GETTING HELP

Depression, even the most severe cases, can be treated. The earlier that treatment can begin, the more effective it is. Depression is usually treated with medications, psychotherapy or a combination of the two. Research has found that a combination of the two is the most effective way to treat depression. Independently, psychotherapy and medication can cause changes in the brain to improve symptoms of depression. In addition, psychotherapy helps people develop more helpful thinking styles which prevents future episodes of depression.

If these treatments do not reduce symptoms, electroconvulsive therapy (ECT) and other brain stimulation therapies may be options to explore.

Psychotherapy

Psychotherapy is a form of treatment that involves talking to a therapist about your thoughts and feelings. Unlike other medical treatments, psychotherapy is based on the collaborative relationship between an individual and a psychologist.

Several forms of psychotherapy have been shown to be effective in treating depression. These include:

  • Behaviour Therapy/Behavioral Activation
  • Cognitive Therapy
  • Cognitive Behavioral Analysis System of Psychotherapy
  • Interpersonal Therapy
  • Problem-Solving Therapy
  • Self-Management/Self-Control Therapy

Even though we recommend that you pick a form of therapy which has been shown to be effective, there is no one "right" approach to therapy. Whichever form of therapy you decide to go with, it is important that the therapy should be backed up by evidence showing its effectiveness as a treatment for mental illness. However, the content will differ based on the therapist and patient. Therapists work closely with their patients to create tailored treatment plans to address their unique needs and concerns. Psychotherapy can help patients learn ways to better cope with stress and manage their symptoms of depression. These strategies can lead to recovery and enable patients to function at their best.

Medication

Most people with moderate or severe depression benefit from antidepressants, but not everybody does. You may respond to one antidepressant but not to another, and you may need to try two or more treatments before you find one that works for you.

The different types of antidepressant work about as well as each other. However, side effects vary between different treatments and people.

When you start taking antidepressants, you should see your GP or specialist nurse every week or two for at least four weeks to assess how well they're working. If they're working, you'll need to continue taking them at the same dose for at least four to six months after your symptoms have eased. Data from clinical trials that improvement can start immediately, with the greatest degree of improvement occurring in the first week; the curve begins to flatten off thereafter, with a smaller degree of improvement as time goes on.

A systematic review of available evidence suggests that antidepressant drugs, when considered individually or by class, are more effective than placebo in the treatment of major depression, and are generally equally effective. However, Selective Serotonin Reuptake Inhibitors (SSRIs) are generally better tolerated than antidepressants from other classes and is recommended as a first-line pharmacological treatment of moderate to severe depression by the Royal College of Psychiatrists, UK. SSRIs increases the amount of serotonin, a neurotransmitter in your brain (chemicals that relay signals between the brain cells).

Examples of SSRIs are:

  • Citalopram (Celexa)
  • Escitalopram (Lexapro)
  • Fluoxetine (Prozac)
  • Paroxetine (Paxil, Pexeva)
  • Sertraline (Zoloft)
  • Vilazodone (Viibryd)

Antidepressant treatment has been associated with an increased risk of suicidal thoughts and acts, particularly in adolescents and young adults. However, the absolute risk remains small and the risk of suicide in untreated depression is greater than the increased risk of suicidal thoughts and acts due to antidepressant medication.

Other types of antidepressants include:
Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs). SNRIs increase the amount of two neurotransmitters (serotonin and norepinephrine) in your brain. In general, SSRIs are as effective as SNRIs, with some evidence suggesting SNRIs may be slightly more effective than SSRIs. There tends to be greater side-effects compared to SSRIs and is more toxic than the SSRIs in overdose.

Examples of SNRIs are:

  • Duloxetine (Cymbalta)
  • Venlafaxine (Effexor XR)
  • Desvenlafaxine (Pristiq, Khedezla)
  • Levomilnacipran (Fetzima)
  • Tricyclic antidepressants (TCAs)

TCAs increase the amount of two neurotransmitters (Serotonin and noradrenaline) in your brain. Tricyclic antidepressants are at least as effective as newer antidepressants such as selective serotonin reuptake inhibitors (SSRIs) and serotonin and noradrenaline reuptake inhibitors (SNRIs), but they usually cause more side effects, such as constipation, dry mouth and dizziness. Some studies suggest TCA may be more effective for severe depression.

Examples of TCAs are:

  • Imipramine (Tofranil)
  • Nortriptyline (Pamelor)
  • Amitriptyline
  • Doxepin
  • Trimipramine (Surmontil)
  • Desipramine (Norpramin)
  • Protriptyline (Vivactil)
  • Monoamine oxidase inhibitors (MAOIs)

MAOIs increase the number of certain neurotransmitters (adrenaline, noradrenaline, dopamine and serotonin) in your brain. They are not commonly used now because they have potentially serious interactions with many other medicines and foods, and safer antidepressants are available. MAOIs have also been shown to be effective treatments for some patients with atypical features of depression and those who have not responded to other antidepressant medications.

Examples of MAOIs are:

  • Tranylcypromine (Parnate)
  • Phenelzine (Nardil)
  • Isocarboxazid (Marplan)

Alternative Forms of Treatment

1. St. John's wort
Several reviews have shown that there is no consistent clear effect of St. John's wort on depression.

2. Omega-3 fatty acids
There is no consistent clear effect of Omega-3 fatty acids on depression. Overall, the results seem to suggest that Omega-3 fatty acids could be beneficial to depressive symptoms but should not be taken as a standalone therapy for depression.

3. Light therapy
Overall the results suggest that there are clinical benefits of bright light therapy in seasonal major depressive disorder (SAD).

4. Acupuncture
Studies show that acupuncture is not an effective treatment for depression.

References
  • https://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0016605/pdf/PubMedHealth_PMH0016605.pdf
  • http://www.apa.org/helpcenter/depression.aspx
  • http://www.div12.org/psychological-treatments/disorders/depression/
  • https://psychiatryonline.org/pb/assets/raw/sitewide/practice_guidelines/guidelines/mdd.pdf
  • http://www.nps.org.au/conditions/mental-health-conditions/mood-disorders/depression/for-individuals/medicines-for-depression-antidepressants/types-of-antidepressants/tcas-tricyclic-antidepressants
  • http://www.mayoclinic.org/diseases-conditions/depression/basics/treatment/con-20032977
  • Thase, M.E. (2008). Are SNRIs more effective than SSRIs? A review of the current state of the controversy. Psychopharmacol Bull, 41, 58-85. Access from: https://www.ncbi.nlm.nih.gov/pubmed/18668017

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