Depression Support Journal

Thursday, January 19, 2006
11:20:00 PM EST
Feeling Sad
Treatment

The development of newer antidepressant medications and mood-stabilizing drugs has improved the treatment of depression. Medications can relieve symptoms of depression and have become the first line of treatment for most types of the disorder.

Treatment may also include psychotherapy, which may help you cope with ongoing problems that may trigger or contribute to depression. A combination of medications and a brief course of psychotherapy usually is effective if you have mild to moderate depression. If you're severely depressed, initial treatment usually is with medications or electroconvulsive therapy. Once you improve, psychotherapy can be more effective.

Doctors usually treat depression in two stages. Acute treatment with medications helps relieve symptoms until you feel well. Once your symptoms ease, maintenance treatment typically continues for six to 12 months to prevent a relapse. It's important to keep taking your medication even though you feel fine and are back to your usual activities. Episodes of depression recur in the majority of people who have one episode, but continuing treatment for at least six months greatly reduces your risk of a rapid relapse. If you've had two or more previous episodes of depression, your doctor may suggest long-term treatment with antidepressants.

Medications

• Selective serotonin reuptake inhibitors (SSRIs). Doctors often consider selective serotonin reuptake inhibitors, such as fluoxetine (Prozac, Sarafem), paroxetine (Paxil), sertraline (Zoloft), citalopram (Celexa) and escitalopram (Lexapro), as the first-line treatment for depression because they have fewer serious side effects. They seem to work by increasing the availability of the neurotransmitter serotonin in your brain. Drugs similar to SSRIs include serotonin and norepinephrine reuptake inhibitors (SNRIs), such as nefazodone (Serzone), trazodone (Desyrel) and venlafaxine (Effexor), and dopamine reuptake inhibitors, such as bupropion (Wellbutrin, Zyban).
• Tricyclic and tetracyclic antidepressants. These medications also affect neurotransmitters, but by a different mechanism than SSRIs. They may be used for any type of depression, be it mild or severe. Among tricyclic antidepressants are amitriptyline (Elavil), desipramine (Norpramin, Pertofrane), nortriptyline (Aventyl, Pamelor), protriptyline (Vivactil), trimipramine (Surmontil) and a combination of perphenazine and amitriptyline (Triavil, Etrafon). Tetracyclics include maprotiline and mirtazapine (Remeron).
• Monoamine oxidase inhibitors (MAOIs). These drugs, which include phenelzine (Nardil) and tranylcypromine (Parnate), prevent the breakdown of neurotransmitters. The drugs have potentially serious side effects if combined with certain other medications or food products. Doctors rarely use them unless other options have failed. Your doctor may prescribe them if you have chronic depression and eat or sleep excessively.
• Stimulants. If you're severely depressed, your doctor may initially prescribe a stimulant such as methylphenidate (Ritalin, Concerta), dextroamphetamine (Dexedrine, Dextrostat) or modafinil (Provigil) in addition to an antidepressant because most antidepressants are slow to work. After one to four weeks, your doctor may then switch you to just an antidepressant.
• Lithium and mood-stabilizing medications. Doctors prescribe lithium (Eskalith, Lithobid), valproic acid (Depakene), divalproex (Depakote) and carbamazepine (Epitol, Tegretol, Carbatrol) to treat bipolar depression. Medications called atypical antipsychotics such as olanzapine (Zyprexa), risperidone (Risperdal) and quetiapine (Seroquel) were initially developed for treatment of psychotic disorders. Doctors sometimes also use them to treat bipolar disorder.

According to the American Diabetes Association, certain antipsychotic drugs may increase the risk of diabetes, obesity and high blood pressure. A study published in the February 2004 issue of Diabetes Care recommends that doctors screen and monitor people who take Risperdal, Seroquel and Zyprexa.

Most antidepressants have a similar level of effectiveness. However, a medication that works for someone else might not work for you. Doctors choose antidepressants based on your family history and the match between your symptoms and the medication's side effects. For example, if you have insomnia, a sedating antidepressant may help you. But if you're lethargic, then a more energizing antidepressant may be more helpful.

Most antidepressants are slow to work. You may see a response in two weeks, but many people don't see a full benefit for six to eight weeks. If your response to medication hasn't resulted in satisfactory progress after six to eight weeks, your doctor may suggest either adding another antidepressant or replacing the first medication with another drug from a different chemical family.

One person's body may break down drugs faster or slower than another person's body. Scientists are developing techniques to measure this. If you've taken several medications and your condition hasn't improved or you've experienced side effects, tell your doctor. He or she may order blood tests for you to determine how rapidly your body breaks down your current medications.

In addition to medications, depression treatment may include:

Psychotherapy
There are several types of psychotherapy. Each type involves a short-term, goal-oriented approach aimed at helping you deal with a specific issue. Prolonged psychotherapy is seldom necessary to treat depression. If an underlying factor contributing to your depression is an inability to get along with others or difficulty finding your place in life, then prolonged psychotherapy could help you.

The success of therapy depends on finding a doctor, psychiatrist or psychologist you're comfortable with. Both medications and psychotherapy can take four to eight weeks to have an effect. Specialized and supervised group therapy, such as bereavement groups, stress management classes, marital counseling and family therapy, also may help.

Electroconvulsive therapy
Despite the images that many people conjure up, electroconvulsive therapy is generally safe and effective. In fact, it's the gold standard for treatment of severe depression.

In this therapy, you receive a light general anesthesia and a muscle relaxant. An electrical current is passed through your brain for one to three seconds. The stimulus causes a controlled seizure, which typically lasts for 20 to 90 seconds. You wake up in five to 10 minutes and should rest for about half an hour. Most people require six to 10 treatments.

Experts aren't sure how this therapy relieves symptoms of depression. The seizure may affect levels of neurotransmitters in your brain. The most common side effect is confusion that lasts a few minutes to several hours. A few people have some memory loss for several weeks. This therapy is usually used for people who don't respond to medications and for those at high risk of suicide. It may be the only treatment available for severely depressed older adults who can't take medications because of heart disease.

Light therapy
This therapy may help if you have seasonal affective disorder. This disorder involves periods of depression that recur at the same time each year, usually when days are shorter in the fall and winter. Scientists believe fewer hours of sunlight may increase levels of melatonin, a brain hormone thought to induce sleep and depress mood. Treatment in the morning with a specialized type of bright light, which suppresses production of melatonin, may help if you have this disorder.

Self-care

Once treatment for depression begins, you still have to manage on a day-to-day basis. Here are some guidelines:

• See your doctor regularly. Your doctor can monitor your progress, provide support and encouragement, and adjust your medication if necessary.
• Take your medications. Finding the best medication for you may take several tries. It may take several weeks for you to start seeing results. Once you feel better, continue to take your medication as prescribed.
• Don't become isolated. Try to participate in normal activities.
• Take care of yourself. Eat a healthy diet and get the right amount of sleep and exercise. Exercise can help treat some forms of depression, ease stress and help you relax.
• Avoid alcohol and recreational drugs. Abuse of alcohol and drugs will slow or prevent your recovery.

Coping skills

Self-help organizations have become potent allies for people who are coping with mental illness or who care about someone with such an illness. For depression or other mental illnesses, self-help groups include the National Mental Health Association (NMHA) and the National Alliance for the Mentally Ill (NAMI).

The NMHA is based in Washington, D.C., and has hundreds of affiliates in the United States. The group educates the public and the policy makers about mental health issues. The association's online resources include discussion groups and screening for depression.

The NAMI provides support and education to people with severe mental illness and their families. Founded in 1979, the group has more than 1,200 state and local chapters. The chapters rely on volunteers, most of whom have had mental illness in their families.

Complementary and alternative medicine

Herbal and dietary supplements soldin stores have become increasingly popular. People take them to help prevent or treat a number of health conditions. Some of these alternative therapies are being studied to determine their effectiveness in helping depression. Within the next few years, researchers may know more about these products, how effective they are and if they can cause other health problems or interfere with medications.

In the meantime, talk with your doctor before taking any herbal or dietary supplement. The downfall of herbal and dietary products is that they aren't regulated. The Food and Drug Administration doesn't test them for safety, purity or effectiveness. You can't always be sure of what you're getting and if it's safe.

Some popular supplements marketed or taken for treatment of depression include:

• St. John's wort. St. John's wort is an herbal preparation from the Hypericum perforatum plant. It has long been used in folk medicine, and today it's widely prescribed in Europe to treat anxiety, depression and sleep disorders. In the United States, it's sold in health food stores and pharmacies in the form of tablets or tea.

  European studies suggest that St. John's wort may work as well as antidepressants in mild depression and with fewer side effects. Adverse reactions include dry mouth, dizziness, digestive problems, fatigue, confusion and sensitivity to sunlight. In most cases, signs and symptoms are mild. Of concern is that St. John's wort can interfere with the effectiveness of prescription medications, including antidepressants, drugs to treat human immunodeficiency virus (HIV) infections and AIDS, and drugs to prevent organ rejection in people who've had transplants. There's also a risk of serotonin syndrome if St. John's wort is used with an SSRI or another serotonin-active antidepressant.

• SAM-e. Pronounced "sammy," short for S-adenosyl-methionine, this chemical substance is available in Europe as a prescription drug to treat depression. In the United States it's sold as an over-the-counter dietary supplement.

  SAM-e is a chemical substance found in all human cells and plays a role in many body functions. It's thought to increase levels of serotonin and dopamine, but this is unproved. The pills are expensive, especially considering their effectiveness is unproved. Too much of this product could be harmful, boosting serotonin to dangerously high levels.

• 5-HTP. One of the raw materials that your body needs to make serotonin is a chemical called 5-HTP, which is short for 5-hydroxytryptophan. 5-HTP is prescribed in Europe to treat depression and other conditions, including obesity and insomnia. In the United States it's available as an over-the-counter supplement.

  In theory, if you boost your body's level of 5-HTP, you should also elevate your levels of serotonin. But there's not enough evidence to determine if 5-HTP is effective and safe. Larger studies than have been conducted to date are needed.

• Omega-3 fatty acid. Omega-3 fatty acids are found in fish oil and certain plants. They're being studied as a possible mood stabilizer for people with bipolar depression and other psychiatric disorders. Some studies have suggested that people with depression have decreased amounts of an active ingredient found in omega-3 fatty acids.

  Fish oil capsules containing omega-3 fatty acids are sold in stores. The capsules are high in fat and calories and may produce gastrointestinal problems. Another way to get more omega-3 fatty acids is simply to eat more fish.

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This entry has 1 comments: (Add your own)

• #1 Comment from artloner 
  1/20/06 12:54 AM | Permalink

  I've had good experiences with NAMI.