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Medical Disability Advisor  >  Depression Major  >  Treatment

Depression, Major

Related Terms

  • Clinical Depression
  • Depressive Psychosis
  • Endogenous Depression
  • Major Depressive Disorder
  • Psychotic Depression
  • Unipolar Depression

Specialists

  • Clinical Psychologist
  • Psychiatrist

Comorbid Conditions

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Factors Influencing Duration

Length of disability may be influenced by the severity of the illness, the presence of complicating factors such as substance abuse or suicide attempts, response to therapy, and job requirements. Only in the most severe and unusual cases should major depression result in permanent disability.

Substance abuse will complicate treatment and may significantly delay returning to work. Suicide attempts that lead to hospitalization will also be associated with longer periods of disability.

Duration Trends from Reference Data

DURATION TRENDS
 ICD-9-CM: 296.2  
CasesMeanMinMaxNo Lost TimeOver 6 Months
117775902661.5%3.6%
 
  
 
Percentile:5th25thMedian75th95th
Days:6214381172
 
  
 

DURATION TRENDS
 ICD-9-CM: 296.3, 296.32, 296.33  
CasesMeanMinMaxNo Lost TimeOver 6 Months
90217403600.2%5.9%
 
  
 
Percentile:5th25thMedian75th95th
Days:13325998183
 
  
 

DURATION TRENDS
 ICD-9-CM: 311  
CasesMeanMinMaxNo Lost TimeOver 6 Months
229406503150.3%4.8%
 
  
 
Percentile:5th25thMedian75th95th
Days:11274888179
 
  
 

Differences may exist between the duration tables and the reference graphs. Duration tables provide expected recovery periods based on the type of work performed by the individual. The reference graphs reflect the actual experience of many individuals across the spectrum of physical conditions, in a variety of industries, and with varying levels of case management. Selected graphs combine multiple codes based on similar means and medians.

Medical Codes

ICD-9-CM:
296.2 - Major Depressive Disorder, Single Episode
296.20 - Major Depressive Disorder, Single Episode; Unspecified
296.21 - Major Depressive Disorder, Single Episode; Mild
296.22 - Major Depressive Disorder, Single Episode; Moderate
296.23 - Major Depressive Disorder, Single Episode; Severe, without Mention of Psychotic Behavior
296.24 - Major Depressive Disorder, Single Episode; Severe, Specified as with Psychotic Behavior
296.25 - Major Depressive Disorder, Single Episode; in Partial or Unspecified Remission
296.26 - Major Depressive Disorder, Single Episode; in Full Remission
296.3 - Major Depressive Disorder, Recurrent Episode
296.30 - Major Depressive Disorder, Recurrent Episode; Unspecified
296.31 - Major Depressive Disorder, Recurrent Episode; Mild
296.32 - Major Depressive Disorder, Recurrent Episode; Moderate
296.33 - Major Depressive Disorder, Recurrent Episode; Severe, without Mention of Psychotic Behavior
296.34 - Major Depressive Disorder, Recurrent Episode; Severe, Specified as with Psychotic Behavior
296.35 - Major Depressive Disorder, Recurrent Episode; in Partial or Unspecified Remission
296.36 - Major Depressive Disorder, Recurrent Episode; in Full Remission
311 - Depressive Disorder, Not Elsewhere Classified

Treatment

Treatment choice depends on the outcome of the evaluation (history, physical exam, and tests). Treatment usually consists of some form of psychotherapy, antidepressant medications, or a combination of the two. One or more antidepressant medications may be prescribed, such as selective serotonin reuptake inhibitors (SSRIs), tricyclic antidepressants (TCAs), or monoamine oxidase inhibitors (MAOIs). These medications work by correcting imbalances in the levels of brain chemicals (the monoamine neurotransmitters serotonin, dopamine, and norepinephrine). About two-thirds of individuals treated will respond to one or more medications. Generally, these medications take full effect 3 to 6 weeks after treatment has begun. Psychiatrists usually recommend that individuals continue to take the medication for five or more months after symptoms have improved.

Treatment of depression consists of three phases. Acute treatment, lasting 6 to 12 weeks, is aimed at remission of symptoms. Continuation treatment, lasting 4 to 9 months, is aimed at preventing relapse. During this phase, medication is continued at full dosage, and psychotherapy may be initiated. Maintenance treatment is aimed at preventing new episodes (recurrence) in individuals with prior episodes. Both maintenance medication and maintenance psychotherapy can prevent relapse or delay the next episode. Electroconvulsive therapy (ECT) is another treatment option that has been shown to be safe and effective in treating individuals of all ages who have not responded sufficiently to antidepressant medications and psychotherapy or whose depression is severe and prolonged. Although the precise mechanism of action of ECT is not understood, it is believed to work by increasing neurotransmitter levels in the brain, improving neurotransmission and elevating mood (Moore).

Psychotherapy, or talk therapy, may be used alone for treatment of mild depression. Antidepressant medications in combination with psychotherapy are used for moderate to major depression. The different types of psychotherapy include cognitive-behavioral therapy, psychodynamic psychotherapy, interpersonal therapy, and supportive psychotherapy. Research suggests that using a combination of antidepressants and talk therapy is more effective than either treatment alone for most individuals.

For individuals whose depressive episodes can be attributed to use of specific medications, changes in medication or changes in dosage may be required.

Psychiatric hospitalization is warranted when the individual neglects self-care or is at high risk of self-harm. Other forms of more intensive treatment, such as partial hospitalization and intensive outpatient care, may be considered for patients who fail to recover in a reasonable period of time with more standard treatments.

Before treatment, individuals and their families should be educated about the diagnosis, likely outcome, treatment options, cost of treatment, and potential side effects and complications.

Source: Medical Disability Advisor






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