Battling Depression?
Medications and Cognitive Therapy Prove Effective!
It's estimated that one in five patients seen by a primary care doctor has depression, but only one in 10 will actively seek treatment. For many, the most difficult part of dealing with depression is getting started.
What is depression?
The cause of depression is not completely understood, but it is real, it
has physical symptoms (e.g., fatigue, impaired bowel function, insomnia)
and it is not a character weakness. Depression can be differentiated
from "the blues" or sadness by its pervasiveness and longevity. It can
affect how one lives, how (or if) one is able to enjoy life, and it can
last weeks, months or even years. Depression has many facets and can be
mild to severe.
Chronic diseases such as diabetes can aggravate depression, and depression can make other medical problems worse. People with depression are four times more likely to have heart attacks due to cardiac disease associated with depression.
Who does it affect?
Approximately 21 million people each year - nearly 10% of adults in the
U.S. - are affected by depression. It is estimated that 15% of all
people in the U.S. will suffer from major depression at least once in
their lives. Research suggests that depression may be genetic, chemical,
mental, environmental or - most likely - a combination of factors.
How is it diagnosed?
The first step is a physical exam to rule out other medical problems.
There is no laboratory test to diagnose depression so many clinicians
use a questionnaire or depression inventory to screen for it. A person's
responses and perceived ability to perform and enjoy daily life
activities will determine if symptoms of depression are present.
Changes or impairment in eating, sleeping, working, relating to others, or being unable to enjoy once-pleasurable activities are indicators of depression. Referral to a trained clinician, most likely a psychiatrist, is the next step.
How is depression treated?
The good news is that depression is highly treatable. The most common
treatments include medications and/or psychotherapy. Severe depression
is best treated with a combination of both. The first objective is to
treat the symptoms and reduce anxiety. The second goal is to restore
normal function in daily life activities.
Do medications help?
There are many effective antidepressants, and anxiolytics (to treat
anxiety) are used as well. The physician will help determine which would
be best based on symptoms, lifestyle, priorities, and income. Most
antidepressants work on regulating chemicals in the brain called
neurotransmitters, and it can take 3 - 6 weeks for antidepressants to
reach a therapeutic level.
Antidepressant side effects are usually mild (nausea, constipation or diarrhea, nervousness) and tend to go away after the first few weeks of treatment. Paradoxically, suicide risk may increase as the person improves. Previously paralyzed by severe depression, the individual now has energy to act but is not yet prepared to make thoughtful decisions. It is important for the patient and his family to be aware of this and notify a healthcare professional if thoughts of suicide or agitation emerge or worsen. Like most symptoms, suicidal ideation usually goes away as the dose is stabilized.
What is cognitive therapy?
Cognitive therapy, sometimes called cognitive-behavioral therapy or CBT,
is a form of psychotherapy. It empowers patients to identify negative
self-talk and positively change behavior. People suffering from severe
depression may feel helpless, hopeless and have persistent negative
thoughts. This in turn causes feelings of unworthiness, which makes them
feel helpless and hopeless...
Through no fault of their own - this is not the time for patients to experiment with self-analysis - people with severe depression find they are caught in a spiraling whirlpool; they cannot swim out under their own power.
Working with the psychiatrist, they learn to use CBT to recognize when the "plug has been pulled" and respond in a practiced and positive manner. CBT enables a patient to identify a whirlpool before it pulls him in, consider his options, and formulate a plan to keep his head above water. Computer-assisted and telephonic CBT programs are being used for additional support.
How long will treatment continue?
People often want to stop taking medication when they begin to feel
better, but antidepressants should not be stopped abruptly, and weaning
should always be done under a doctor's supervision.
For moderate depression that responds to medication therapy, regular evaluations should continue for 6 months to a year, at which time the psychiatrist and patient may discuss gradually tapering the medication. Patients with severe or recurrent depression and strong personal or family histories of depressive disorders may need to continue treatment another year or possibly longer.
About 25% of depressions are chronic, meaning long-term treatment is best.
Depending on how severe the depression is, it can take a few weeks or months to achieve wellness, but most people see a significant improvement in just 10 - 15 visits. Eighty to 90% of people treated for depression significantly improve, and almost all experience some relief of their symptoms.