The Course of Depression Treatment
Genetics, environment and traumatic episodes can all lead to depression and each cause may require a different course of treatment. The different degrees of depression -mild, moderate and severe- come with their own set of symptoms. Some symptoms, like suicidal thoughts require more immediate treatment than others. This can have a considerable impact on a person’s course of treatment for depression.
Much like the different degrees of depression, some treatment approaches are more intense than others. In the case of someone with severe depression, alleviating symptoms as soon as possible is often imperative. Under these circumstances, intense treatment approaches are used at the start. This stage of treatment is known as acute treatment and typically lasts anywhere from six to eight weeks.
Acute treatment approaches are intended to stabilize a person’s condition to the point where they can function in everyday life. Once stabilized, a continuation treatment period begins. Continuation treatment typically lasts anywhere from four to nine months. The overall purpose is to further reduce a person’s symptoms and maintain any progress made along the way. People likely to have future episodes of depression are advised to enter into preventative long-term treatment. This period can last for years depending on how severe a person’s ongoing symptoms are.
A recent divorce or the loss of a job can easily trigger depression episodes as these can be devastating events. As a treatment for depression, psychotherapy involves talking through any current or past issues that may be fueling depression symptoms. Psychotherapy also offers coping strategies for dealing with everyday stressors in healthy ways. Depending on the issues involved, individual, group or family therapy may be used at different stages of treatment. Oftentimes, psychotherapy and medication treatments are used together, especially during acute stages of depression.
Cognitive behavioral therapy or CBT is the most commonly used therapies for depression treatment. CBT combines two different approaches known as cognitive and behavioral therapies. In essence, the cognitive approach helps a person identify destructive thinking patterns and beliefs while replacing them with a constructive outlook and attitude. The behavioral approach is designed to help a person unlearn the destructive behaviors that feed their depression and replace them with healthy behaviors.
Psychoanalysis is another commonly used form of psychotherapy. Psychoanalysis addresses any unresolved conflicts or unconscious conflicts that may be feeding a person’s depression symptoms. This approach is much more in-depth than CBT and typically takes years of ongoing therapy as opposed to the three month to six month timeframe involved with CBT approaches.
Chemical imbalances in the brain are believed to play a central role in causing feelings of depression. The three chemicals involved in this process are serotonin, dopamine and norepinephrine. As a depression treatment, antidepressant medications help to level off one or more of these chemicals by either increasing the amounts secreted or altering how brain receptors respond to them.
Different classes of antidepressants affect each of the chemicals in different ways. The most commonly used antidepressant classes include –
• Tricyclic antidepressants (TCAs)
• Monoamine oxidase inhibitors (MAOIs)
• Selective serotonin reuptake inhibitors (SSRIs)
• Serotonin and norepinephrine reuptake inhibors (SNRIs)
Tricyclic medications target serotonin and norepinephine chemicals. Though TCAs are effective at reducing depression symptoms, they do cause the most side effects of all three medication classes. Monoamine oxidase inhibitors work best for people who suffer from more resistant forms of depression that don’t respond to other medication types. MAOIs do have a tendency to interact with certain types of foods, such as wine, cheese and also with other types of medications. These interactions reduce the effectiveness of the drug.
Selective serotonin reuptake inhibitors help the brain to maintain balanced levels of serotonin by preventing brain cells from reabsorbing the chemical too quickly. Serotonin and norepinephrine reuptake inhibitors have the same effect on both serotonin and norepinephrine.
Treatments for Treatment-Resistant Depression
Some people may experience a form of depression that doesn’t respond to medications or psychotherapy. This is known as treatment-resistant depression. Depression treatments used to treat this condition often involve some form of electrical stimulation to the brain or the vagus nerve. The vagus nerve sends information back and forth between the brain and body.
Doctors use electroconvulsive therapy (ECT) in the most severe of conditions where a person becomes a threat to themselves or others. ECT involves sending a brief electric current into the brain. Though it does cause an immediate seizure, this treatment has proven to be quite effective in treating severe forms of depression.
Vagus nerve stimulation or VNS uses a pacemaker-like implant that sends electric pulses through the vagus nerve. These pulses help to restore normal chemical balances in the brain. Another treatment known as transcranial magnetic stimulation (TMS) creates a magnetic field inside specific areas of the brain. Unlike electroconvulsive therapy, TMS does not cause a seizure and can be used to treat mild depression conditions.
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