Provide education to the patient and the family
Education concerning major depressive disorder and its
treatments should be provided to all patients. Education is
an essential element of obtaining informed consent to
treatment. Whenever possible, education should also be
provided to involved family members and significant others,
although generally the patient’s consent is required
before such information can be shared. Specific topics to
discuss may include that major depressive disorder is a
medical illness and that effective treatments are both necessary
and available. This information may be especially
important for patients who attribute their illness to a
moral defect, or for family members who are convinced
that there is nothing wrong with the patient. Education
regarding available treatment options will help patients
make informed decisions, anticipate side effects, and adhere
to treatments. Patients with depression can become
easily discouraged in treatment, especially if there is less
than a full initial response. The psychiatrist should encourage
and educate patients to distinguish between the
hopelessness that is a symptom of depression and the relatively
hopeful actual prognosis. In addition, for patients
treated with antidepressant medication or ECT, psychiatrists
may choose to discuss a predictable progression of
treatment effects: first, side effects may emerge, then neurovegetative
symptoms remit, and finally mood improves.
Often significant others notice symptomatic improvement
before the patient does.
Given the chronic, episodic