Finding the right treatment for depression can be as difficult
as convincing someone that they need help. However, clinical depression
is one of the most treatable of all medical illnesses.
Today, most people with depression can be treated
successfully with antidepressant medications, "talk"
therapy (psychotherapy), or a combination of the two. Experts
agree that successful treatment also hinges on early intervention.
And early treatment increases the likelihood of preventing serious
· Drug treatment
There are different types of antidepressants:
Existing antidepressant drugs -
These are known to influence the functioning primarily of either
or both of two neurotransmitters in the brain--serotonin and norepinephrine.
Older medication drugs -
Tricyclic antidepressants (TCAs) and monoamine oxidase inhibitors
(MAOIs) affect the activity of both of these neurotransmitters
simultaneously. Their disadvantage is that they can be difficult
to tolerate due to significant side effects, or, in the case of
MAOIs, dietary and medication restrictions.
Newer medication drugs -
Selective serotonin reuptake inhibitors (SSRIs) have fewer side
effects than the older drugs, making it easier for people, including
older adults, to adhere to treatment.
Both generations of medications are effective in
relieving depression, although some people will respond to one
type of drug, but not another.
Although some improvement may be seen in the first
few weeks, antidepressants usually must be taken regularly for
three to four weeks (and sometimes longer) before full therapeutic
The medication most often used to treat bipolar
disorder is lithium (Eskalith, Lithane, Lithobid, Cibalith-S).
Lithium evens out mood swings in both directions, from mania to
depression, and depression to mania. It is used not just for manic
attacks or flare-ups of the illness, but also as an ongoing maintenance
treatment for bipolar disorder.
Antidepressant drugs are not considered to be candidates
for abuse. However, as is the case with any type of medication,
use of antidepressants must be carefully monitored to make sure
the correct dosage is being given. Care also is needed when antidepressants
As is often seen with antibiotics, people may be
tempted to stop antidepressants too soon. They may feel better
and think they no longer need the medication, or they may believe
the medication isn't working. But quickly stopping certain antidepressants
is linked to side effects ranging from flu-like symptoms to sensory
disturbances. As a result, new labeling, as specified by the FDA,
recommends that patients taper off these medications slowly. If
a person encounters problems going off a drug, he or she is advised
to consult a physician rather than reduce dosage without supervision.
In psychotherapy, also called "talk therapy," a person
discusses with a mental health professional the feelings, thoughts
and behaviours that seem to cause difficulty. The goal of psychotherapy
is to help people understand and manage their problems so that
they can function better. Finding a therapist who believes in
recovery is the first step. Someone who can teach you to think
differently and learn new behaviours.
Psychotherapy can help people with bipolar disorder,
and their families, identify early warning signs and manage emotional
stress, which may help prevent a bipolar episode.
People need to help themselves "break the bad
habits in their lives that set them up for depression." Waking
up and going to sleep at the same time each day, for example,
might help those people prone to bouts of insomnia due to irregular
sleep patterns. People are responsible for their own recovery.
They must learn to take care of themselves and structure their
lives so that they're less likely to trigger an episode.
When people are unresponsive to psychotherapy and
medications, or the combination of the two works too slowly to
relieve severe symptoms, such as psychosis or recurring thoughts
of suicide, electroconvulsive therapy (ECT) may be considered.
Electrodes are placed at precise locations on the head to deliver
electrical impulses. The stimulation causes a 30-second seizure
within the brain; however, the person does not consciously feel
the stimulus. Three sessions per week typically are given for
full therapeutic benefit. Like antidepressants, ECT is believed
to affect the chemical balance of the brain's neurotransmitters.