Treatment Of Depression

As I discussed in my North Hills Monthly column a couple of months ago, depression is a medical illness that affects the mind and body. You may not be able to pursue your usual daily activities and the illness might make you feel as though life is not worth living. For many people who struggle with depression, the illness may be chronic, like diabetes or high blood pressure, and require long-term treatment. Some people may have only one full-blown episode of depression but suffer from repeated episodes of less severe depressive symptoms over the course of their lives.

Depression is often a relapsing illness – in fact, after two episodes, the risk of recurrence within five years is approximately 75 percent. Successful treatment can reduce or eliminate symptoms of depression and make it possible for most people with even severe depression to return to their usual daily activities and enjoying life, often within weeks.

Treatment for depression may initially include changes in lifestyle and behavior, psychotherapy, and/or medication. If medication is required, your physician will likely recommend drugs in combination with psychotherapy and lifestyle changes in order to help you feel better faster and longer. Lifestyle and behavioral changes will involve focusing on activities that make you feel better. Don’t isolate yourself. Maintain good communication with family and friends and even consider joining a support group. Follow a regimen of regular exercise and eat a nutritious, balanced diet. Develop a regular sleeping pattern and get enough rest. Avoid drinking alcohol.

Psychotherapy is a way of treating depression by talking about your condition and related issues, typically with a psychologist or psychotherapist. Through these sessions, you learn about the causes of depression so that you can better understand it. You learn how to identify and make changes in unhealthy behavior or thoughts. It may also help you to adjust to a crisis or difficult period in your life. Significant improvement in symptoms may be apparent in six to 10 sessions, and almost all patients will notice relief in 20 to 30 sessions.

Medication is often prescribed for depression although, like the other recommended treatment options, it may take several weeks before the full benefits are realized. Sometimes depression is the result of difficulty coping with specific life problems, like the death of a loved one or job pressures. Medication will not make these problems go away, and you may be well-advised to seek out a psychotherapist.

Many medications are available to deal with depression, and they are characterized by how they affect the biochemicals—particularly serotonin, dopamine and norepinephrine—that occur naturally in the brain and affect your mood. The usual first choice antidepressant is an SSRI (selective serotonin reuptake inhibitor) such as Prozac, Zoloft, Celexa, Paxil and Lexapro. They typically are effective and have few side effects. Other typical first choices include SNRIs (serotonin and norepinephrine reuptake inhibitors) like Effexor and Cymbalta, and miscellaneous drugs like Wellbutrin and Remeron. Tricyclic anti-depressants have been around longer than SSRIs and are effective, but tend to have more side effects and so are not used as frequently. MAO inhibitors are also effective but have some severe side effects and are not usually prescribed by a primary care physician.

About 10 to 20 percent of patients do not receive relief from psychotherapy or typical medications and are said to have resistant depression. These patients may in fact have bipolar disorder or panic disorder and would benefit from a different treatment strategy. Other treatments for resistant depression include the addition of supplemental medications such as thyroid hormones, lithium, an atypical antipsychotic medication like Abilify, a stimulant drug like Ritalin, or a second antidepressant. Sometimes treatments other than drugs are required. Electroconvulsive therapy (ECT or ‘shock therapy’) is much safer than in previous times and is one the most effective ways to quickly relieve the symptoms of severe depression.

Once you have begun a treatment with medications, you will likely need to remain on the drug for several months or even years. When the medications are stopped, they should be tapered over at least two to four weeks in order to avoid side effects associated with stopping therapy.

Kelly McMahon, MD, a graduate of Yale University and the University of Pittsburgh School of Medicine, is board certified in Internal Medicine. She is a member of the American College of Physicians and the Allegheny County and Pennsylvania Medical Societies. She is in solo practice in the North Hills of Pittsburgh.