Depression is a mood disorder and is generally accompanied by feelings of intense sadness and hopelessness. Anyone, irrespective of age, race, or gender can be afflicted with depression and it is one of the most common illnesses afflicting people around the world. According to WHO, about 121 million are affected by depressive disorders globally (Callahan and Berrios, 2005). In the United States, about 19 million people are diagnosed with depression every year (Paolucci, 2007).
This means, more people in the US have depression than have heart disease, cancer, and AIDS combined. Though it has a wide range of symptoms, ranging from mild to moderate to severe, depression is a treatable medical illness. The most effective ways of treating people with depression include pharmacotherapy, psychotherapy, or a combination of both. Studies show that the earlier the treatment, the lesser the chances of relapse.
Initially, depression was treated using tricyclic antidepressant drugs (TCAs) and monoamine oxidase inhibitors (MAOIs) that influenced the functioning of neurotransmitters in the brain such as serotonin and norepinephrine. But these drugs had many side effects. Newer medications such as selective serotonin reuptake inhibitors (SSRIs) have shown greater efficacy with lesser side effects making it easier for people to stick to treatment. Thomas Laughren, M.D., of the FDA, points to the fact that different drugs seem to work for different people and it’s difficult to predict which drug will be most efficient for a particular person. Generally, treatment using anti-depressive medications tends to be long and extend over three to four weeks (Lewis, 2003). Drugs used to treat depression can be divided into three groups –
- tricyclics and other cyclists, the monoamine oxidase inhibitors (MAOI), and the atypical antidepressants like trazodone and bupropion;
- mood regulators including lithium and carbamazepine and
- stimulants, sedatives, and tranquilizers.
The overall effectiveness of the tricycles has been found to be around 60-70% (Freeman et al, 1986).
In psychotherapy, the patient is allowed to discuss his feelings with a mental health professional seeking a better understanding of his depression and how to cope with it. Psychotherapy works best in the case of bipolar disorder helping people to diagnose the disorder very early and helping to prevent a bipolar episode. Cognitive therapy has been found to be very successful in the treatment of depression especially in the context of long-term outcomes.
It is based on the work of Aaron Beck. The cognitive treatment model for treating depression has four major steps: developing awareness of emotional variability; detecting automatic thoughts and identifying beliefs; evaluating automatic thoughts and beliefs, and changing negative automatic thoughts and maladaptive beliefs. Several studies have shown that cognitive therapy is equally effective as antidepressant medications in treating depression.
More impressively, in a double-blind study by Ruch, Beck, Kovacs, and Hollon (1977) it has been found that cognitive psychotherapy was more effective than medications in the treatment of depression as its effects lasted longer. Richard O’Connor, Ph.D., a psychotherapist in Canaan, Conn., suggests that self-help is the best way out of depression and it is important that people assume responsibility for their own recovery, resort to good healthy habits and regularize their life patterns (Lewis, 2003). However, when depression does not respond to medications or psychotherapy, it may be treated using electroconvulsive therapy (ECT).
In ECT, certain points on the patient’s head are stimulated using electrical impulses by placing electrodes and a 30-second seizure is caused within the brain (Lewis, 2003). For full benefit, ECT may be carried out thrice per week. ECT is supposed to work like medications by affecting the brain’s neurotransmitters. The efficacy of this treatment is so well established that ECT is often recommended as a primary treatment without the necessity of prior trials of medication. A 1964 study by de Carolis and co-workers in Italy showed that delusional depressed patients who are less responsive to imipramine showed responsiveness to ECT. This is the best evidence of the efficacy of ECT in patients with psychotic depressions (Taylor and Fink, 2006).
Bibliography
Callahan, M. Christopher and Berrios E. G. (2005). Reinventing depression: a history of the treatment of depression in primary care, 1940-2004. Oxford University Press US.
Freeman, Arthur; Epstein, Norman and Simon, M. Karen (1986). Depression in the Family. Haworth Press.
Lewis, Carol (2003). The Lowdown on Depression. FDA Consumer, 37 (1).
Paolucci, L. Susan (2007). Depression FAQs. PMPH-USA.
Rush, A. J.; Beck, A. T.; Kovacs, M. and Hollon, S. D. (1977). Comparative efficacy of cognitive therapy and pharmacotherapy in the treatment of depressed outpatients. Cognitive Therapy and Research, Volume 1, 17-37.
Taylor, Alan Michael and Fink, Max (2006). Melancholia: the diagnosis, pathophysiology, and treatment of depressive illness. Cambridge University Press.