Modern inpatient hospitalization does not normally involve a long stay in the hospital. Instead, the goal is to return to the person to a less intensive level of care as quickly as possible. Where forty years ago patients might have stayed in the hospital for months, today, it is the rare patient who stays for longer than several weeks. Many hospitalizations last less than one week. Patients discharged from inpatient settings are often discharged to additional (but less intensive) treatment settings such as outpatient care or partial (e.g., daytime) hospitalization so that there is minimal discontinuity of patient care upon leaving the hospital. Treatment is typically coordinated prior to discharge from the hospital so that it can pick up immediately where inpatient care leaves off.
There is no single therapy that works equally well for every depressed person. If you are suffering from depression, you should keep this in mind, and work with your doctor to find the treatment regimen that works best for you. There are a wide variety of antidepressant medications and types of psychotherapy available today that can be used to treat depressive disorders. Some people with milder forms of depression may do well with psychotherapy alone, while people with moderate to severe depression most often benefit from an initial course of antidepressants followed by psychotherapy. Most people do best with combination treatment: medication to gain relatively quick symptom relief and psychotherapy to aid in learning effective coping skills necessary to challenge and alter depressive thoughts and behavior patterns and enable long-term recovery.
Though treatments offer the promise of relief from depressive symptoms, they come with side effects and other potential disadvantages. Antidepressants generally take weeks before they will have a noticeable effect, and most come with associated unpleasant or at least inconvenient side effects (including sexual side effects where it may be difficult to have an orgasm). Psychotherapy requires time and commitment before it can help to relieve symptoms. It can be expensive for people who don't have adequate mental health insurance coverage. ECT (see explanation below) generally causes temporary memory loss. It is a good idea to talk to your doctor about the pros and cons associated with the treatments that have been recommended for you.
Theoretically, treatment can be divided into three phases: the acute phase, the continuance phase, and the maintenance phase. There are no sharp lines dividing the phases, and very few people take a straight and unhindered path through them. The acute phase of treatment is primarily focused on symptom relief. Generally, symptoms decrease in severity within 6 to 12 weeks, but some people take longer before they notice relief. During the continuation phase, the depressed person and clinician work together to maximize symptomatic improvements. Further treatment adjustments, such as modifying the dosage of medication, may occur during this period, which can last four to nine months.
By the end of the continuation phase, the patient has (theoretically) experienced maximal symptom improvement, and is hopefully doing well. The maintenance phase is therefore structured around relapse prevention. Ongoing maintenance treatment may be necessary, especially if a patient has recurrent depressive episodes, has chronic low mood, or risk factors that make a recurrence more likely. The maintenance phase can last a long time, sometimes even a lifetime. As mentioned previously, making and sustaining healthy lifestyle changes can mean the difference between recurring episodes and a balanced maintenance phase during which depressive relapses do not occur. Exactly what lifestyle changes tend to be helpful in stabilizing treatment maintenance are discussed in more depth in a later section of this document.