Treatment Options for Healing Depression
disorders, which pose a substantial risk of death and disability
and are associated with suicide and poor work productivity, affect
about eight percent of adults. Moreover, close to twenty percent
of adults will suffer from some type of mood disorder that requires
treatment during their lifetime. Mood disorders often have tragic
results -- 15 percent of those affected commit suicide.
Depression, a common
type of depressive disorder, is responsible for about 66 percent
of all suicides. The disease occurs twice as often in women as in
men and the risk increases if depression is present in an immediate
family member. As the leading cause of premature death and disability
in people between the ages of 18 and 44 years, it is surprising
that there are no universally accepted diagnostic criteria for depression.
There are often errors
in the diagnosis or treatment of the disease, and only 33 percent
of depressed patients receive proper treatment. These errors are
associated with insufficient questioning of the patient leading
to diagnostic failure; failure to receive adequate information regarding
the patients symptoms from family members; diagnosing a mood disorder
and starting treatment despite a lack of diagnostic criteria; attempting
to blame depression on stressful events, rather than diagnosing
or treating the disease.
One set of diagnostic
criteria commonly used to assess depression is known as SIGECAPS
(see table below). This stands for sleep, interest, guilt, energy,
concentration, appetite, psychomotor and suicide. If four or more
of these items are a concern, it indicates major depression. However,
other criteria, such as watching for symptoms other than just mood
change and obtaining supporting information from family members,
criteria for major depressive disorder*
patient has depressed mood (e.g., sad or empty feeling)
or loss of interest or pleasure most of the time for 2
or more weeks plus 4 or more of hte following symptoms:
or hypersomnia nearly every day
diminshed interest or pleasure in nearly all activities
most of the time
or inappropriate feelings of guilt or worthlessness most
of the time
of energy or fatigue most of the time
ability to think or concentrate; indecisiveness most of
or decrease in appetite
thoughts of death/suicidal ideation
symptoms do not meet crieteria for mixed episode (major
depressive episode and manic episode)
symptoms cause clinically significant distress or impairment
in social, occupational, or other improtant areas of functioning
symptoms are not due to the direct physiological effects
of a substance (e.g., a drug of abuse, a medication) or
a general medical condition
symptoms are not better accounted for by bereavement
from the Diagnostic and Statistical Manual of Mental Disorders,
The cause of depression
is thought to be a disruption of the brains neurochemistry.
Central norepinephrine neural pathways in the brain play a role
in vigilance, motivation and energy levels. These pathways are associated
with serotonin neural pathways, which are involved in controlling
impulsivity, and share a role with the dopamine pathways in appetite,
sex and aggression.
Depression is expected
to be the second leading cause of disability for people of all ages
by 2020. In general, an unhealthy lifestyle is more common among
those depressed than those who are not. Additionally, children of
those with depression are thought to have increased rates of behavior
problems and lower levels of self-esteem than children with mothers
who do not have depression.
In cases of moderate
to severe major depression, antidepressant drugs are often used
for treatment. Typically, about 60 percent of patients respond to
the treatment, with the amount reaching 80 percent when a second
drug is tried if the initial antidepressant drug fails. The goal
of treatment is a full remission of symptoms, which may take up
to four months. Patient recovery is not linear, however, as symptoms
may reoccur after resolving.
Current guidelines suggest
that antidepressant therapy should continue for at least six months
after recovery in order to lessen the chance of a recurrence of
depression, which occurs in more than 70 percent of patients.
using antidepressant therapy for an indefinite amount of time, is
considered as a treatment option for those who have additional risk
factors of depression, such as especially difficult episodes or
two or more episodes in a five-year period. The therapys goal
is to prevent recurrence of the illness, however, costs and side
effects of continued medication should be reviewed.
Phototherapy, or light
therapy, is particularly used for fall/winter seasonal depressions.
Treatment, typically prescribed for mild to moderate cases, consists
of exposure to full-sprectrum white light for at least 30 minutes
per day throughout the episode.
Another treatment used
for mild to moderate major depression is psychological treatment.
This type of intervention, including interpersonal and cognitive
behavioral therapies, has been found to be as effective as antidepressant
therapy. The treatment can be administered individually or in a
group setting and usually lasts for 8 to 16 weekly sessions.
for example anti-depressants with psychological treatment, are also
used. The decision of which treatment to use should be based on
patient preference, advice from a clinician, cost, practicality
and success rates of different treatment types within an individual
Canadian Medical Journal November 26, 2002