Depression, or major depressive disorder, is a significant cause of disability worldwide. This devastating disease is very common. It affects 10% of individuals in the U.S. at any one time and one in six people during their lifetime. The good news is that depression is treatable. The majority of patients who receive treatment recover or experience some level of relief from depressive symptoms.
The following is a guide to several treatment options. Keep in mind that not every person responds in the same way. It is important to work with your doctor to develop a treatment plan that is best for you.
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Psychotherapy (talk therapy)
Though the term may sound daunting, psychotherapy (also called “talk therapy”) involves speaking with a therapist to work through underlying emotional causes of depression and develop effective coping strategies It is often the first course of treatment, and is often adequate for the treatment of mild depression. Psychotherapy by itself is however often not adequate for managing more severe cases of depression. (though it can be helpful in conjunction with other types of treatments.) A licensed mental health professional conducts therapy sessions. Treatment can be one-on-one, with a family member, or in a group setting.
Cognitive behavioral therapy is a form of therapy that focuses on identifying distorted thoughts. The goal of this type of treatment is to make positive changes in thinking patterns and behaviors. Interpersonal therapy focuses on interpersonal relationships and resolving the thoughts, communication patterns and triggers that led to the onset of depression. This treatment also helps patients build social skills and a support network. In any type of psychotherapy for depression, the goals may include:
- Help with the adjustment to a crisis or complication in life
- Teaching methods for healthy coping with stressors
- Learning how to avoid situations that make depression worse
- Teaching the patient to regain satisfaction and control in life
In general, depression is related to changes in brain chemistry. The brain uses many types of signals to relay messages and regulate your feelings and behavior at a molecular level. One important element are neurotransmitters, or chemical messengers which deliver electrical signals between nerve cells or neurons. Three major neurotransmitters (serotonin, dopamine, and norepinephrine) help control feelings of happiness, accomplishment, motivation, energy, and other positive emotions. Disruption in the production of these molecules or their receptors can cause conditions such as depression.
Often in depression, one or more of the three major emotional neurotransmitters is in low supply. This may be because not enough is being produced, or because it is being broken down or reabsorbed too fast. A class of antidepressant drugs called reuptake inhibitors slows the reabsorption rate of these molecules. This leads to higher levels of these neurotransmitters in your brain, and improved signaling from them. Also, a class of drugs called monoamine oxidase inhibitors (MAOIs) slows the degradation of these neurotransmitters. It does so by obstructing the enzyme monoamine oxidase, which breaks down serotonin, dopamine, and norepinephrine.
Antidepressants can improve your mood, reduce recurrent negative thoughts, and increase energy. Unfortunately, they also can come with many side effects. Common complications include changes in appetite and weight, sexual problems, restlessness, constipation, nausea, insomnia, fatigue, or dry mouth. Missing a few doses or discontinuing an antidepressant can cause withdrawal-like symptoms to develop.
Additionally, antidepressants take at least one month to begin working. During the first month or two, teenagers and adults under the age of 25 are at a higher suicide risk due to higher energy levels along with depressive thoughts. This is less common in newer medications, and suicide risk is lowered by long-term medication use.
Transcranial Magnetic Stimulation (TMS)
Along with a better understanding of molecular neuroscience and the underlying causes of depression, several neuromodulation techniques have been introduced in the past 15- 20 years that do not rely on pharmaceutical drugs. One such technique that shows strong outcomes is transcranial magnetic stimulation (TMS). This is a non-invasive procedure that uses magnetic pulses to stimulate electrical activity in the specific region of the brain impacted by depression..
Many forms of TMS only work on surface areas of the brain. But deep TMS (dTMS) can reach deep into the cerebral cortex. During a dTMS procedure, a magnetic coil is placed on the scalp. A painless magnetic pulse is emitted which boosts neuronal activity in a region of the brain with lower activity due to depression. TMS is effective in relieving symptoms of depression, even in people resistant to antidepressant medications. Side effects minor and short-lasting and may include headaches scalp discomfort, lightheadedness, and tingling, twitching, or spasms of facial muscles.