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Treating Depression

Depression treatments and how people respond to them vary considerably, which is why it’s so important to seek professional help to get the right treatment.

Depression is a complex disease with a variety of causes, symptoms and degrees of severity. As such, it cannot be treated with a one-size-fits-all approach; different types of depression and different individuals will respond very differently to treatment.

If you think you are depressed, or are concerned about someone you know, then the first step is to seek help from a doctor, who can determine whether you have depression, assess the type of depression it may be and develop an appropriate treatment regime.

Treatments for depression include approaches as simple as regular physical activity and meditation, to psychological therapies, such as cognitive behavioural therapy or interpersonal psychotherapy, medication and even electroconvulsive therapy.

Psychological therapy

Psychological therapy is often described as ‘talking’ therapy. While people with non-melancholic depression, which tends to be brought on by a stressful life event or personality type, generally respond well to psychological therapy, this approach is much less successful in initially treating melancholic depression and not at all effective with psychotic depression if used in isolation.

Cognitive behavioural therapy (CBT) can help you to challenge your negative internal dialogue about yourself and the world around you, showing you how such thinking affects your mood and how to turn that around. It’s a structured treatment approach, and has been found to be extremely effective in treating non-melancholic depression. Therapy usually involves a series of sessions with a trained therapist, which may be a GP but is usually a psychologist. It can also be conducted over the internet.

Counselling can help if you are dealing with stressful situations or life events by providing you with an opportunity to work out coping mechanisms or strategies to solve challenges. Counselling generally refers to a less structured approach than other psychological therapies.

Interpersonal psychotherapy examines problems in your relationships and explores your social functioning, helping you to recognise destructive patterns in relationships and how these contribute to your depression. This form of therapy usually involves 12 to 16 sessions with three main phases; an evaluation of your history, an exploration of your problem areas and construction of a treatment ‘contract’, and an examination and consolidation of progress (what you have learned, and how you might recognise and deal with depressive problems in an ongoing way).

Psychotherapy is generally a more long-term therapy that enables you to build a relationship with a therapist and for you to work together to address the causes and triggers of depression. It’s often about examining your past experiences and how that links to your present troubles. (The term psychotherapy is also sometimes used more generically to mean ‘psychological therapy’.)

Mindfulness is a strategy that encourages individuals to focus on, live in and accept what is happening in the present moment rather than stressing over what has happened in the past or what might happen in the future. It can also be incorporated into meditation or in other forms of therapy such as cognitive behavioural therapy.

Medication

Whether medication is the best treatment option depends on how severe the person’s depression is, their history of illness, their age (medication is not recommended as a first choice for children and adolescents), and their personal preferences.

Melancholic and psychotic depression invariably need to be treated with medication.

Depending on your type of depression and your response to treatment, there are different types of medicines you might be offered. Antidepressants are the main medicine used for depression. People with psychotic depression or bipolar disorder (what used to be called manic depression) may be prescribed antipsychotic medicines or mood stabilisers.

Antidepressants are the most common medications used for most people with depression and there is a wide variety available.

Side effects are an important factor to consider with antidepressants. The side effect profiles vary between different drugs and some are more severe than others. When deciding on a first-line treatment, a doctor might try to match the patient’s particular symptoms with the side-effect profile of the drug – for example, if sleeping too much is a problem, you wouldn’t choose an antidepressant known to cause drowsiness. However, individuals can respond very differently to medicines and it’s not always possible to predict your response or the side effects.

Not all depression will benefit from antidepressants, and they are generally not recommended for use as a first-line option in children or adolescents. Pregnant or breast-feeding women can take antidepressants but it’s important to talk to your doctor about your treatment options. Also antidepressants can take two to three weeks to have any effect, and another four to six weeks to have a significant effect.

Electroconvulsive therapy

Electroconvulsive therapy (ECT) is a medical treatment that induces controlled seizures by placing small electrodes at specific locations on the head.

While ECT has a dark past, much smaller doses are used today. There is clinical evidence that it can help relieve symptoms of psychotic depression or severe melancholic depression where there is a high risk of suicide or the patient is too ill to eat, drink or take medications. It can also be used to treat life-threatening mania or severe postnatal depression.

Therapy is given under general anaesthetic so the person being treated has no memory of the experience. Some people respond after just a few sessions while others may need as many as 20 to 25 rounds of treatment. Treatments are usually given 2 to 3 times a week.

Memory impairment lasting some weeks after treatment is a common side effect but otherwise the treatment is considered to be relatively safe.

Alternative therapies

Alternative (or complementary) therapies, including herbal medicines, are increasingly popular. But like conventional therapies, what suits one person may not suit another.

It can also be difficult to compare alternative treatments to more conventional therapies (antidepressants and psychological therapies), because less research has been done on alternative therapies. However, this is starting to change.

If you or someone you know is depressed it is best to speak to a health professional, and discuss your situation and your choice of treatment.

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