title: Psychological management of unipolar depression.
abstract: OBJECTIVE
  To be used in conjunction with 'Pharmacological management of unipolar depression' [Malhi et al. Acta Psychiatr Scand 2013;127(Suppl. 443):6-23] and 'Lifestyle management of unipolar depression' [Berk et al. Acta Psychiatr Scand 2013;127(Suppl. 443):38-54]. To provide clinically relevant recommendations for the use of psychological treatments in depression derived from a literature review.
  
  
  METHODS
  Medical databases including MEDLINE and PubMed were searched for pertinent literature, with an emphasis on recent publications.
  
  
  RESULTS
  Structured psychological treatments such as cognitive behaviour therapy and interpersonal therapy (IPT) have a robust evidence base for efficacy in treating depression, even in severe cases of depression. However, they may not offer benefit as quickly as antidepressants, and maximal efficacy requires well-trained and experienced therapists. These therapies are effective across the lifespan and may be preferred where it is desired to avoid pharmacotherapy. In some instances, combination with pharmacotherapy may enhance outcome. Psychological therapy may have more enduring protective effects than medication and be effective in relapse prevention. Newer structured psychological therapies such as mindfulness-based cognitive therapy and acceptance and commitment therapy lack an extensive outcome literature, but the few published studies yielding positive outcomes suggest they should be considered options for treatment.
  
  
  CONCLUSIONS
  Cognitive behaviour therapy and IPT can be effective in alleviating acute depression for all levels of severity and in maintaining improvement. Psychological treatments for depression have demonstrated efficacy across the lifespan and may present a preferred treatment option in some groups, for example, children and adolescents and women who are pregnant or postnatal.
authors.affiliation: CADE Clinic, Department of Psychiatry, Royal North Shore Hospital, Sydney, NSW, Australia. lisa.lampe@sydney.edu.au
authors.forename: L
authors.initials: L
authors.lastname: Lampe
authors.forename: C M
authors.initials: CM
authors.lastname: Coulston
authors.forename: L
authors.initials: L
authors.lastname: Berk
mesh_terms: D000367:Age Factors; D000928:Antidepressive Agents / Q000627:therapeutic use*; D032763:Behavior Control / Q000379:methods / Q000523:psychology; D001526:Behavioral Symptoms / Q000628:therapy*; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D003131:Combined Modality Therapy; D003865:Major Depressive Disorder / Q000523:psychology / Q000628:therapy; D019468:Disease Management; D006801:Humans; D018579:Patient Selection; D011569:Psychiatric Status Rating Scales; D055502:Secondary Prevention; D013995:Time; D016896:Treatment Outcome
chemical_list: D000928:Antidepressive Agents