Just as depression causes and its symptoms differ in different patients, depression treatment options too, vary. A particular treatment may work for one but may not suit another. Again, the depression may be mild, moderate, or severe because of which the intensity of the treatment will differ.
This is because there are different types of depression and certain factors such as age and any accompanying health conditions have to be taken into account when putting the patient on medication.
There may be certain serious medical conditions present such as heart or liver or kidney disease, which might make certain medications unsafe and ineffective.
However, the combination of medication (antidepressants) and psychotherapy is effective for most people. The effects of depression can be serious and therefore, taking timely and complete treatment is essential.
Finding the doctor for depression
It is best to see a trained doctor who has specialized in treating mental health conditions. Such a specialist is called a psychiatrist who has the expertise to treat your depression.
He or she is more experienced and qualified in this branch of psychiatric medicine and usually can give successful results earlier.
You can get referral lists of such licensed reputed therapists from mental health organizations.
Treating depression is a complex process and may take time. To deal with it, you need to take the help of a psychiatrist who will examine the various treatment options, which will benefit you the most and give the best results for your depression therapy. These include:
- Depression drugs called antidepressants
- Psychotherapy or talk therapy
- Electroconvulsive therapy (ECT)
- Self-help for depression, which involves correction of your lifestyle habits and using certain home and natural remedies.
To summarize, therefore, dealing with depression involves therapy, which needs a combination of various treatment options.
The doctor puts you on certain antidepressants, which may during treatment need a change in the drugs or their dosage. A combination of two antidepressants may sometimes be required.
Usually, depression treatment is started with an antidepressant and psychotherapy and this usually works out as a good and efficient remedy for a cure.
The method of curing depression varies according to the severity of the condition. Below is an overview of treating depression as per its severity.
Treating mild and moderate depression
- Mild depression may improve on its own and antidepressants are usually not prescribed immediately. A “watchful waiting”, monitors the progress for two weeks.
- Exercises are prescribed for this period preferably under the guidance of a qualified fitness trainer.
- Self-help books and computerized cognitive behavioral therapy (CBT) are recommended. CBT is talk therapy where you talk about yourself and other people and how what you do affects your thought and feelings. This helps you change the way you think and what you do. This makes you feel better.
- Cases of dysthymia (also called chronic depression), which is a form of mild depression, are a little difficult to treat especially when they are of 2 years duration or more. In such cases, treatment with an antidepressant may become necessary.
Moderate depression is managed with antidepressants and psychotherapy. In addition, exercises, self-help books, and CBT are recommended.
Treatment of severe depression
- A hospital stay may be required.
- Antidepressants or a combination of such depression medicines are given.
- Talk therapy or CBT or psychotherapy is prescribed.
- Electroconvulsive therapy is advised in resistant cases or where the risk of suicidal attempts is high.
Drugs for depression: Antidepressants
Medicines for depression are called antidepressants. An antidepressant is a prescription medication used in psychiatry to treat mood disorders such as depression and anxiety. There are various types of antidepressants, but choosing the right medication and its proper dose is important.
Antidepressants are classified according to their mode of action on the naturally occurring chemicals in the brain called neurotransmitters, which are responsible for the mood of the person.
Selective Serotonin Reuptake Inhibitors (SSRIs)
SSRIs are the drugs for depression that most doctors use to start antidepressive therapy. They are effective, and safer to use and their side effects are few compared to other types of antidepressants. An inadequate amount of neurotransmitters, which are naturally occurring brain chemicals, is a possible cause of depression. Serotonin also called 5-HT, is one such neurotransmitter. SSRIs raise the levels of serotonin in the brain which brings about a “good mood” effect.
Examples of such drugs for depression are Fluoxetine (Prozac), Paroxetine (Paxil), Sertraline (Zoloft), Citalopram (Celexa), Escitalopram (Lexapro), and Vibryd (recently approved in early 2011).
Some common side effects include loss of libido and a delayed orgasm, digestive problems, headache, nausea, and restlessness.
Serotonin and Norepinephrine Reuptake Inhibitors (SNRIs)
Serotonin and Norepinephrine Reuptake Inhibitors are a newer form of antidepressants and work by acting on serotonin and norepinephrine, which are naturally occurring brain chemicals whose low levels are associated with depression.
Examples of these depression medicines are Duloxetine (Cymbalta), Venlafaxine (Effexor XR), and Desvenlafaxine ( Pristiq).
Side effects are similar to those of SSRIs. SNRIs are contraindicated in patients with liver damage. Withdrawal symptoms may present on discontinuation of the drug. Its dose is, therefore, tapered off when stopping the drug. Some patients benefit more from this dual-acting antidepressant.
Dopamine and Norepinephrine Reuptake Inhibitors ( NDRIs)
NDRIs differ from other types of antidepressants and have a weaker effect on brain chemicals.
This antidepressant has the advantage that it does not cause sexual side effects. In high doses, it may cause seizures. Bupropion (Wellbutrin) belongs to this category of antidepressants.
Trazodone (Desyrel) and Mirtazapine ( Remeron) belong to this category of antidepressants. They produce a sedating effect and therefore, have to be taken in the evening. They are sometimes given along with another antidepressant to induce sleep. Their side effects include weight gain, increased triglycerides, and dizziness.
Tricyclic Antidepressants (TCAs)
These classes of depression medicines have been in use for a long time and are as effective as the newer types. They work by increasing the levels of neurotransmitters, serotonin, and noradrenaline in the brain.
But, because of their potential side effects, their use is restricted. Their importance lies in the fact they are effective in cases, which have been resistant to other types of antidepressants. Their examples include Amitriptyline (Elavil), Imipramine (Tofranil), and Trimipramine( Surmontil).
Side effects of Tricyclic Antidepressants vary from person to person. Side effects seen are dry mouth, constipation, blurred vision, fall in blood pressure, retention of urine, disorientation, confusion, increased heart rate, and changes in blood sugar levels.
Most of the side effects of these depression medications ease after about 10 days as your body gets accustomed to these medicines.
Monoamine Oxidase Inhibitors (MAOIs)
They can cause negative interactions with some other medications and certain types of food, especially those rich in tyramine. Such foods include cheese, chocolates, bananas, wine, and chicken liver. These reactions cause a sudden spike in blood pressure, which can lead to a brain hemorrhage.
The positive side of MAOIs is that they can show positive results in certain forms of depression where other medications have been ineffective.
Monoamine oxidase, which is a brain and liver enzyme is responsible for the depletion of neurotransmitter levels in the brain. Neurotransmitters are naturally occurring brain chemicals, which are responsible for the mood of the person. Their depletion leads to depression. MAOIs block the action of monoamine oxidase thereby, maintaining neurotransmitter levels and mood.
Examples of these depression medications include Phenezil (Nardil) and Tranylcypromine (Parnate).
Other medications for depression treatment
Antipsychotic medicines, stimulants, mood stabilizers, or anti-anxiety medicines may be prescribed in addition to antidepressants when required in resistant cases. This is called augmentation.
A combination of two antidepressants may be prescribed in certain cases. Lithium is given at times when other antidepressants have not worked. Lithium carbonate or lithium citrate is used. Only one of these is used and not mixed up with the other.
For lithium to work, it is necessary that some amount of it be present in the blood. High levels of lithium can be toxic and therefore, it is necessary that blood is checked every three months for lithium levels when on lithium therapy.
A low-salt diet too can cause lithium to become toxic. Lithium can be combined with other depression medicines to make them more effective.
Side effects of lithium include tremors, nausea, mental dullness, sedation, increased urination, and kidney and thyroid problems.
Before starting lithium, it is necessary to have an ECG to rule out any cardiac problem, and thyroid and kidney tests to rule out any respective pathology.
Psychotherapy (also referred to as Talk Therapy)
Psychotherapy, also called talk therapy or just therapy is a psychological treatment of mental disorders such as depression. This therapy involves a series of talk sessions between the depressed patient and the psychotherapist.
Psychotherapy alone is not sufficient to treat depression but it becomes very effective when used in combination with medications for depression. Psychotherapy has no risks except facing an awkward moment when confessing during psychotherapy.
How does psychotherapy help with depression?
Psychotherapy helps the depressed person understand the various causes and trigger factors of depression and this helps to identify a particular factor, which could be the reason for his depression
Besides the chemical changes in the brain believed to be the cause of depression, certain lifestyle habits, and social and environmental factors too, contribute as risk factors.
Antidepressants take care of the chemical changes in the brain while psychotherapy helps you to fight and adjust to social and environmental factors.
Psychotherapy takes away your negative attitude and feeling. It also helps you to cope with stress factors and increases your stress threshold.
Psychotherapy helps you to take control of your sinking life and hold it together. You learn to face challenges and problem-solving skills, which then make you a more confident person to take good and healthy decisions that were lost earlier.
There are various types of psychotherapy techniques and each has its own approach and indications.
Electroconvulsive therapy (ECT)
Electroconvulsive therapy or ECT involves the passing of low-dose electric currents through the brain to produce a therapeutic effect in certain mental disorders. This is done by placing one (unilateral ECT) or two electrodes (bilateral ECT) on the scalp.
With these low-dose electric currents, generalized and controlled seizures are induced in the anesthetized patient to produce the therapeutic effect. It is not yet known how this helps to relieve the symptoms of depression.
Electroconvulsive therapy produces a large release of neurotransmitters in the brain caused by controlled seizures. Another school of thought proposes that seizures adjust the stress hormone levels in the brain which affect mood, energy, sleep, and appetite.
ECT is used for severe depression, which has not responded to other depression treatments, or when it is accompanied by psychosis (loss of reality) and suicidal tendencies. ECT is the fastest way to give relief. Significant improvement is seen within one to two weeks.
The most common side effect of ECT is confusion and short-term memory loss, which can last from a few minutes to a few hours.
Other treatments for depression
If treatments mentioned above with depression medications, psychotherapy, and ECT have failed to deliver results, especially in cases of chronic and resistant depression, certain treatments exist, which are not commonly used. They are: :
Vagus nerve stimulation (VNS)
This has been approved for use in 1997 by the US FDA for adult patients with chronic or recurrent drug-resistant depression. Through an outpatient procedure done without anesthesia, a vagus nerve stimulator is implanted through an incision in the left chest below the shoulder bone (clavicle) under the skin. A second incision is made in the neck which exposes the vagus nerve.
The vagus nerve serves the sensory as well as the motor function. It originates in the medulla oblongata of the brain and moves down to the abdomen to innervate the abdominal viscera.
The leads from the stimulator are then connected to the vagus nerve. Once this procedure has been successfully completed, the stimulator sends electric impulses at regular intervals so as to stimulate the brain through the left vagus nerve.
The right vagus nerve supplies the heart and plays a role in cardiac functions and therefore, is not chosen because the electric impulses to the right vagus nerve can have a detrimental effect on heart functions.
Transcranial Magnetic Stimulation (TMS)
Transcranial magnetic stimulation is approved for use in adults in whom the milder forms of depression have refused to respond to treatment with one antidepressant. (not two or more).
In this therapy, a large electromagnetic coil is placed against the scalp near the forehead so that the magnetic field produces a small electric current in the specific area of the brain without causing seizures and loss of consciousness.
This is an outpatient procedure done without giving any sedation to the patient. This treatment is given four to five times a week for four weeks.
Treatment for depression has various options and as per the requirement, these options are exercised. Medication for depression again is of different types and each of these depression drugs has its indications. Psychotherapy is usually given along with these antidepressants to achieve better results.
Severe and resistant cases of depression, which do not respond to medication and psychotherapy are treated with electroconvulsive therapy or ECT. Further treatment, if required, is available in the form of vagus nerve stimulation or transcranial magnetic stimulation.
It is important to note that since the treatment for depression is complex with a variety of options and a necessity for using the right therapy, only an experienced and qualified doctor such as a psychiatrist be consulted because he or she has specialized in this faculty of medicine.