How can depression be treated?
It's an illness, treat it!
It is important to realize that since depression is an illness, it cannot be fought alone by the patient. It can't be wished away. It needs specific medical treatment to correct the imbalance just like insulin is used to treat diabetes. The most important first step is for the patient to accept the diagnosis and consent to treatment. Even mild chemical depressions can be cleared with medications so there is no need to wait until one is suicidal to begin treatment.
There are many impediments to treatment. Patients and their families are often afraid of mental health professionals and so won't come for help. They refuse to accept the diagnosis due to the stigma and stereotypes surrounding mental illnesses and psychiatric treatment.
What do the drugs do?
The medical treatment of mood disorders involves the use of drugs which are extremely effective in restoring the normal balance of neurotransmitter chemicals. For depression, there are nearly twenty medications called antidepressants. They restore brain serotonin levels and correct the imbalance. Concentration, mood and thought control will then be restored and the racing thoughts will stop (see figure 6). For bipolar or manic depressives, the mood stabilizing drugs like Lithium, Valproic Acid, or Carbamazapine are used to eliminate and prevent mood swings (see figure 7). Some bipolar patients will need to take a combination of stabilizers and antidepressants to prevent both depression and mood swings. If we use the vision analogy again, this is like wearing bifocals, a lens for distance and one for reading.
Before treatment Serotonin levels are low
With treatment, levels are higher, reuptake is blocked
Most of these medicines have been around for many years and have an excellent track record for long term safety. They are not habit forming and do not include tranquilizers. They are not "uppers" or "happy pills," they only restore normal mood and the ability to control one's thoughts. They do not create an artificial high nor artificial personality and have no affect at all on a person with normal mood.
Figure 6:
Antidepressants will slowly raise mood by restoring concentration and brain chemical balance.
It is not possible to know in advance which antidepressant medication will work for any given person. Many may have to be tried before finding the right one. The benefit of a pill can take six weeks to feel, which is frustratingly slow. I warn everyone that it may take six to eight months to find the right medication that will give maximum benefit with the least side effects. This process is similar to trying to find the right key to open a lock. Many keys may have to be tried before the lock opens. During this waiting period the person needs lots of encouragement to continue trying to find the right medicine.
Once the correct medicine is found, one must stay on it for at least six months after the end of depressive symptoms. This long period lessens the chance of relapse after the medications have been stopped. Statistics have shown that after one episode of depressive illness, fifty percent of recovered people will suffer from another episode within two years. After having two episodes, the risk of relapse within two years increases to seventy percent. After three episodes the relapse risk is ninety percent. It's important that patients recognize the symptoms of relapse early and start treatment as soon as possible. It is generally recommended that the best way to prevent or reduce the risk of relapse is to stay on antidepressant medications indefinitely. For those people who remain on treatment, medications must be considered equivalent to eyeglasses, insulin or heart pills which must be taken for life. These medications are not a crutch but they actually correct the problem as long as they are taken continuously.
Figure 7:
Lithium and other mood stabilizers will normalize mood through restoring brain chemical balance and flattening mood swings.
Unfortunately, the chances that someone will stay on their medications for the correct time period are very low. The drop out rates from treatment range from ten to seventy percent. This is certainly true in my clinic. The majority of patients will drop out of treatment after three visits to the clinic. The reasons for these bad statistics are many. Often the patient does not accept the reality of the illness and won't take the medications. In other cases friends and family encourage them to stop treatment or the side effects are intolerable. In any event there are many people who should be in treatment but refuse. It is estimated that only twenty percent of the mood disorder population is receiving treatment.
While I was preparing this book I came across a newspaper article which described the use of antidepressants in animals. It appears that chemical imbalances are found in many mammals. In this article, it explained how veterinarians in the Calgary, Alberta Zoo were using Prozac to help a polar bear stop its "neurotic pacing." The improvement was dramatic so they are doing a study on the use of antidepressants in animals. We will have to wait and see how pet owners will cope with the stigma of their animals being on mood altering drugs.
You mean I can't drink coffee?
One very important fact which is often overlooked in the treatment of depression is the disruptive role of caffeine and other "over the counter" substances. It has been my observation over the years that caffeine directly opposes the action of antidepressants and mood stabilizers. This is true of all "stimulants" like ginseng, decongestants and many other "natural" products designed to "pick you up" or help you lose weight. In each case the stimulant increases the repetitive disturbing thoughts that the medications are trying to subdue. Caffeine and other stimulants work directly against the medications. I have been astonished at how much my patients improve when they eliminate caffeine and stimulants from their diets. In some cases I have been able to reduce their doses once the aggravating substance has been removed. I have also noticed that a frustrating tendency for antidepressants to lose their effectiveness over time is reduced if caffeine is eliminated. Caffeine comes in many products including pain killers, coffee, tea, colas and chocolate. Whenever there is an unexpected decline in the mood of one of my patients, I always look for something they may be consuming that is causing a drug interaction with their medications.
Are tranquilizers ever used?
In many cases tranquilizers are used to temporarily relieve the torment of repetitive anxious thoughts. They do not correct the underlying imbalance but cover it over for a short time. These medicines have generic names that commonly end with the letters "..pam," for example "diazapam." Tranquilizers are useful in the short term treatment of an acute episode of anxiety or mood disturbance. They are commonly used for immediate symptom relief while waiting the several weeks it takes for an antidepressant to take effect. Since tranquilizers can be habit forming, they are usually tapered off as the antidepressant corrects the underlying problem.
Antipsychotic medications are used to stop psychotic symptoms which can occur with severe depression, mania or schizophrenia. They can be combined with antidepressants and stabilizers when necessary.
What is "Shock Treatment?"
Shock treatment is more properly known as E.C.T., electroconvulsive therapy. It was the original treatment for depression but is now rarely used due to the effectiveness of medications.
E.C.T. is the application of an electric shock to one side of the brain to induce a seizure while the person is safely under general anesthesia. The seizure causes a rapid release of all the nerve cell chemicals which are used to regulate brain function. Some of those chemicals are the ones deficient in depression. The sudden release helps correct the chemical imbalance and restores normal mood. Usually up to ten treatments are required to get the chemicals up to the necessary levels to restore mood. Antidepressant medications are often used to maintain the recovery after E.C.T.
E.C.T. is now generally used only in those who do not respond to medications. It is a safe and rapidly effective treatment. I have had suicidal patients recover dramatically within two weeks of having E.C.T. after failing to improve on medications. Please don't ever discourage someone from accepting this form of treatment since it could save their lives.
What about the families?
One very often overlooked part of the treatment of depression is the support that is needed for the families of depressed people. These families are living under severe relationship stress and need to understand the illness and how it is treated. They must be helped with the guilt that they carry for having this problem in their family.
Personal and family counseling is a very important part of the treatment. There are usually many scars to heal as a result of psychological trauma and conflict. Counseling works best after the depressed person has regained control of their thoughts and concentration. Friends and counselors can be very helpful in supporting the person while they are waiting for the medications to work.
Support groups are now widely available for those suffering with emotional disorders. I have found them to be extremely helpful in providing education to the patient and their families. Perhaps their greatest value however, is to provide encouragement to the sufferer to persist with treatment until they have recovered.
What can you do?
If you are a friend or loved one of someone suffering from a mental illness you can play a pivotal role in your loved one's recovery. The most important way you can help is by encouraging the person to get help and to stay in treatment even during the frustrating weeks needed to find the right medications. You can be a constant encouragement for them to go on. You can keep reminding them that this is a medical problem, that it's not their fault.
The treatment of depression involves both medications and counseling. All those involved in treatment should work together and support the efforts of the others. Competition between treatment modalities is unhealthy and has caused many to give up treatment altogether.
With correct treatment, a supportive family and friends, a depressed person can become relaxed, content, optimistic and in full control of their thoughts and behaviors.
The text of this section contains excerpts from "Healthy Moods".
Illustrations by Rev. Jim Keddy
For more information visit Answers to common mental health questions.
Copyright Dr. Grant Mullen. No part of this website can be reproduced without the written permission of the author and publisher.
