Conditions & Diseases: Psychological & Mental Health

Depression

Treatment of Major Depression

Major depression, if diagnosed, can be treated effectively. Around 80 to 90 percent of those that receive treatment recover and return to their normal and productive life. There are several treatment options available:

A. Selective serotonin reuptake inhibitors (SSRIs) is a group of antidepressants that correct the serotonin imbalance by blocking the reuptake of the serotonin from the synapse to the nerve and artificially increasing the serotonin that is available in the synapse.

The selective serotonin reuptake inhibitors include: fluoxetine (Prozac), sertraline (Zoloft), paroxetine (Paxil), citalopram (Celexa), escitalopram (Lexapro), and fluvoxamine (Luvox). The common side effects of the selective serotonin reuptake inhibitors include: gastrointestinal problems and headaches, and in some cases, can cause insomnia, anxiety, and agitation.

B. Serotonin and norepinephrine reuptake inhibitors (SNRIs) is the second most common prescribed antidepressants after SSRIs that treat depression. These drugs work by blocking the reuptake of both serotonin and norepinephrine from the synapse into the nerve, and increase the amount of both neurotransmitters that participate in signal transmission.

The serotonin and norepinephrine reuptake inhibitors include: venlafaxine (Effexor) and duloxetine (Cymbalta).

C. Norepinephrine-dopamine reuptake inhibitor (NDRI). The most prescribed antidepressant from this group is buspar (Wellbutrin), which blocks the reuptake of dopamine and norepinephrine.

D. Mirtazapine (Remeron) is an agent that targets specific serotonin and norepinephrine receptors in the brain increasing (indirectly) the activity of several circuits in the brain.

E. Tricyclic antidepressants (TCAs) is a group of antidepressants that work similar with the SNRIs, but are not used anymore as a first-line treatment because of their high rate of side effects. These antidepressants are usually prescribed when other antidepressants do not work.

Tricyclic antidepressants include: amitriptyline (Elavil, Limbitrol), desipramine (Norpramin), doxepin (Sinequan), imipramine (Norpramin, Tofranil), nortriptyline (Pamelor, Aventyl), and protriptyline (Vivactil).

Some of the tricyclic side effects include: drowsiness (Elavil), anxiety and restlessness (Vivactil), heart problems, blurred vision, dry mouth, constipation, weight gain, dizziness when changing position, increased sweating, difficulty urinating, changes in sexual desire, decrease in sexual ability, muscle twitches, fatigue, and weakness.

II. Psychotherapy: Another effective approach in treating depression is psychotherapy. There are two forms of psychotherapy that have proven to be effective:

1. Cognitive-Behavioral Therapy (CBT): This is a type of therapy based on the Cognitive Model of Emotional Response, and considers that our thoughts and not the external situations, people or events, trigger the behavior and feelings. The benefit of this perspective is that a person can change the way he or she thinks and further the way he or she feels and acts when the situations, other people or events do not change. A depressed person learns how to replace the negative thinking and unsatisfying behavior associated with depression with proactive and positive thinking, feeling and acting patterns.

2. Interpersonal Therapy (IPT): This is a short term therapy that has been proven to be effective in treating depression by focusing in improving dysfunctional personal relationships and adopting a new, more functional life role. Even if depression can be triggered by exterior events, it usually involves an interpersonal component which affects relationships and roles in these relationships. The interpersonal therapy focuses in identifying those interpersonal events such as conflicts, interpersonal role transitions, prolong grief, that cause and maintain the depression.

III. Electroconvulsive Therapy (ECT) is a treatment option used only in severe cases of depression when the other two options (medication and psychotherapy) do not work and the patient experiences symptoms such as psychosis (a severe mental disorder in which contact with reality is lost or highly is distorted) or thoughts of suicide. This treatment approach uses an electric shock to cause a seizure (a short period of irregular brain activity) which releases a lot of brain chemicals (neurotransmitters that help deliver messages from one brain cell to another). This therapy is administered by a psychiatrist in a hospital setting up to three times per week, but usually no more than 12 session are needed. Before the treatment, the patient receives an IV line that allows medication to go straight into the blood. The patient also receives general anesthesia and muscle relaxers. During the treatment, the patient’s blood pressure and breathing are closely monitored. A 1 to 2 second electric shock is applied to the heart which causes the brain seizure. Medication is also given to prevent the body from moving during the shock. The patient will wakes up within 5 to 10 minutes after the treatment.

The most common side effects of the electroconvulsive therapy include: blood pressure or heart rhythm changes during treatment, and temporary short-term memory loss (in few cases, longer-lasting problems with memory), confusion, nausea, muscle aches and headache after treatment.

4. Transcranial Magnetic Stimulation (TMS) is a noninvasive therapy that uses weak electric currents to excites neurons by changing the brain’s magnetic fields. The patient receives the electric current through an electromagnetic coil placed on his or her scalp which creates a magnetic pulse. The magnetic pulse causes small electric currents in the brain which stimulates neurons involved in mood regulation. This treatment is not FDA approved and is used only in clinical trials.

Article by Alina Morrow,
MS Psychology
OmniMedicalSearch.com
Depression Bibliography