COGNITIVE BEHAVIORAL THERAPY
Cognitive Behavioral Therapy or CBT helps people to manage the symptoms of depression by addressing negative thoughts and behaviors. This behavioral technique seeks to determine what factors are maintaining the depressive symptoms and attempt to modify them. CBT consists of attempting to assist the client by replacing the negative thoughts and behaviors with more productive ones. CBT often requires frequent visits (once per week often) and practise exercises at home in between visits to the Therapist. Cognitive Behavioral Therapy has been a very successful means to manage depression and many people who undergo this therapy show marked improvements and improved quality of life.
PSYCHOTHERAPY
The basic description of psychotherapy is a form of talk therapy that seeks to help the patient to get at the root of their problems. This form of therapy is different from Cognitive Behavior Therapy in that CBT is not concerned with the root causes but the current factors contributing to the behavior and thoughts that intensify the depression. By getting at the root of the problems, psychotherapy seeks to reduce or eliminate the depressive symptoms. There are many varieties and approaches with the psychotherapy realm.
ELECTROCONVULSIVE THERAPY
Electroconvulsive Thearpy (ECT) is generally known as shock treatments. The ECT treatments are used only on the most severely ill depressed patients. The basic description is that an electrical current is pushed through an individuals brain while the patient is under general anesthesia. The current which is administered for approximately 30 seconds causes seizures to occur. Research has determined that it is effective with some people. However, there are also side-effects of this treatment which include significant memory loss. The reason ECT is successful in some patients is not known. I do not recommend this procedure because of the somewhat unpredictable side-effects of extended memory loss.
VAGUS NERVE STIMULATION
Vagus Nerve Stimulation (VNS) is a technique in which an electrode is implanted just beneath the skin along the vagus nerve in the neck. Simply put, the electrode sends electric current to the brain. The vagus nerve is believed to send signals from the brain to organs such as the heart, lungs, intestines and parts of the brain. It is surmised via research that the electrical stimulation from the electrode alters the levels of brain chemicals associated with mood.
MEDICATIONS
As previously mentioned, the most successful treatment of depression continues to be therapy in conjunction with medications. There are issues with anti-depressant medications. Often it takes several attempts with different medications to find one that is effective and the effects of the medication take 4 to 6 weeks to become effective. There is some research that indicates that it is possible that some anti-depressant medications may increase suicide risk, especially in younger people. Most anti-depressants should not be taken during pregnancy and anti-depressants should never be abruptly stopped due to possible serious withdrawal symptoms. Often these symptoms can be effectively managed by a slow titration off the medication.
The following is a list of the different types of medications that are used to treat depression.
- Selective Serotonin Reuptake Inhibitors (SSRI): SSRI medications tends to be safer than other anti-depressant medications and have few side-effects. SSRI work by increasing the amount of Serotonin, a neurotransmitter (brain chemical). SSRI medications block the reabsorbtion of Serotonin, thus increasing the amount in the brain. This type of medication is called 'selective' because it primarily just effects Serotonin levels not other neurotransmitters. Examples of SSRI medications include: fluoxetine (Prozac), paroxetine (Paxil), sertraline (Zoloft) and citalipram (Celexa).
- Serotonin-norepinephrine Reuptake Inhibitors (SNRI): It should be noted that SNRIs are also used to treat anxiety and neuropathic pain. This class of medications work by blocking the reabsorbtion of both Serotonin and Norepinephrine (both neurotransmitters). This increases the levels of both Serotonin and Norepinephrine in the brain. Examples of SNRIs include: duloxetine (Cymbalta), levomilnacipran (Fetzima), venlaxefine (Effexor) and desvenlaxfaxine (Pristiq).
- Norepinephrine-Dopamine Reuptake Inhibitors (NDRIs): It should be mentioned that NDRI medications are used for other disorders including: Attention Deficit Hyperactivity Disorder (ADHD), narcolepsy and Parkinson's disease and symptoms. These medications work by blocking the reabsorbtion of Norepinephrine and Dopamine, thus increasing their levels in the brain. An example of a NDRI is Bupropion (Wellbutrin). This class of medications does not appear to have sexual side effects that many other anti-depressants do.
- Tricyclic Anti-depressants: Tricyclic anti-depressants have been around for a long time and can be effective. However, they also tend to have many more side-effects than other anti-depressants. These medications have been mostly replaced by newer medications with fewer side-effects. Examples of this class of medications include: Norpramin, Pamelor, etc.
- Monoamine Oxidase Inhibitors (MAOIs): This was the first class of medications prescribed to treat depression. This class of anti-depressant medications are usually prescribed when other medications have not worked. MAOIs work by preventing monoamine oxidase from removing Serotonin, Norepinephrine and Dopamine from the brain, thus increasing the presence of those neurotransmitters (brain chemicals). MAOIs can cause very high blood pressure when combined with certain foods and medications. Examples of MAOIs include: tranylcypromine (Parnate), isocarboxazid (Marplan) and phenelzine (Nardil).
- Other Anti-Depressant Medications: There are other medications that are used to treat depression such as Atypical Anti-depressants.
OTHER TREATMENTS
There are other methods and treatments which may be helpful in reducing depression. These other alternative treatments should never replace your prescribed treatment. Do NOT suggest someone stop their medications and only use these supplements or treatments. That can be extremely dangerous. Included here are just two of them:
- Supplements: Supplements are often used by people suffering from a variety of disorders including depression. Supplements like St. John's Wort must be used with extreme care. People often believe that non-prescription medications and supplements are totally safe, but they are not. Many of these supplements and over the counter medications have serious interaction effects with other medications, foods, etc. Do not use them without first researching it thoroughly and speaking to your physician.
- Exercise: Mayo Clinic and several research sources have shown exercise to be helpful with depression for a number of reasons. Research also shows, however, that exercise works best with people with mild depression. Recent articles and social media posts have recently begun suggesting that traditional treatments including anti-depressant medications be abandoned in favor of exercise. This is a very dangerous and irresponsible claim. One of the misunderstood aspects of the positive effects of exercise with people with major depression is that it simply isn't possible for many to exercise when in severe depression. It is often difficult just to get out of bed. If the individual can exercise, that's great. But do not recommend to depressed individuals to abandon their prescribed medication or therapy. They work and it has been proven over time.
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