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Depression (cont.)

Other Therapy

Psychotherapy

Psychotherapy ("talk therapy") involves working with a trained therapist to figure out ways to solve problems and cope with depression. Three major approaches are commonly used to treat clinical depression. In general, these therapies take weeks to months to complete. Each has a goal of alleviating your symptoms. More intense psychotherapy may be needed for longer when treating very severe depression or for depression with other psychiatric symptoms.

Interpersonal therapy (IPT): This helps to alleviate depressive symptoms and helps you develop more effective skills for coping with social and interpersonal relationships. IPT employs two strategies to achieve these goals.

The first is education about the nature of depression. The therapist will emphasize that depression is a common illness and that most people can expect to get better with treatment.

The second is defining your problems (such as abnormal grief or interpersonal conflicts). After the problems are defined, the therapist is able to help set realistic goals for solving these problems. Together you will use various treatment techniques to reach these goals.

Cognitive behavioral therapy (CBT): This helps to alleviate depression and reduce the likelihood it will come back by helping you change your way of thinking. In CBT, the therapist uses three techniques to accomplish these goals.

Didactic component: This phase helps to set up positive expectations for therapy and promote your cooperation.

Cognitive component: This helps to identify the thoughts and assumptions that influence your behaviors, particularly those that may predispose you to being depressed.

Behavioral component: This employs behavior-modification techniques to teach you more effective strategies for dealing with problems.

Behavioral therapy (BT): This helps to modify your depressive behaviors through highly structured, goal-oriented therapy. BT uses three techniques to accomplish these goals.

Functional analysis of behavior: This helps to define the behaviors that will be targeted for change.

Selection of specific techniques: Various techniques can be employed to help modify the selected behavior, including relaxation training, assertion training, role-playing, and time-management tips.

Monitoring behavior: Progress and program effectiveness can be monitored by logs and records you keep.

Alternative treatments

Several nonprescription herbal and dietary supplements are used by some people to treat depression. Little is known about the safety, effectiveness, or appropriate dosage of these remedies, although they are taken by thousands of people around the world.

A few of the best-known ones continue to be studied scientifically to see how well they work, but to date, there is little evidence that herbal remedies effectively treat moderate to severe clinical depression.

Medical professionals usually are hesitant to recommend these products because they are not regulated by the U.S. Food and Drug Administration (FDA), as prescription drugs are, to ensure their purity and quality. Regardless, if you are on any medication, dietary supplement, or other remedy, be sure to check with your health-care provider before starting an herbal or dietary supplement.

When you buy a supplement from the drug store or health-food store, you cannot be sure exactly what you are getting and what is the appropriate dosage.

There are few guidelines for correct doses. Potency can vary from product to product, even batch to batch of the same product.

St. John's wort: This is probably the best-known alternative therapy for depression. It is derived from a plant, Hypericum perforatum, and has been part of folk medicine for centuries.

It has been widely used in North America and Europe to treat anxiety, mild to moderately severe depression, and sleep disorders.

It is available in pill form, like capsules, tablets, as a liquid extract, and in various teas.

Studies conducted in Europe suggested that St. John's wort works as well as prescription antidepressants with fewer side effects. In other more recent studies sponsored and well designed by the National Institutes of Health, St. John's wort worked no better than a sugar pill (placebo) in relieving depression.

St. John's wort is not without its own negative effects.

One problem with St. John's wort is that it interacts with many other medications. Some of these interactions can be dangerous.

It also may make other medications stop working, including some that are used to treat cancer or HIV infection or to prevent organ rejection after transplant.

If taken with an SSRI drug, St John's wort can cause a potentially dangerous condition called serotonin syndrome. The combination is not recommended.

Common side effects include dry mouth, dizziness, digestive symptoms, fatigue, and increased sensitivity to sunlight. It is not recommended for people with seasonal depression using bright light therapy.

SAM-e: The chemical name of this agent is S-adenosyl-methionine. It occurs naturally in the body and has many functions.

Some believe that it increases neurotransmitter levels in the brain, but this has not been proven.

In Europe, it is a prescription drug.

In the United States, it is available without prescription and is sold as a dietary supplement, although it is quite expensive.

Its effectiveness in depression is unknown.

It has few side effects.

5-HTP: This agent, 5-hydroxytryptophan, is another substance that occurs naturally in the body, where it is used to make serotonin. Although there is some evidence that this agent relieves depression with fewer side effects than SSRIs, the evidence is by no means conclusive.

Omega-3 fatty acids: Deficiencies in these natural substances have been linked to depression, especially bipolar disorder. They are found in certain plants and fish oil. Fish-oil capsules are available at natural-food stores, but they have digestive side effects in many people. By far the best source is fish, especially oily fish such as salmon and mackerel. These fatty acids also promote a healthy heart and blood vessels.

Complementary therapies

Many different complementary therapies are advocated by different groups and individuals to assist in dealing with depression. These include the following:

lifestyle changes such as adopting a healthy diet, exercise, and stress reduction;

meditation, biofeedback, and other relaxation therapies;

physical therapies such as massage, reflexology, and acupuncture;

environmental therapies such as aromatherapy and music therapy;

spiritual or faith-based activities;

interactions with other people and animals; and

limiting alcohol intake and refraining from using illicit drugs or abusing prescription drugs altogether.

Most of these are safe for all or most people and may contribute to your overall well-being.

They are not, however, a replacement for medical therapy known to be effective in most people.

Check with your health-care provider, especially if you are taking antidepressant medication, before starting any new diet or exercise program, new medications, or herbal preparations or supplements.

Electroconvulsive therapy

Electroconvulsive (ECT) or shock therapy is a safe and effective on a short-term basis as an alternative for people with very severe clinical depression who have not improved with a number of other treatments or in people who cannot safely take antidepressant medication. It involves the induction of seizures in a controlled medical setting by a trained health-care practitioner in a patient who is appropriately sedated. Although there has been much controversy about ECT, much of this debate has been caused by impressions of ECT when it was fairly new (its use was begun in 1939) and not as sophisticated or specifically done as it is today. ECT has been shown to alter the levels of brain neurotransmitters that may cause depression.

ECT is often reserved for those with severe symptoms that do not respond to medications or for people who are suicidal.

Elderly people who cannot tolerate the side effects of antidepressant medications are sometimes good candidates for ECT. Specifically, elderly individuals have been found to tolerate and benefit from ECT as well as younger adults.

Prior to undergoing ECT, you would have a complete medical evaluation. Typically, you are sedated and cannot remember the ECT procedure itself.

Commonly, you might have a brief period of confusion after the procedure. You may feel muscle aches or a headache after treatment. Some memory loss, usually quite temporary, is fairly common with ECT as well. Those who receive 12 or more ECT treatments may experience more long-lasting memory and learning problems.

ECT treatments are generally given every other day for two to three weeks (for about six to 10 treatments). The actual duration of therapy depends on your response to it. Some people need to follow up with regularly scheduled "booster treatments," or so-called "maintenance ECT," after improving with this treatment. Over the longer term, the effects of ECT may fade.