Managing depression: analytic, antidepressants or both?

Abstract

Patients with depression cover the spectrum, in terms of severity of psychopathology, between those receptive to analytic psychotherapy and those that require treatment with medication. In this paper, the author demonstrates how a psychoanalytic framework of understanding has a place in the latter group, and can aid general psychiatrists in relating to their depressed patients. The notion of a pathological ego-destructive superego taking over control in depression is explored, with the need to unseat it and replace it with a more mature superego providing an overall framework of approach to treatment.

Over-formalising the formulation?

“…Psychotherapy and psychiatry are both very complex areas and I believe it is important to integrate, rather than keep separate, diagnostic and psychodynamic aspects, incorporating them into an overall treatment plan (Lucas, 2004). We need to recognise that the dominant underlying internal psychodynamics can differ in people with depression, borderline states and schizophrenia and these differences need to be incorporated into the formulation.…”

Consideration of the Role of Psychotherapy in Reducing the Risk of Suicide in Affective Disorders – A Case Study

“…It is argued that in affective disorders, as distinct from other causes of depressed states, there is a hidden psychosis and that tuning into the psychotic wavelength is necessary in order to make a significant impact (Lucas 2004). Features that can obscure appreciation of this underlying psychopathology are considered, together with technical issues of how to create a meaningful dialogue.…”