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This article addresses the management of the mental disorder known as major depressive disorder or often called simply "depression". This syndrome is being diagnosed more frequently in developed countries, where up to 20% of the population is affected at some stage of their lives.〔(【引用サイトリンク】title=Beyond Blue )〕 According to WHO (World Health Organization), depression is currently fourth among the top 10 leading causes of the global burden of disease; it is predicted that by the year 2020, depression will be ranked second. Though psychiatric medication is the most frequently prescribed therapy for major depression,〔Carson VB (2000). (Mental health nursing: the nurse-patient journey ) W.B. Saunders. ISBN 978-0-7216-8053-8. pp 423.〕 psychotherapy may be effective, either alone or in combination with medication.〔(The Merck Manual of Diagnosis and Therapy )〕 Antidepressant medications fail to consistently demonstrate superiority over placebo pills, or their benefit is small. Likewise, psychotherapy has been unable to demonstrate substantial superiority over no-treatment. Combining psychotherapy and antidepressants may provide a "slight advantage", but antidepressants alone or psychotherapy alone are not significantly different from other treatments, or "active intervention controls". Given an accurate diagnosis of major depressive disorder, in general the type of treatment (psychotherapy and/or antidepressants, alternate or other treatments, or active intervention) is "less important than getting depressed patients involved in an active therapeutic program." Psychotherapy is the treatment of choice in those under the age of 18, with medication offered only in conjunction with the former and generally not as a first line agent. The possibility of depression, substance misuse or other mental health problems in the parents should be considered and, if present and if it may help the child, the parent should be treated in parallel with the child. == Psychotherapy == (詳細はclinical social workers, counselors or psychiatric nurses. With more chronic forms of depression, the most effective treatment is often considered to be a combination of medication and psychotherapy.〔 Psychotherapy is the treatment of choice in people under 18.〔 The most studied form of psychotherapy for depression is ''cognitive behavioral therapy'' (CBT), thought to work by teaching clients to learn a set of cognitive and behavioral skills, which they can employ on their own. Earlier research suggested that cognitive behavioral therapy was not as effective as antidepressant medication in the treatment of depression; however, more recent research suggests that it can perform as well as antidepressants in treating patients with moderate to severe depression. A systematic review of data comparing low-intensity CBT (such as guided self-help by means of written materials and limited professional support, and website-based interventions) with usual care found that patients who initially had more severe depression benefited from low-intensity interventions at least as much as less-depressed patients. For the treatment of adolescent depression, one published study found that CBT without medication performed no better than a placebo, and significantly worse than the antidepressant fluoxetine. However, the same article reported that CBT and fluoxetine outperformed treatment with only fluoxetine. Combining fluoxetine with CBT appeared to bring no additional benefit in two different studies or, at the most, only marginal benefit, in a fourth study. Behavior therapy for depression is sometimes referred to as behavioral activation. Studies exist showing behavioral activation to be superior to CBT. In addition, behavioral activation appears to take less time and lead to longer lasting change. Acceptance and commitment therapy (ACT), a mindfulness form of CBT, which has its roots in behavior analysis, also demonstrates that it is effective in treating depression, and can be more helpful than traditional CBT, especially where depression is accompanied by anxiety and where it is resistant to traditional CBT.〔(【引用サイトリンク】url=http://www.div12.org/PsychologicalTreatments/treatments.html )〕 A review of four studies on the effectiveness of mindfulness-based cognitive therapy (MBCT), a recently developed class-based program designed to prevent relapse, suggests that MBCT may have an additive effect when provided with the usual care in patients who have had three or more depressive episodes, although the usual care did not include antidepressant treatment or any psychotherapy, and the improvement observed may have reflected non-specific or placebo effects. ''Interpersonal psychotherapy'' focuses on the social and interpersonal triggers that may cause depression. There is evidence that it is an effective treatment for depression. Here, the therapy takes a structured course with a set number of weekly sessions (often 12) as in the case of CBT; however, the focus is on relationships with others. Therapy can be used to help a person develop or improve interpersonal skills in order to allow him or her to communicate more effectively and reduce stress.〔〕 ''Psychoanalysis'', a school of thought founded by Sigmund Freud that emphasizes the resolution of unconscious mental conflicts, is used by its practitioners to treat clients presenting with major depression. A more widely practiced technique, called ''psychodynamic psychotherapy'', is loosely based on psychoanalysis and has an additional social and interpersonal focus.〔〕 In a meta-analysis of three controlled trials, psychodynamic psychotherapy was found to be as effective as medication for mild to moderate depression. 抄文引用元・出典: フリー百科事典『 ウィキペディア（Wikipedia）』 ■ウィキペディアで「Management of depression」の詳細全文を読む スポンサード リンク
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