Treatment of major depressive disorder includes

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The most effective treatment is a combination of medication and psychotherapy. Most patients have relief of symptoms and a good prognosis if they respond favorably to antidepressant therapy. SSRIs including fluoxetine are first-line therapy, but many patients with major depression also may have been prescribed tricyclics amitriptyline/nortriptyline along with the SSRI. Atypical antipsychotics may be used in severe cases of major depressive disorder. Depression may occur as a single episode or may be recurrent. ECT helps when a patient is severely incapacitated, has psychotic features, or does not respond to other therapeutic measures. Family support and education are considered important in the recovery process.
Patients who commit suicide have a high incidence of the hopelessness of acute depression. The suicidal patient often wishes to discuss suicidal fears and does not want to die but sees suicide as the only escape from an intolerable situation. A reluctance to discuss suicidal thoughts makes it important for the examiner to explore the patient's preoccupation with death or comments such as, "People would be better off without me" or "better off dead." Suicide intervention is an attempt by medical, mental health, and community organizations to help the depressed individual through the crisis situation. Most telephone directories list crisis intervention centers. Hospital emergency departments and law enforcement agencies have professionals immediately available to offer support and personal contact to this individual. Mental health agencies routinely offer their clients a 24-hour "hotline" number for contacting a counselor. Structures that are often used as jumping points, such as bridges, have strategically placed signs that offer crisis intervention telephone numbers (see Figure 14-16).

Treatment of Major Depressive Disorder Includes