Depression is treated more successfully than ever. There are several treatment options for intermittent and chronic depression and its symptoms. Treatment usually involves a combination of therapies:
- Antidepressant medication
- Cognitive behavioral therapy
- Electroconvulsive therapy (ECT), or "shock treatment"
The goal of these treatments is to relieve symptoms of a major depressive episode and reduce the risk for recurrence.
Treatment for depression is evolving all the time. New forms of treatment include behavioral, familial, and interpersonal therapies. Although methods may vary, treatments are essentially aimed at recognizing and reforming the patient's ability to function in society. These types of therapies usually last 3 to 4 months, and sessions are conducted in individual and group settings.
Cognitive behavior therapy (CBT) is an effective treatment for depression. The goal of CBT is to help the patient effect a change in their state of mind by teaching them how to look at life from a positive perspective and how to reward themselves for experiencing pleasure and accomplishment. Cognitive behavior therapy helps depressed people gain new insight, feel better, and improve their mood.
Cognitive therapists believe that causes for depression are low self-esteem; the inability to set rational, achievable goals; and pessimism. Once the patient learns to identify stressful, anxiety-inducing situations, they can implement effective coping strategies rather than become depressed. In this way, they learn to manage the stress that once caused depression.
Psychotherapy also treats depression as a manifestation of cognitive-behavioral dysfunction and its goal is to change self-perception and behavior.
Psychoanalytic therapists rely on suggestion, hypnosis, and reeducation to reform self-esteem, and helps the person construct coping strategies to deal with grief, sadness, disappointment, achievement, and pleasure. Psychotherapy is usually combined with antidepressant medication in the treatment of depression.
There is controversy surrounding the use of ECT, primarily because many patients who receive the treatment suffer short-term, and sometimes permanent, memory loss. Use of ECT is reserved for patients with chronic depression who do not respond to antidepressant medications, and patients who suffer severe depression and are in danger of harming themselves and/or others.
ECT increases monoamine neurotransmitter (i.e., serotonin, dopamine, norepinephrine) levels in the brain, which improves neurotransmission and elevates mood. ECT produces this effect almost immediately and neurotransmitter levels increase with each ECT treatment. Psychomotor retardation, diminished appetite, and insomnia, which are associated with moderate and severe depression, also may improve with ECT.
In ECT, strategically placed electrodes carry electricity to the brain and cause a seizure. There are two methods used, bilateral and unilateral. In bilateral ECT (the first method used), one electrode is placed over each hemisphere of the brain. In unilateral ECT, both electrodes are placed over the nondominant hemisphere, that is, the left hemisphere (in right-handed people). One method is not more effective than the other. However, the adverse effects of ECT, such as memory loss, are more common with bilateral ECT, so the unilateral method is usually recommended.
Depression & Hospitalization
A physician determines if symptoms require hospitalization. The decision is based on observations of the following:
- Does the person appear to be taking care of him- or herself?
- Does the person understand the situation?
- Does the person have a family support system?
- Is the person suicidal or dangerous to others?
- Are extended diagnostics needed for evaluation?