TREATMENT
Depression
can be treated in a number of ways. Click on the topic links
for more details. Treatments vary according to both the
cause of depression as well as its severity, though in general
antidepressant medications combined with psychotherapy is
considered the standard of care in the United States and
has been found to be the most effective. Medications are
used to adjust or correct neurochemical imbalances believed
to cause depression. Psychotherapy
and counseling aim to help people overcome negative
thoughts and feelings and to help evaluate from where, and
why, these detrimental feelings arise.
There
are several classes of prescription antidepressants, the
major ones being:selective serotonin reuptake inhibitors
(SSRIs), tricyclics, and monoamine oxidase inhibitor (MAO-inhibitors).
These names refer to the chemical structure and function
of the drugs. There are also several new drugs which do
not fit neatly into any of these classes, such as Remeron,
Effexor, Serzone, and Wellbutrin (these are discussed in
the "newer
medication" section).
None
of the prescription antidepressants are believed to be addictive,
but they (like all medications) have side effects. Today,
doctors often start out with an SSRI
or one of the newer
medications
because they often have the fewest and least serious side
effects of all the common prescription medications. All
antidepressant medications must be used for several weeks
before one can expect to experience an improvement in mood
and symptoms. SSRIs, MAO-inhibitors, and tricyclic antidepressants
are all quite effective. In fact, medications from each
of these three classes have been shown to be effective in
up to 80% of those who take them as directed. Click on the
links to learn more about each class of medication.
The
most common medications used today are fluoxetine (Prozac),
paroxetine (Paxil), and sertraline (Zoloft). These medications
have effects on serotonin-containing neurons and are called
selective serotonin
reuptake inhibitors (SSROs).
For most patients, and many children and adolescents with
depression, the SSRIs are the first line choice of medication.
Developed
in the 1950s, tricyclic
antidepressants (TCAs) (based on their chemical 3-ringed
structure) are another class of antidepressants commonly
prescribed. Today, these medications are often used after
an initial or second line treatment fails. Though certainly
safer than the older MAO
inhibitors, the tricyclic antidepressants also have
a long list of potential side effects.
Some
medications do not require a prescription. St.
John's Wort and other herbal remedies, for example,
are chemicals that has been proven to work for some people
with depression. Your physician can further discuss the
role of herbal medications in the treatment of depression.
Finally,
electric shock treatment, or more appropriately called electroconvulsive
therapy (ECT), is a tried and true method of treating
refractory depression. ECT is accomplished by passing an
80 volt electric shock through electrodes on the patient's
head which results in an electrical current through the
brain. Despite the barbaric sounding nature of this procedure,
the shock is not felt by the patient, who is under general
anesthesia. This technique is probably as effective - if
not more so - than many oral medications. It is unclear
why ECT is effective; it is believed to work by "rebooting"
the depression centers of the brain. Believe it or not,
ECT is quite safe and should be seriously considered in
those with severe depression resistant to the techniques
discussed above or those unable to adequately try other
treatments (e.g., severely suicidal patients). It is usually
administered three times a week for two weeks.
I
have a depressed friend now, how can I help?
The
National Institute of Mental Health provides some information
here. One can get a referral to a qualified counselor
by calling or clicking to 1-800-therapist.
If you or somebody you know is suicidal, you can get immediate
help and information at the National Crisis Line at 1- 888-SUICIDE.
And finally, if you feel somebody is in immediate danger
of hurting themselves or somebody else, you can always call
the police for help (911).
