Untreated depression may cause a person to be depressed for weeks, months or even years. If a physical examination rules out physical causes, then a psychiatric evaluation should be conducted. Many effective medications and therapies are available. Most patients do best with combined treatment – medication and therapy.
Psychotherapy is an intervention used by trained psychotherapists to aid patients in problems of living.
- Individual therapy is frequently done in combination with family or group therapy, and, when needed, psychopharmacology (medications).
- Family therapy, also referred to as couples or family systems therapy, looks at the interactions between family members and emphasizes family or partner relationships as an important factor in psychological health.
- Group therapy is a form of therapy in which a small number of people meet together under the guidance of a professionally trained therapist to help themselves and one another.
- Cognitive behavioral therapy (CBT) is based on the idea that how we think (cognition), how we feel (emotion), and how we act (behavior) all interact together. CBT helps patients to understand distortions in their thinking and actions and to learn new ways of coping with their illness.
- Dialectical behavior therapy (DBT) is a psychosocial treatment developed to treat individuals with borderline personality disorder. While DBT was designed for individuals with borderline personality disorder, it may be used for patients with other diagnoses as well.
Psychiatric medications should only be used under the supervision of a physician. Medications come in the form of pills, liquids, patches, and injections. The National Institute of Mental Health, which has provided some of the following information, and private research groups are sponsoring studies of various medications for depression. Each antidepressant differs in its side effects and in its effectiveness in treating an individual person, but the majority of people with depression can be treated fairly effectively by one of these medications.
- Tricyclic antidepressants (named for their chemical structure) were the first line of treatment for major depression. They are effective in treating depression but their side effects are usually unpleasant. Today, tricyclics such as imipramine, amitriptyline, nortriptyline, and desipramine are used as a second- or third-line treatment.
- Monoamine oxidase inhibitors (MAOIs) are effective for some people with major depression who do not respond to other antidepressants. They are also effective for the treatment of panic disorder and bipolar depression. MAOIs approved for the treatment of depression are phenelzine (Nardil), tranylcypromine (Parnate), and isocarboxazid (Marplan). Because substances in certain foods, beverages, and medications can cause dangerous interactions when combined with MAOIs, people on these agents must adhere to dietary restrictions. A recently approved drug in this class comes in the form of a patch (Selegiline) and does not have the same risk for interactions with foods.
- A new generation of antidepressants with fewer side effects than tricyclic and MAOI antidepressants has been developed in the past decade. Some of these drugs primarily affect one neurotransmitter, serotonin, and are called selective serotonin reuptake inhibitors (SSRIs). These include fluoxetine (Prozac), sertraline (Zoloft), fluvoxamine (Luvox), paroxetine (Paxil), citalopram (Celexa), and escitalopam (Lexapro). Other medications that affect both norepinephrine and serotonin include venlafaxine (Effexor), duloxetine (Cymbalta), mirtazapine (Remeron), and nefazadone (Serzone). Yet another in this category, bupropion (Wellbutrin), is thought to work though noreppinephrone and dopamine.
In just the past five years, major developments have taken place in the development of technologies to stimulate brain function directly with energy fields rather (as contrasted by stimulation through chemical interventions such as antidepressant medications).
Our understanding of the general locations of abnormal brain activity associated with psychiatric disorders has grown, leading to target areas for brain stimulation treatments. Researchers at Butler Hospital have played critical roles in the development of new types of treatments for mood and anxiety disorders. This category of treatment is called “neuromodulation” or “neurostimulation.” This modality is typically used only after all other types of treatments have failed to produce full and sustained relief from the psychiatric disorder.
- Vagus Nerve Stimulation (VNS) uses a stimulator that sends electric impulses to the vagus nerve in the neck via a lead implanted under the skin. Already used for treating epilepsy, it was approved by the Food and Drug Administration (FDA) in 2005 for treating severe forms of depression after extensive testing at Butler Hospital and other sites around the country.
- Transcranial Magnetic Stimulation (TMS) uses powerful magnets outside of the person’s head. Studies indicate that the magnetic field generated by the magnets can help reduce symptoms of depression with little or no side effects.
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