns wort is an herbal medication, dosing may not be consistent among formulations. Moreover, ECT is considered safe[113]. Population-based study of first onset and chronicity in major depressive disorder. Federal government websites often end in .gov or .mil. VNS involves the implantation of a pacemaker under the collarbone that is connected to an electrode surrounding the left vagus nerve. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. http://creativecommons.org/Licenses/by-nc/4.0/, https://www.who.int/healthinfo/global_burden_disease/2004_report_update/en/, https://www.researchgate.net/directory/publications, Confirmed the role of monoaminergic transmission in depression, Led to a new search methodologies to develop new antidepressants, Efficacy in patients with more severe symptoms of MDD, Cardiovascular toxicity and anticholinergic side effects. Magnetic seizure therapy improves mood in refractory major depression. Overview of psychotherapy in different clinical situations of depression. Problem-solving therapy: The problem-solving therapy (PST) approach combines cognitive and interpersonal elements, focusing on negative assessments of situations and problem-solving strategies. Aaronson ST, Carpenter LL, Conway CR, Reimherr FW, Lisanby SH, Schwartz TL, Moreno FA, Dunner DL, Lesem MD, Thompson PM, Husain M, Vine CJ, Banov MD, Bernstein LP, Lehman RB, Brannon GE, Keepers GA, O'Reardon JP, Rudolph RL, Bunker M. Vagus nerve stimulation therapy randomized to different amounts of electrical charge for treatment-resistant depression: acute and chronic effects. Family therapy uses similar principles as other forms of therapy while involving all family members and considering depression within the context of pathological family dynamics[93]. Leicester (UK): British Psychological Society; 2010. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. So don't give up. In more severe cases of a depressive episode, hospitalization may be required, especially if the individual poses a risk of self-harm or suicide. The mortality rate of electroconvulsive therapy: a systematic review and pooled analysis. Treatment can reduce the symptoms, help you cope, and enable you to function on a day-to-day basis. This series is coordinated by Michael J. Arnold, MD, contributing editor. Lozano AM, Mayberg HS, Giacobbe P, Hamani C, Craddock RC, Kennedy SH. However, no differences have been detected in outpatients who are considered less severely ill[18,20]. Sack RL, Lewy AJ, White DM, Singer CM, Fireman MJ, Vandiver R. Morning. Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Bennabi D, Charpeaud T, Yrondi A, Genty JB, Destouches S, Lancrenon S, Alali N, Bellivier F, Bougerol T, Camus V, Dorey JM, Doumy O, Haesebaert F, Holtzmann J, Lanon C, Lefebvre M, Moliere F, Nieto I, Rabu C, Richieri R, Schmitt L, Stephan F, Vaiva G, Walter M, Leboyer M, El-Hage W, Llorca PM, Courtet P, Aouizerate B, Haffen E. Clinical guidelines for the management of treatment-resistant depression: French recommendations from experts, the French Association for Biological Psychiatry and Neuropsychopharmacology and the fondation FondaMental. The effects of psychological stress on depression. Psychological Treatment of Depression in Primary Care: Recent Developments. Work group on major depressive disorder, 2010: 152. CBT is also a promising option for elderly depressed patients, though substantial evidence is still lacking because of the limited data on the subject[88]. All these therapeutic options are summarized in Figure Figure11. Depression-focused psychotherapy is typically considered the initial treatment method for mild to moderate MDD. Wiles NJ, Fischer K, Cowen P, Nutt D, Peters TJ, Lewis G, White IR. You can reach out to a mental healthcare provider or contact your primary care doctor for a diagnosis or referral. Antidepressant prescribing in five European countries: application of common definitions to assess the prevalence, clinical observations, and methodological implications. Liu Y, Lin D, Wu B, Zhou W. Ketamine abuse potential and use disorder. Adverse effects are less common than with standard antidepressants and include gastrointestinal upset, mild sedation, restlessness, photosensitivity, and serotonin syndrome. In many situations, depression can also be managed via somatic treatments. However, VNS has demonstrated progressively increasing improvements in depressive symptoms, with significant positive outcomes observed after six to 12 mo; these benefits can last for up to two years[143]. Tursi MF, Baes Cv, Camacho FR, Tofoli SM, Juruena MF. Here we raise several concerns regarding the Review by Steven Marwaha and colleagues.1 First, the concept of treatment-resistant depression does not have reliable criteria for research and is conceptually empty. Continuing medications for at least six months after symptom remission will reduce relapse by nearly one-third. The current lack of guidelines about the therapeutic monitoring of ketamine treatment for depression further complicates the expanding use of this treatment[56]. Gartlehner G, Gaynes BN, Hansen RA, Thieda P, DeVeaugh-Geiss A, Krebs EE, Moore CG, Morgan L, Lohr KN. Thus, it is a potential alternative to reduce, or even stop, antidepressant treatment without increasing the risk of depressive recurrence, especially for patients at a high risk of relapse (i.e., patients with more than two previous episodes and patients who have experienced childhood abuse or trauma)[102]. If you suspect you may have depression, youre not alone. Preliminary research has revealed synergistic (e.g., rTMS/quetiapine) and antagonizing (e.g., rTMS/cannabinoid receptor (CB1) antagonist) interactions between neuro-modulation and pharmacotherapy[128]. The role of ECT in suicide prevention. Scope. Honagodu AR, Krishna M, Sundarachar R, Lepping P. Group psychotherapies for depression in persons with HIV: A systematic review. Monoamine depletion in psychiatric and healthy populations: review. These are some of the types of therapy that can help treat depression: You should expect to start feeling better after the first 10 to 15 sessions of therapy. However, they appear to produce less sexual dysfunction and, in the specific case of vortioxetine, have particular benefits in depression-related cognitive impairment[49]. Bobo WV, Vande Voort JL, Croarkin PE, Leung JG, Tye SJ, Frye MA. Common adverse effects of ketamine include dizziness, neurotoxicity, cognitive dysfunction, blurred vision, psychosis, dissociation, urological dysfunction, restlessness, headache, nausea, vomiting, and cardiovascular symptoms[58]. Neuro-modulation treatments offer a range of treatment options for patients with depression. In most cases, TCAs should generally be reserved for situations when first-line drug treatments have failed[25]. Cipriani A, Furukawa TA, Salanti G, Geddes JR, Higgins JP, Churchill R, Watanabe N, Nakagawa A, Omori IM, McGuire H, Tansella M, Barbui C. Comparative efficacy and acceptability of 12 new-generation antidepressants: a multiple-treatments meta-analysis. 2015;13(4):494-504. doi:10.2174/1570159X1304150831150507, Rosenblat JD, Kurdyak P, Cosci F, et al. Efficacy of duloxetine and selective serotonin reuptake inhibitors: comparisons as assessed by remission rates in patients with major depressive disorder. Depression in the medically ill. Aust N Z J Psychiatry. TCAs-such as amitriptyline, nortriptyline, protriptyline, imipramine, desipramine, doxepin, and trimipramine-are about as effective as other classes of antidepressants-including SSRIs, SNRIs, and MAOIs-in treating major depression[18,19]. Johns Hopkins Medicine. Orsolini L, Tomasetti C, Valchera A, Iasevoli F, Buonaguro EF, Fornaro M, Fiengo ALC, Martinotti G, Vellante F, Matarazzo I, Vecchiotti R, Perna G, Di Nicola M, Carano A, Di Bartolomeis A, De Giannantonio M, De Berardis D. Current and Future Perspectives on the Major Depressive Disorder: Focus on the New Multimodal Antidepressant Vortioxetine. Its important to seek treatment for depression as soon as possible, because the earlier it is treated, the more effective the treatment can be. Comparative Efficacy and Acceptability of 21 Antidepressant Drugs for the Acute Treatment of Adults With Major Depressive Disorder: A Systematic Review and Network Meta-Analysis. Ketamine is not a miracle drug, and many important factors still need to be defined, such as the most effective dose and the optimal administration route[61,62]. Behavioral activation is one such technique, consisting of integrating pleasant activities into daily life to increase the number and intensity of the positive interactions that the patient has with their environment[82,83]. Tranylcypromine. Systematic review and guide to selection of selective serotonin reuptake inhibitors. Raskin A, Crook TH. Currently available SNRIs are venlafaxine, desvenlafaxine (the principal metabolite of venlafaxine), and duloxetine. Nemeroff CB, Entsuah R, Benattia I, Demitrack M, Sloan DM, Thase ME. Ketamine for treatment-resistant depression: recent developments and clinical applications. Collaborative care models, which include multiprofessional care, structured management, scheduled follow-up, and interprofessional communication, improve patient symptoms and satisfaction over usual care. If the depression persists, brain stimulation may help. Klier CM, Muzik M, Rosenblum KL, Lenz G. Interpersonal psychotherapy adapted for the group setting in the treatment of postpartum depression. Nuninga JO, Mandl RCW, Boks MP, Bakker S, Somers M, Heringa SM, Nieuwdorp W, Hoogduin H, Kahn RS, Luijten P, Sommer IEC. Therapeutic modalities for treatment resistant depression: focus on vagal nerve stimulation and ketamine. Psychotherapy, or talk therapy, can help treat depression. F. Cunningham LA, Borison RL, Carman JS, Chouinard G, Crowder JE, Diamond BI, Fischer DE, Hearst E. A comparison of venlafaxine, trazodone, and placebo in major depression. Nearly 7% of U.S. adults -- 15 million Americans -- suffer depression each year. According to the World Health Organization, depression is the second-leading cause of disability in the world and is projected to rank first by 2030[1]. De Risio L, Borgi M, Pettorruso M, Miuli A, Ottomana AM, Sociali A, Martinotti G, Nicol G, Macr S, di Giannantonio M, Zoratto F. Recovering from depression with repetitive transcranial magnetic stimulation (rTMS): a systematic review and meta-analysis of preclinical studies. Depression. 2020;54(4):346-366. doi:10.1177/0004867419888576. For example, an individual participant level of analysis of clinical . ECT reduces the number of hospital readmissions and lightens the burden of depression, leading to a better quality of life[111,112]. Treatment for depression may involve medication, therapy, or brain stimulation. Indeed, vortioxetine is a very recent antidepressant with a multimodal mechanism that is thought to have a high affinity for serotonin transporters and 5-HT3, 5HT1A, 5HT7 receptors. Prediction of major depressive disorder onset in college students. Interventions delivered by telehealth appear to be as effective as in-person treatment. Major depressive disorder: new clinical, neurobiological, and treatment perspectives. Moderate to severe cases of depression may be treated with a combination of medication and psychotherapy. Roukaya Benjelloun, Department of Psychiatry, Faculty of Medicine, Mohammed VI University of Health Sciences, Casablanca 20000, Morocco. See permissionsforcopyrightquestions and/or permission requests. Group CBT for patients with subthreshold depression is an effective post-depressive-symptomatology treatment but not during the follow-up period[99]. Part I: monoamine oxidase inhibitors. In more cases of severe depression, ST and PEI are used only to augment pharmacological treatments. Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for mood disorders. The origins and current status of behavioral activation treatments for depression. Treatment of depression with atypical features: a meta-analytic approach. The current practice of ECT continues to improve as protocols become more advanced, mainly owing to bioinformatics, and as more research is carried out in this domain[121-125]. Culpepper L, Kovalick LJ. National Institute of Mental Health. Pharmacotherapy of depression: a historical analysis. This article explores effective and valid therapies for treating depression by addressing current and future research topics for different treatment categories. Latest findings in LIFU for major depressive disorder. Nat Rev Dis Primers. Rush AJ, Marangell LB, Sackeim HA, George MS, Brannan SK, Davis SM, Howland R, Kling MA, Rittberg BR, Burke WJ, Rapaport MH, Zajecka J, Nierenberg AA, Husain MM, Ginsberg D, Cooke RG. Several other MAOIs have been introduced since 1957[8]. ECT in pregnancy: a review of the literature from 1941 to 2007. Gelenberg AJ, Freeman MP, Markowitz JC, Rosenbaum JF, Thase ME, Trivedi MH, Van Rhoads RS, Depaulo JR, Schneck CD. Trazodone: a 5-year review of antidepressant efficacy. Content is reviewed before publication and upon substantial updates. Major depression. Lower tolerability (highest rates of nausea, vomiting, and sexual dysfunction), A better tolerability profile (minimal weight gain or even weight loss). Experimental medication treatment approaches for depression. Nevertheless, psychiatrists use of MAOIs has declined over the years[15,16]. It has been shown to be an effective antidepressant in placebo-controlled research. Psychotherapy for patients with depression strengthens the therapeutic alliance and enables the patient to monitor their mood, improve their functioning, understand their symptoms better, and master the practical tools they need to cope with stressful events[75]. Zhu W, Ding Z, Zhang Y, Shi J, Hashimoto K, Lu L. Risks Associated with Misuse of Ketamine as a Rapid-Acting Antidepressant. Depression, or major depressive disorder, is a . Alonzo A, Fong J, Ball N, Martin D, Chand N, Loo C. Pilot trial of home-administered transcranial direct current stimulation for the treatment of depression. Efficacy and acceptability of transcranial direct current stimulation (tDCS) for major depressive disorder: An individual patient data meta-analysis. Bolton P, Bass J, Neugebauer R, Verdeli H, Clougherty KF, Wickramaratne P, Speelman L, Ndogoni L, Weissman M. Group interpersonal psychotherapy for depression in rural Uganda: a randomized controlled trial. The treatment modalities chosen can depend on the severity of the depression and your individual needs. Clinical depression (major depressive disorder): A diagnosis of major depressive disorder means you've felt sad, low or worthless most days for at least two weeks while also having other symptoms such as sleep problems, loss of interest in activities or change in appetite. Li Z, Maglione M, Tu W, Mojica W, Arterburn D, Shugarman LR, Hilton L, Suttorp M, Solomon V, Shekelle PG, Morton SC. It is easy to use, safe, and tolerable[131]. Lab tests. Meta-regression analysis. Prudic J, Sackeim HA, Devanand DP. Although antidepressants may not cure depression, they can reduce symptoms. Efficacy and safety of electroconvulsive therapy in depressive disorders: a systematic review and meta-analysis. How Depression Is Diagnosed According to the DSM-5, Moderate Depression: Symptoms, Treatment, and Coping, How Treatment-Resistant Depression is Treated, Psychomotor Retardation: Symptoms, Causes, Treatment, Daily Tips for a Healthy Mind to Your Inbox, Major depressive disorder: new clinical, neurobiological, and treatment perspectives, Prediction of major depressive disorder onset in college students, The effects of psychological stress on depression, Feeling worthless, hopeless, or pessimistic, Feeling restless, frustrated, or irritated, Losing interest in things you once enjoyed, Having difficulty paying attention, remembering, or making decisions, Having difficulty sleeping, waking up too early, or oversleeping, Experiencing unplanned changes in eating habits and weight, Experiencing headaches, cramps, digestive issues, or other aches and pains that dont have a clear cause and dont get better with treatment, Having a persistently depressed mood and lack of interest in activities, Having five or more symptoms of depression, Having symptoms every day, almost all day, Being unable to function like you did before, due to the symptoms, Share your feelings with close friends and family members, Understand that recovery may be gradual, so set, Postpone important decisions until you feel better. This article explores the symptoms, causes, and diagnosis of major depressive disorder, as well as some treatment options and coping strategies that may be helpful. Carneiro LF, Mota MP, Schuch F, Deslandes A, Vasconcelos-Raposo J. Portuguese and Brazilian guidelines for the treatment of depression: exercise as medicine. It can affect how you feel and your ability to function on a day-to-day basis. For mild cases of depression, your healthcare provider may recommend only psychotherapy, whereas for moderate to severe cases, a combination of medication and therapy may be recommended. Conflict-of-interest statement: All authors declare that they have no conflict of interest related to this article. The apgar score revisited. Papakostas GI, Homberger CH, Fava M. A meta-analysis of clinical trials comparing mirtazapine with selective serotonin reuptake inhibitors for the treatment of major depressive disorder. However, for individuals with low to moderate levels of anxiety, the efficacy of bupropion in treating MDD is comparable to that of SSRIs[46]. Psychotherapy for Major Depressive Disorder and Generalized Anxiety Disorder: A Health Technology Assessment. Effectiveness of problem-solving therapy for older, primary care patients with depression: results from the IMPACT project. Otte C, Gold SM, Penninx BW, et al. Safety profile is similar to SSRIs, The most commonly reported adverse effect was nausea, Less sexual dysfunction (low evidence). Since the turn of the century, numerous studies have demonstrated the efficacy of VNS in resistant depression[140-142]. (2018). Gonda X, Sharma SR, Tarazi FI. Major depression. Therapeutic Modulation of Glutamate Receptors in Major Depressive Disorder. Wei Y, Zhu J, Pan S, Su H, Li H, Wang J. Meta-analysis of the Efficacy and Safety of Repetitive Transcranial Magnetic Stimulation (rTMS) in the Treatment of Depression. The specific psychotherapy approach chosen for any given case depends on the patients preference, as well as on the clinicians background and availability[74]. Major depressive disorder. In adolescent patients with depression, CBT is also a recommended option with plenty of evidence from multiple trials. Research on depression pharmacotherapy continues to examine new molecules implicated in gamma-aminobutyric acid regulation and glutamate transmission. McGrath PJ, Stewart JW, Fava M, Trivedi MH, Wisniewski SR, Nierenberg AA, Thase ME, Davis L, Biggs MM, Shores-Wilson K, Luther JF, Niederehe G, Warden D, Rush AJ. In intravenous sub-anesthetic doses, ketamine has very quick effects on resistant unipolar (and, possibly, bipolar) depression and acute suicidal ideation[54,55]. Your healthcare provider will ask you a series of questions that will likely cover your symptoms, thoughts and feelings, and medical history. Pereira VS, Hiroaki-Sato VA. A brief history of antidepressant drug development: from tricyclics to beyond ketamine. Currently available SSRIs include fluoxetine, sertraline, paroxetine, fluvoxamine, citalopram, and escitalopram. Cozanitis DA. Dr. Sabrina Romanoff, PsyD, is a licensed clinical psychologist and a professor at Yeshiva Universitys clinical psychology doctoral program. 2012;379(9820):1045-1055. doi:10.1016/S0140-6736(11)60602-8, Ebert DD, Buntrock C, Mortier P, et al. Limited study shows similar improvements in depressive symptoms and quality of life. Depression-focused psychotherapy is the second most common option for helping patients overcome the acute phase, maintain remission, and prevent relapses. Since then, many researchers have studied the link between the structures and activities of different antihistaminic agents, contributing to the discovery of almost all antidepressants[5]. CBT is also recommended for patients with resistant depression in combination with antidepressants[85]. Antidepressants are a type of medication that can help treat depression. The advantages of these agents (e.g., vilazodone and vortioxetine) over SSRIs are not fully clear. In December 1987, a series of clinical studies confirmed that an SSRI called fluoxetine was as effective as TCAs for treating depression while causing fewer adverse effects[26]. ST: Although ST is not as well-structured or well-evaluated as CBT or IPT, it is still commonly used to support depressed patients. Physical exercise: Most guidelines for treating depression, including the National Institute for Health and Care Excellence, the American Psychiatric Association, and the Royal Australian and New Zealand College of Psychiatrists, recommend that depressed patients perform regular physical activity to alleviate symptoms and prevent relapses[104]. Curr Neuropharmacol. The frequency, severity, and duration of the symptoms can also vary from person to person. Montgomery SA. After remission, CBT, PEI, and mindfulness-based cognitive therapy (MBCT) are proposed to maintain and prevent depression. The endogenous--neurotic distinction as a predictor of response to antidepressant drugs. PST has been used in different clinical situations, like preventing depression among the elderly and treating patients with mild depressive symptoms, especially in primary care. Moreover, patients should be encouraged to maintain healthy lifestyles and enhance their social skills to prevent depression and boost their overall mental health.
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