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detecting depressionDepression, even the most severe cases, is a highly treatable disorder.

As with many illnesses, the earlier that treatment can begin, the more effective it is and the greater the likelihood that recurrence can be prevented.

The first step to getting appropriate treatment is to visit a doctor. Certain medications, and some medical conditions such as viruses or a thyroid disorder, can cause the same symptoms as depression. A doctor can rule out these possibilities by conducting a physical examination, interview and lab tests. If the doctor can eliminate a medical condition as a cause, he or she should conduct a psychological evaluation or refer the patient to a mental health professional.

The doctor or mental health professional will conduct a complete diagnostic evaluation. He or she should discuss any family history of depression, and get a complete history of symptoms, e.g., when they started, how long they have lasted, their severity, and whether they have occurred before and if so, how they were treated. He or she should also ask if the patient is using alcohol or drugs, and whether the patient is thinking about death or suicide.

Once diagnosed, a person with depression can be treated with a number of methods. The most common treatments are medication and psychotherapy.

Types of Treatments:

Antidepressant Medication
Psychotherapy or Talk Therapy
Electroconvulsive Therapy (ECT)
Vagus Nerve Stimulation (VNS)

1. Antidepressant Medications

Antidepressants work to normalize naturally occurring brain chemicals called neurotransmitters, notably serotonin and norepinephrine. Other antidepressants work on the neurotransmitter dopamine. Scientists studying depression have found that these particular chemicals are involved in regulating mood, but they are unsure of the exact ways in which they work.

The newest and most popular types of antidepressant medications are called selective serotonin reuptake inhibitors (SSRIs). SSRIs include fluoxetine (Prozac), citalopram (Celexa), sertraline (Zoloft) and several others. Serotonin and norepinephrine reuptake inhibitors (SNRIs) are similar to SSRIs and include venlafaxine (Effexor) and duloxetine (Cymbalta). SSRIs and SNRIs are more popular than the older classes of antidepressants, such as tricyclics–named for their chemical structure and monoamine oxidase inhibitors (MAOIs) because they tend to have fewer side effects. However, medications affect everyone differently. No one-size-fits-all approach to medication exists. Therefore, for some people, tricyclics or MAOIs may be the best choice.

Despite the relative safety and popularity of antidepressants, some studies have suggested that they may have unintentional effects on some people, especially adolescents and young adults. Furthermore, the Food and Drug Administration (FDA) issued a warning emphasizing that patients of all ages taking antidepressants should be closely monitored, especially during the initial weeks of treatment. Possible side effects to look for are worsening depression, suicidal thinking or behavior, or any unusual changes in behavior such as sleeplessness, agitation, or withdrawal from normal social situations. The warning adds that families and caregivers should also be told of the need for close monitoring and report any changes to the physician.

2. Psychotherapy or "talk therapy"

This is one of the most common treatments to help people with depression. Some regimens are short-term (10 to 20 weeks) and other regimens are longer-term, depending on the needs of the individual.

Two main types of psychotherapies

  • Cognitive Behavioral Therapy (CBT)– CBT helps people change negative styles of thinking and behaving that may contribute to their depression.

  • Interpersonal Therapy (IPT)– IPT helps people understand and work through troubled personal relationships that may cause their depression or make it worse.

For mild to moderate depression, psychotherapy may be the best treatment option. However, for major depression or for certain people, psychotherapy may not be enough. Studies have indicated that for adolescents, a combination of medication and psychotherapy may be the most effective approach to treating major depression and reducing the likelihood for recurrence.

Similarly, a study examining depression treatment among older adults found that patients who responded to initial treatment of medication and IPT were less likely to have recurring depression if they continued their combination treatment for at least two years.


3. Electroconvulsive Therapy (ECT)

For cases in which medication and/or psychotherapy does not help alleviate a person's treatment resistant depression, electroconvulsive therapy (ECT) may be useful. ECT, formerly known as "shock therapy," once had a bad reputation. But in recent years, it has greatly improved and can provide relief for people with severe depression who have not been able to feel better with other treatments.

Before ECT is administered, a patient takes a muscle relaxant and is put under brief anesthesia. He or she does not consciously feel the electrical impulse administered in ECT. A patient typically will undergo ECT several times a week, and often will need to take an antidepressant or mood stabilizing medication to supplement the ECT treatments and prevent relapse. Although some patients will need only a few courses of ECT, others may need maintenance ECT, usually once a week at first, then gradually decreasing to monthly treatments for up to one year.

ECT is very effective, but it has serious drawbacks: It's costly, requires multiple hospital visits and may cause some short-term side effects, including confusion, disorientation and memory loss. But these side effects typically clear soon after treatment. Research has indicated that after one year of ECT treatments, patients showed no adverse cognitive effects.


4. Vagus Nerve Stimulation (VNS)

This is a newer method for treating depression. It was first used for depression by Dr. Mark George of the Medical University of South Carolina and now approved by the U.S. Food and Drug Administration. VNS serves as a sort of "pacemaker" for the brain. A surgically implanted device periodically sends small electric pulses up the vagus nerve in the neck and into the brain. George says researchers don't fully understand why VNS works, but it does. However, it does require invasive surgery.

What efforts are underway to improve treatment?

Researchers are looking for ways to better understand, diagnose and treat depression among all groups of people. New potential treatments are being tested that give hope to those who live with depression that is particularly difficult to treat, and researchers are studying the risk factors for depression and how it affects the brain.

If you or someone you know needs help, but don't know where to go, read Getting Help For Depression to get information on who to contact and where to contact them.

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