Treatment in hospital

During your admission to hospital, you may be offered various forms of treatment, which are described in more detail below.

Psychoeducational training

Psychoeducational training means that we teach you about your illness by explaining to you things such as

• what it means to suffer from depression
• the typical development of the illness
• treatment options
• the effects and side-effects of the medicine

Training often consists of many discussions. It is effective because you gain an insight into your illness and you also get a good idea of how you will recover from the illness.

Environmental therapy

Environmental therapy involves giving help to enable people to live with the illness, training in social skills and the ability to perceive reality realistically. Environmental therapy can for example involve taking part in shared tasks or activities with others. Environmental therapy can be given by nurses, carers, occupational therapists or social workers on the ward.

Psychotherapy

In some cases, we choose to treat people using psychotherapy. However, in the case of severe depression we will not use psychotherapy until later in the development of the illness. In the case of severe depression, patients will be so ill that they will find it difficult to take part in a normal conversation. Patients would therefore find it even more difficult to be active in psychotherapy.

There are several psychotherapeutic treatment methods; we often use cognitive psychotherapy. The psychotherapy treatment can be individual or group-based.

Medicine

If your depression becomes so serious that you are admitted, treatment using medicine will almost always be necessary. We distinguish between two types of medicine:

• antidepressants (i.e. medicines which treat the depression itself)
• support medicine (e.g. anxiety suppressing medicines, sleeping pills, antipsychotic medicines and lithium)

Antidepressants are effective in the treatment of depression. The medicine removes the symptoms of the depression in just a few weeks. But the treatment will only work if you continue taking the medicine. It is very important to remember this.

Our decision as to which treatment to give will be based, among other things, on your physical health and the effectiveness and side-effects of the medicine. We often decide to use one of the older tricyclic antidepressants (TCA). Today, there is general agreement that the tricyclic antidepressants are better than the SSRIs for treating severe depression with admission.

When you are treated using antidepressants, it will take 2-4 weeks before you notice an effect. If you suffer from severe anxiety and serious problems sleeping, you can use support medicine such as anxiety-suppressing pills during this period.

Treatment using support medicine must however be restricted to a minimum, because excessive doses can worsen the depression. The support medicine can also extend the treatment unnecessarily.

Some forms of support medicine can be addictive if you use them wrongly. The use of support medicine must therefore be scaled down as the depression eases.

A treatment such as the one we have described would be effective in the vast majority of cases.

ECT treatment

There is a risk that you may be one of the few people who do not respond to treatment using medicine and there are also a few people who cannot cope with treatment using antidepressants.

For these people, ECT treatment is an alternative. This treatment works faster than treatment using medicine and it is effective if you are having serious suicidal thoughts.