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  • Cognitive therapy

  • Cognitive-behavior therapy

  • Dialectical behavior therapy

  • Exposure therapy

  • Interpersonal therapy

  • Play therapy

  • Psychoanalysis

  • Psychodynamic psychotherapy

  • Psychoeducation

Primary care providers are the initial healthcare provider for a significant number of depressed individuals. Incorporating a combined treatment intervention of pharmacotherapy and psychotherapy is often a more efficacious treatment approach than either intervention alone. What’s more, referring depressed patients for psychotherapy may (1) increase treatment acceptance and compliance; (2) increase treatment success rate; (3) decrease the risk of depressive relapse or suicide; and (4) share responsibility for patient management with licensed mental health professionals.49 Psychotherapy in combination with antidepressants has been shown to significantly improve response rates in people with depression. In addition, studies show that combined therapy significantly reduces dropout rates from therapy.50

The individual with depression can be referred to mental health services from many settings: the physician’s office, an outpatient clinic, a hospital, or a community setting. The care manager involved can assist with the transition of care and referral process. The care manager can also be instrumental in the continued evaluation of the individual’s adherence and response to treatment. While the care manager is not responsible for recommending treatment, the care manager should be working to increase the individual’s motivation to adherence. Should the individual with depression have a less than favorable response to treatment or if barriers to adherence are discovered, it is the care manager’s responsibility to share these with the treatment team for possible modifications in the current treatment plan.

The Role of Pharmacotherapy

Pharmacotherapy takes on many forms in depression. Medications may be used alone or in combination with other medications. Often the individual with depression may have Bipolar Disorder. Medications used to treat depression may exacerbate the mood swing into mania. Antidepressant medications must be balanced with drugs that produce a leveling effect for Bipolar Disorders. Similarly, a phenomenon known as “activation” may cause an increase or




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