mental health disorders
Depression
Treatment of Depression
Support Psychotherapy Medications, mainly Medications for Treatment of Depression None Most people with depression do not require hospitalization. However, some people should be hospitalized, especially if they are contemplating suicide or have attempted it, are frail because of weight loss, or are at risk of heart problems because of severe agitation. Treatment depends on the severity and type of depression: Mild depression: Support (including frequent doctor visits and education) and psychotherapy Moderate to severe depression: Medications, psychotherapy, or both and sometimes electroconvulsive therapy Seasonal depression: Phototherapy Prolonged grief disorder: Psychotherapy tailored to this disorder Depression can usually be treated successfully. If a cause (such as a medication or another disorder) can be identified, it is corrected first, but medications to treat depression may also be needed. Doctors explain to people with depression and their family members that depression has physical causes and requires specific treatment, which is usually effective. Doctors reassure them that depression does not reflect a character flaw, such as weakness. It is important for family members to understand the disorder, be involved in treatment, and provide support. Learning about depression can help people understand and deal with the disorder. For example, people learn that the path to recovery is often bumpy and that episodes of sadness and dark thoughts may recur but they will stop. Thus, people can put any setbacks in perspective and are more likely to continue their treatment and not give up. Becoming more active—taking walks and exercising regularly—can help, as can interacting more with others. Support groups (such as the Depression and Bipolar Support Alliance—DBSA) can help by providing a forum to share common experiences and feelings. Psychotherapy alone may be just as effective as medications for mild depression. When used with medications, psychotherapy can be useful for severe depression. Individual or group psychotherapy can help people with depression gradually resume former responsibilities and adapt to the normal pressures of life. Interpersonal therapy focuses on the person's past and present social roles, identifies problems with how the person interacts with other people, and provides guidance as the person adjusts to changes in life roles. Cognitive-behavioral therapy can help change hopelessness and negative thinking. Several types of Medications for Treatment of Depression are available (see table Selective serotonin reuptake inhibitors (SSRIs) (SSRIs) Norepinephrine-dopamine reuptake inhibitors, serotonin modulators, and serotonin-norepinephrine reuptake inhibitors None Heterocyclic (including tricyclic) antidepressants None Monoamine oxidase inhibitors (MAOIs) (MAOIs) Melatonergic antidepressant Ketamineandesketamine Drug therapy None St. John’s Wort None Electroconvulsive therapy (in the past sometimes called shock therapy) is sometimes used to treat people with severe depression, including people who have psychosis, are threatening suicide, or are refusing to eat. It is also used to treat depression during pregnancy when medications are ineffective. This type of therapy is usually very effective and can relieve depression quickly, unlike most antidepressants, which can take up to several weeks. The speed with which it takes effect can save lives. After electroconvulsive therapy is stopped, episodes of depression can recur. To help prevent them, doctors often prescribe antidepressants. For electroconvulsive therapy, electrodes are placed on the head, and an electrical current is applied to induce a seizure in the brain. For reasons that are not understood, the seizures relieve depression. Usually, at least 5 to 7 treatments (one treatment every other day) are given. Because the electrical current can cause muscle contractions and pain, general anesthesia is required during treatments. Electroconvulsive therapy may cause some temporary memory loss and, rarely, permanent memory loss. Phototherapy using a light therapy box is the most effective treatment for seasonal depression but may be helpful for other types of depressive disorders. Phototherapy involves sitting a specific distance from a light box that provides light with the necessary intensity. People are instructed not to look directly at the light and to remain in front of the light for 30 to 60 minutes a day. Phototherapy can be done at home. If people go to sleep and get up late, phototherapy is most effective in the morning. If people go to sleep and get up early, phototherapy is most effective between the late afternoon and early evening. Other therapies that stimulate the brain may be tried when initial treatments are ineffective. They include Repetitive transcranial magnetic stimulation Stimulation of the vagus nerve The stimulated cells are thought to release chemical messengers (neurotransmitters), which help regulate mood and may thus relieve symptoms of depression. These therapies may help people with severe depression that does not respond to medications or psychotherapy. Forrepetitive transcranial magnetic stimulation,an electromagnetic coil is placed against the forehead near an area of the brain thought to be involved in regulating mood. The electromagnet produces painless magnetic pulses that doctors think stimulate nerve cells in the targeted area of the brain. The most common side effects are headaches and discomfort near where the coil was placed. Forvagus nerve stimulation,a device that looks like a heart pacemaker (vagus nerve stimulator) is implanted under the left collarbone and is connected to the vagus nerve in the neck with a wire that runs under the skin. (The pair of vagus nerves run from the brain stem, located near the base of the skull, through the neck and down each side of the chest and abdomen to organs, such as the heart and lungs.) The device is programmed to periodically stimulate the vagus nerve with a painless electrical signal. It may be useful for depression when other treatments are ineffective, but it usually takes 3 to 6 months to take effect. Side effects of vagus nerve stimulation include hoarseness, cough, and deepening of the voice when the nerve is stimulated. 