Depression - Complementary treatment for depression using psychotheraphy and depression medications.
Depression
Psychotherapy Treatment for Depression
Drugs and Medication for Depression
Complementary and Alternative Treatment for Depresseion
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| Psychotherapy as depression treatment |
Psychotherapy
Cognitive-behavioral therapy is a type of psychotherapy in which individuals learn to identify and change distorted perceptions about themselves and adapt new behaviors to better cope with the world around them. This therapy is frequently considered the treatment of choice for people with mild to moderate depression, but it may not be recommended for those with severe depression. Studies of people with depression indicate that cognitive-behavioral therapy is at least as effective as tricyclic antidepressants. Compared to those treated with antidepressants, people treated with cognitive-behavioral therapy demonstrated similar, or better, results and lower relapse rates.
Other therapeutic approaches that may be applied by a psychiatrist, psychologist, or social worker include:
- Psychodynamic psychotherapy—based on Freud's theories about unresolved conflicts in childhood and depression as a grief process
- Interpersonal therapy—acknowledges childhood roots of depression, but focuses on current problems contributing to depression; considered very effective treatment for depression
- Supportive psychotherapy—nonjudgmental advice, attention, and sympathy; this approach may improve compliance with taking medication
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| Drugs and Medicine for Treating Depression |
Medications
Antidepressant medications are very effective; reports indicate that they are 90% successful in treating depression. In general, medications are taken for at least 4 to 6 months to assure complete and effective treatment. However, antidepressants often cause adverse side effects, making it difficult for some people to comply with taking their medications. Medications must not be stopped without first discussing this change with a physician. Most antidepressants cause withdrawal symptoms if they are not discontinued slowly over time with guidance from a physician.
Some reports indicate that the mineral selenium, found in wheat germ, brewer's yeast, liver, fish, shellfish, garlic, sunflower seeds, Brazil nuts, and grains, significantly affects mood. In one study of people with low levels of selenium, those who consumed a diet high in selenium reported decreased feelings of depression after 5 weeks.
Selective Serotonin Reuptake Inhibitors (SSRIs)
SSRIs increase the activity of a chemical in the brain called serotonin. Most healthcare practitioners will prescribe SSRIs before any other antidepressant medication for depression, in part because the side effects associated with SSRIs are generally fewer than for other classes of antidepressants. Typical side effects caused by SSRIs include stomach upset, weight gain or loss, drowsiness, sexual dysfunction (such as impotence, decreased libido, and diminished orgasm), headache, jaw grinding, and apathy. Very unusual side effects from this class of prescription drugs include extreme agitation, impulsivity, tremors, and insomnia. People who discontinue taking SSRIs due to side effects usually attribute their discontent to sexual dysfunction.
Drugs classified as SSRIs include:
- Fluoxetine
- Sertraline
- Paroxetine—most likely in this class to cause sexual dysfunction
- Fluvoxamine
- Citalopram—least likely in this class to cause sexual dysfunction
Another group of antidepressant medications (which are similar to SSRIs, but target other brain chemicals in addition to serotonin) may cause fewer negative sexual side effects. These include:
- Bupropion—should not be used if there is history of or risk for seizure
- Nefazodone—no sexual dysfunction reported; begins to work very quickly; may cause a decrease in blood pressure when going from lying or sitting to standing
- Venlafaxine—may impair sexual function; not recommended in the elderly; may improve quality of life more effectively than other antidepressants, but can cause irregular heart rhythm; withdrawal from the medication is difficult
- Mirtazapine—may be particularly effective if feelings of anxiety are also present; helps with insomnia but may cause drowsiness; other side effects are blurred vision, weight gain, and damage to production of cells in the bone marrow (very rare)
- Maprotiline—may cause dry mouth, drowsiness, sensitivity to the sun, and seizures
Tricyclic Antidepressants
Tricyclics increase the activity of the brain chemicals serotonin and norepinephrine. They are as effective as SSRIs, but are usually prescribed only to those who do not respond well to SSRIs because side effects are quite common and are usually less tolerable. Dry mouth, blurred vision, constipation, sexual dysfunction, weight gain, dizziness, drowsiness, urinary urgency (a sense that one has to urinate even when the bladder is empty), drop in blood pressure when going from lying or sitting to standing (causes dizziness and lightheadedness), and irregular heart rhythm are among the side effects of tricyclics.
Tricyclic antidepressants include:
- * Amitriptyline
- * Amoxapine—increases risk of seizure in those who are prone to have a seizure
- * Clomipramine—used for obsessive/compulsive disorder
- * Desipramine
- * Doxepin—may help with insomnia
- * Imipramine—may cause a rare lung disorder called idiopathic pulmonary fibrosis
- * Nortriptyline—less risk of irregular heart rhythm than others in this class
- * Protriptyline—less drowsiness than others in this class and may even cause weight loss; may lead to sun sensitivity
- * Trimipramine—high risk for irregular heart rhythm
Monoamine Oxidase Inhibitors (MAOIs)
MAOIs boost the levels of norepinephrine, dopamine, and serotonin in the brain. MAOIs are generally prescribed only when other antidepressants have not been effective, which may occur in people with atypical depression. People who take MAOIs may experience a sharp increase in blood pressure after consuming food or drink containing the amino acid tyramine (found in such foods as aged cheeses and red wine). MAOIs also negatively interact with other medications, including ritalin (used for attention deficit hyperactivity disorder) and pseudoephedrine (decongestant in many over the counter and prescription medications), and should not be taken with other classes of antidepressants.
MAOIs include:
- * Phenelzine—should be avoided with a history of seizures or bipolar disorder (manic-depression)
- * Isocarboxazid—side effects include drowsiness, sexual dysfunction, weakness, trembling, and blurred vision
- * Tranylcypromine—should not be used if there is any history of kidney disease or bipolar disorder
Surgery and Other Procedures
- * Electroconvulsive Therapy (ECT) for depression is usually reserved for cases in which all other therapies have been unsuccessful. In this procedure, a small electrical current induces a seizure lasting approximately 40 seconds. A muscle relaxant and mild sedative are administered prior to the procedure. ECT is generally repeated every 2 to 5 days for a total of six treatments. It may cause temporary confusion, memory impairment, headache, muscle aches, irregular heart rhythm, or nausea.
- * Magnetic Resonance Imaging (MRI)-Guided Cingulotomy involves the application of an electrical current to a specific part of the brain; the MRI is used as a guide for an exact placement. Long-term improvement has been reported using this technique in over 50% of people with depression who have not responded to other modes of therapy.
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| Warning and Precautions |
Warnings and Precautions
- * SSRIs should be avoided in people with Parkinson's disease.
- * Tricyclic antidepressants should be avoided in people with coronary artery disease.
- * Several herbal remedies and supplements should not be combined with antidepressant medications. Be sure to inform your healthcare provider of all herbs and supplements you take to avoid adverse interactions.
Prognosis and Complications
Depression is a serious condition that can have a devastating effect on people's lives. It can directly and indirectly contribute to chronic medical conditions, such as heart disease and stroke, because depressed people with these conditions are less likely to engage in healthy behaviors (such as exercise) and more likely to engage in unhealthy behaviors (such as smoking). Suicide is a significant factor in depression; about 15% of people with major depressive disorder commit suicide. Depression also significantly shortens the life-span of the elderly and is associated with the development of memory impairment and dementia.
When left untreated, depression can last up to 2 years. Rates of recurrence are variable: 50% of people who have had one depressive episode will have a second major depressive disorder; 70% will have a third and 90% will have a fourth. Symptoms of depression usually disappear after menopause in women with premenstrual dysphoric disorder or seasonal affective disorder. Fortunately, there are several treatment options available for people with depression and the prognosis improves tremendously for those who seek treatment and comply with their regimen.
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