Treatment Options for Depression: Part 1

Treatment Options for Depression

In light of the apparent suicide of Robin Williams, the media have been devoting a huge amount of space to the issue of suicide and depression. If you have been a follower of my blog, then you know that we’ve been discussing these issues for the past few years. While a huge tragedy, Mr. Williams’ death has had the positive consequence of getting a larger part of society to focus some attention on this invisible disease and if nothing else raising awareness.
Today I would like to reprise a blog that I posted on 5/22/13 discussing treatment options for depression. This is the first in a two part series, so I sincerely hope you come back tomorrow for the conclusion of the discussion regarding treatment options for depression. But, for right now:
Depression: Treatments and Options 1
Welcome back. Yesterday we took a look at depression; what it is, its presentation, symptoms, and the several most common types of depression. Over the next two days I’d like to discuss the most common types of treatment for depression. As we saw yesterday, depression comes in several different varieties, so too its treatment doesn’t come in a one-size-fits-all package. In fact, depression treatments run the gamut from the least invasive/traumatic talk therapy, through drugs, to Electroconvulsive Therapy and surgical implants.
The first thing to keep in mind is that all of these therapies have proven highly effective in the treatment of depression; however, not all therapies are effective for all patients and all types of depression. For example, some of the most common drugs used to treat Major Depressive Disorder (MDD) don’t work well for bipolar depression, and in fact may even make the symptoms worse. Also, keep in mind that treatment takes time and you may actually have to go through several different rounds of therapy before you find the one that’s right for you. The important thing is to be an active participant with your physician…ask questions and be prepared to challenge (after you do your research) a particular type of therapy. Also, don’t be afraid to get a second…or third opinion.
Psychotherapy: The first round and least traumatic type of therapy for depression is talk or psychotherapy. The main thrust of psychotherapy (particularly Cognitive Behavioral Therapy) in treating depression is to assist the client in developing an understanding of their depressive thoughts and then to develop coping strategies to deal with the stressors as well as to challenge the depressive thoughts (cognitive restructuring). Be advised however, that study after study show that talk therapy alone is effective in about 50% of clients, while drug therapy alone is successful in about 50% of clients; however when used together psychotherapy and drug therapy are effective in over 80% of clients. So, don’t be surprised or resistant if your physician suggests a combination of the two.
Drug or Antidepressant Therapy: Today I’m going to discuss the most common types of antidepressants your physician may prescribe; however, tomorrow I’m going to discusses a promising…and controversial…new type of chemical antidepressant therapy. I am not choosing sides or making recommendations…I’m simply offering information to help you make a more informed choice…so you have that to look forward to tomorrow. As the name implies, antidepressant drug therapy is the use of chemicals to help relieve the symptoms of depression. Because there are so many different types of depression and so many different mechanisms through which the brain can experience depression, there are also a wide variety of drugs available to help treat the condition; however, all of them are neurotransmitters and fall into three basic classes. The three basic types of chemicals are norepinephrine, dopamine and serotonin. Neurotransmitters help carry the electrical impulses between the connections (synapses) in your brain. Researchers believe that when there aren’t sufficient quantities of these chemicals in the brain, things slow down and may lead to depression. Taking these drugs increases the level of the available neurotransmitters improving the speed and efficiency of the process. However, how these drugs work is still largely a mystery.
WebMd has an excellent discussion of the different types of drugs and their effective mechanism:

  • Selective serotonin reuptake inhibitors (SSRIs). SSRIs work by altering the amount of a chemical in the brain called serotonin.
  • Serotonin and norepinephrine reuptake inhibitors (SNRIs). SNRIs are another form of antidepressant medicine that treats depression by increasing availability of the brain chemicals serotonin and norepinephrine.
  • Tricyclic antidepressants (TCAs). TCAs primarily affect the levels of two chemical messengers in the brain, norepinephrine and serotonin. Although these drugs are effective in treating depression, they can have more side effects than other drugs. So, they typically aren’t the first drugs prescribed.
  • Monoamine oxidase inhibitors (MAOIs). MAOIs are most effective in people with depression who do not respond to other treatments. They are also effective for treating other mental illnesses. Substances in certain foods like cheese and aged meats, and certain medications (like decongestants or some cough syrups) can interact dangerously with an MAOI. So people taking this drug must adhere to strict dietary restrictions. For this reason these antidepressants also aren’t usually the first drugs prescribed.

 
Today’s discussion has mainly focused on pharmacological treatments for depression and I know that there are a lot of people who resist this idea; I routinely deal with these types of clients in my own practice. They feel that medication will somehow make them a different person or that taking medication somehow makes them a failure.
With these clients I usually bring up the issue of diabetes. I ask them if they have/develop diabetes if they would feel like a failure if they had to take insulin; the response is always a firm “No.” I then ask, “So what about depression medicine makes makes you a failure and insulin doesn’t?” They usually say, “If I don’t take the insulin I’m going to die.” To which I respond, “Thank you for making my point for me.”
Like diabetes, people with depression have bodies/brains that don’t make enough of a particular chemical needed for normal functioning. Taking a medication that replaces those chemicals is a logical and effective treatment. As a therapist, I tell my clients that the meds will largely help mitigate their symptoms so we can spend more time effectively focusing on the underlying issues in therapy. A win-win for all concerned.
Please come back tomorrow for the second installment in our discussion of treatment options for depression.
In the meantime, I hope you have an intentionally great and self-confident day.
Rich

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One Comment

  1. Yes, thank you all. I know that the “media HAVE” and the “data ARE.” It’s just that my fingers don’t speak Latin at 6:00 AM.

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