By Kirsty Topping 20 October 09
People without experience of depression fear the condition. It does not help that sufferers are sometimes thought of as violent and it is this reason that people are afraid to admit to thei suffering for fear of being branded in a certain way. What they really have to remember is that depression is a treatable disorder. The recovery rates for any mental health problem is between 70% and 80% and suffers can live a normal life with proper help.
Treatment of depression varies broadly and is different for each individual. Various types and combinations of treatments may have to be tried, but but may not provide a complete solution to the problem. There are two primary modes of treatment, typically used in conjunction: medication and psychotherapy. A third treatment, electroconvulsive therapy (ECT), may be used when chemical treatment fails.
Other alternative treatments used for depression include exercise and the use of vitamins, herbs, or other nutritional supplements. The effectiveness of treatment often depends on factors such as the amount of optimism and hope the sufferer is able to maintain, the control s/he has over stressors, the severity of symptoms, the amount of time the sufferer has been depressed, the results of previous treatments, and the degree of support of family, friends, and significant others.
Although treatment is generally effective, in some cases the condition does not respond. Treatment-resistant depression warrants a full assessment, which may lead to the addition of psychotherapy, higher medication dosages, changes of medication or combination therapy, a trial of ECT/electroshock, or even a change in the diagnosis, with subsequent treatment changes. Although this process helps many, some people’s symptoms continue unabated.
In emergencies, psychiatric hospitalization is used simply to keep suicidal people safe until they cease to be dangers to themselves. Another treatment program is partial hospitalization where the patient sleeps at home but spends the day, either five or seven days a week, in a psychiatric hospital setting in intense treatment. This treatment usually involves group therapy, individual therapy, psychopharmacology, and academics (in child and adolescent programs).
Medication to relieve the symptoms of depression has been available for several decades. Normally the first kind of treatment that will be tried is a type of drug called a selective serotonin reuptake inhibitor. Selective serotonin reuptake inhibitors (SSRIs) are a family of antidepressant considered to be the current standard of drug treatment. It is thought that one cause of depression is an inadequate amount of serotonin, a chemical used in the brain to transmit signals between neurons. SSRIs are said to work by preventing the reabsorption of serotonin by the nerve cell, thus maintaining the levels the brain needs to function effectively.
This family of drugs includes fluoxetine (Prozac), paroxetine (Paxil), escitalopram (Lexapro), citalopram (Celexa), and sertraline (Zoloft). These antidepressants typically have fewer adverse side effects than other drugs, although such effects as drowsiness, dry mouth, nervousness, anxiety, insomnia, decreased appetite, and decreased ability to function sexually may occur. Some side effects may decrease as a person adjusts to the drug, but other side effects may be persistent.
In psychotherapy the patient receives assistance in understanding and resolving any habits and problems that may be contributing to or the cause of the depression. Effective psychotherapy may result in the individual developing different habitual thoughts and actions, which leads to a lower relapse rate than antidepressant drugs alone. Medication, however, may yield quicker results and be strongly indicated in a crisis. Medication and psychotherapy are generally complementary, and both may be used at the same time. Under some circumstances, medication and psychotherapy may be more effective than either treatment used on its own.
Electroconvulsive therapy is one of the most misunderstood treatments for depression. While it is generally used only in severe or life-threatening cases where medication and therapy haven’t worked, ECT can be effective. ECT works by sending an electrical charge (typically fixed at 0.9 ampere) to the brain that causes a brief and controlled seizure.
A former patient regards his experience of ECT as a positive one: “The darkness is now over. I had been slowly going down-hill for months. I was on countless medications including Lithium and had gained over two stone within six months. The medications weren’t working, and I had lost all hope. But finally, I was offered ECT. I had heard about it before, but wasn’t really sure about the procedure. I searched the internet, but found conflicting information. Most of what I saw was against the practice. After contemplating suicide for many days, I checked myself into the mental ward of a hospital and was given ECT.
“Before my first treatment, I was extremely nervous, but it went just fine. I was sick for a couple of hours after, due to the anesthesia and I had a migraine headache. I then had four more treatments throughout the next couple of weeks. Each became less uncomfortable and I now feel better than I ever have. I can now get out of bed and lead a normal life. I have so much motivation. Mentally, I feel sharp and alert.
“It is important people remember ECT is not nearly as scary as it is made out to be. The risks are very low, and it really works.”
Although the procedure may sound frightening, patients receive it while under general anaesthesia, and awaken with no memory of the procedure. Unlike medications and therapy, ECT tends to have an immediately positive effect on mood, which is why it can be so helpful for those at risk of suicide. Remember that – regardless of how it is sometimes shown in books and movies – ECT is usually a last resort.
ECT has acquired a fearsome reputation, in part from its use as a tool of repression in the former USSR and its barbaric fictional depiction in films such as One Flew Over the Cuckoo’s Nest and Requiem for a Dream, but remains a common treatment where other means of treatment have failed or where the use of drugs is unacceptable.
Recently, repetitive transcranial magnetic stimulation (rTMS) has been looked at as a possible treatment for depression. Initially designed as a tool for physiological studies of the brain, this technique shows promise as a means of alleviating depression. This therapy uses a powerful magnetic field to stimulate the left prefrontal cortex, an area of the brain that typically shows abnormal activity in depressed people.
Recent work in Poland suggested that weak, variable magnetic fields may offer relief from depression in those who have not responded to medication.
Bright light (both sunlight and artificial light) is shown to be effective in seasonal affective disorder, and it is widely believed that physical activity and exercise help depressed patients and promote quicker and better relief from depression. They are also thought to help antidepressants and psychotherapy work better and faster. Lack of motivation, however can prevent the sufferer from taking part in such an activity.
While depression is extremely treatable there is reluctance for people to seek treatment when feeling low, such is the stigma attached to mental illnesses. However, this attitude is slowly being changed with the help of campaigns such as the “see me” campaign and the fact that many high profile celebrities are admitting to suffering from mental ill health.
In the final part of this series, we will look at what has been done to challenge the stigma attached to mental illness.
Depression 3 part series: