Treatment of Depression

Depression typically cannot be shaken or willed away.

An episode must therefore run its course until it weakens either on its own or with treatment.

Depression can be treated effectively with antidepressant drugs, psychotherapy, or a combination of both.

Despite the availability of effective treatment, most depressive disorders go untreated and undiagnosed.

Studies indicate that general physicians fail to recognize depression in their patients at least half of the time.

In addition, many doctors and patients view depression in elderly people as a normal part of aging, even though treatment for depression in older people is usually very effective.

Antidepressant Drugs
Up to 70 percent of people with depression respond to antidepressant drugs.

These medications appear to work by altering the levels of serotonin, norepinephrine, and other neurotransmitters in the brain.

They generally take at least two to three weeks to become effective.

Doctors cannot predict which type of antidepressant drug will work best for any particular person, so depressed people may need to try several types.

Antidepressant drugs are not addictive, but they may produce unwanted side effects.

To avoid relapse, people usually must continue taking the medication for several months after their symptoms improve.

Commonly used antidepressant drugs fall into three major classes: tricyclics, monoamine oxidase inhibitors (MAO inhibitors), and selective serotonin reuptake inhibitors (SSRIs).

Tricyclics, named for their three-ring chemical structure, include amitriptyline (Elavil), imipramine (Tofanil), desipramine (Norpramin), doxepin (Sinequan), and nortriptyline (Pamelor).

Side effects of tricyclics may include drowsiness, dizziness upon standing, blurred vision, nausea, insomnia, constipation, and dry mouth.

MAO inhibitors include isocarboxazid (Marplan), phenelzine (Nardil), and tranylcypromine (Parnate).

People who take MAO inhibitors must follow a diet that excludes tyramine—a substance found in wine, beer, some cheeses, and many fermented foods—to avoid a dangerous rise in blood pressure.

In addition, MAO inhibitors have many of the same side effects as tricyclics.

Selective serotonin reuptake inhibitors include fluoxetine (Prozac), sertraline (Zoloft), and paroxetine (Paxil).

These drugs generally produce fewer and milder side effects than do other types of antidepressants, although SSRIs may cause anxiety, insomnia, drowsiness, headaches, and sexual dysfunction.

Some patients have alleged that Prozac causes violent or suicidal behavior in a small number of cases, but the U.S. Food and Drug Administration has failed to substantiate this claim.

Prozac became the most widely used antidepressant in the world soon after its introduction in the late 1980s by drug manufacturer Eli Lilly and Company.

Many people find Prozac extremely effective in lifting depression.

In addition, some people have reported that Prozac actually tranforms their personality by increasing their self-confidence, optimism, and energy level.

However, mental health professionals have expressed serious ethical concerns over Prozac’s use as a “personality enhancer,” especially among people without clinical depression.

Doctors often prescribe lithium carbonate, a natural mineral salt, to treat people with bipolar disorder .

People often take lithium during periods of relatively normal mood to delay or even prevent subsequent mood swings.

Side effects of lithium include nausea, stomach upset, vertigo, and frequent urination.

Psychotherapy
Studies have shown that short-term psychotherapy can relieve mild to moderate depression as effectively as antidepressant drugs.

Unlike medication, psychotherapy produces no physiological side effects.

In addition, depressed people treated with psychotherapy appear less likely to experience a relapse than those treated only with antidepressant medication.

However, psychotherapy usually takes longer to produce benefits.

There are many kinds of psychotherapy.

# Cognitive-behavioral therapy assumes that depression stems from negative, often irrational thinking about oneself and one’s future.

In this type of therapy, a person learns to understand and eventually eliminate those habits of negative thinking.

# In interpersonal therapy , the therapist helps a person resolve problems in relationships with others that may have caused the depression.

The subsequent improvement in social relationships and support helps alleviate the depression.

# Psychodynamic therapy views depression as the result of internal, unconscious conflicts.

Psychodynamic therapists focus on a person’s past experiences and the resolution of childhood conflicts.

Psychoanalysis is an example of this type of therapy. Critics of long-term psychodynamic therapy argue that its effectiveness is scientifically unproven.

Other Treatments
Electroconvulsive therapy (ECT) can often relieve severe depression in people who fail to respond to antidepressant medication and psychotherapy.

In this type of therapy, a low-voltage electric current is passed through the brain for one to two seconds to produce a controlled seizure.

Patients usually receive six to ten ECT treatments over several weeks.

ECT remains controversial because it can cause disorientation and memory loss.

Nevertheless, research has found it highly effective in alleviating severe depression.

For milder cases of depression, regular aerobic exercise may improve mood as effectively as psychotherapy or medication.

In addition, some research indicates that dietary modifications can influence one’s mood by changing the level of serotonin in the brain.